1. Health Promotion for the Infant Flashcards
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A continuous, orderly series of conditions that leads to activities, new motives for activities, and patterns of behavior
An increase in function and complexity through GROWTH, MATURATION & LEARNING
> i.e. language acquisition
Development
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An increase in the physical size of a whole or any of its parts or an increase in number and size of cells
Can be measured easily and accurately by determining changes in weight & length
Growth
Stages of Growth & Development
Newborn : Birth to 1 month
Infancy : 1 month-1 year
Toddlerhood : 1-3 years
Preschool : 3-6 years
School age : 6-11 or 12 years
Growth & Development - Parameters of Growth
> Weight, length, and height are used to monitor growth
> Head circumference indicates brain growth
> Eruption of teeth also follows a sequential pattern
> Slow, steady weight gain during childhood is followed by GROWTH SPURTS in adolescence
Principles of Growth & Development - Patterns of growth and development
> From head to lower extremities (cephalocaudal)
* At birth head is large when compared to rest of the body
* As child matures body proportions gradually
> From proximal to distal (proximodistal)
* Progression from center outward
> Wide variations within normal limits occur
* General to specific (e.g. whole body response to pain as opposed to guarding in older child)
* Simple to complex (e.g. language - one word to full sentences)
Factors Influencing Growth & Development
* Genetics
* Environment
> Prenatal exposure to maternal smoking, alcohol intake, chemical exposures, and infectious diseases
> After birth socioeconomic status, air, and water pollution
* Culture
* Nutrition
> Obesity - prevalence US 18.5% with boys higher than girls
* Health status
* Family structure
* Parental attitudes
* Child-rearing philosophies
Theories of Growth and Development
* Theories are an attempt to explain human behavior
> Piaget’s theory of cognitive development
* Understanding how thinking during childhood progresses and differs from adult thinking
___ period (birth-2 yr)
* Reflexive behavior used to adapt to environment - involves whole body
___ view of the world
Development of ___ ___ - awareness that objects continue to exist even when they disappear from sight
Sensorimotor
Egocentric
object permanence
___ thought (2-7 yr)
* Language becomes useful
* Situations perceived by their view only - egocentric thinking
* Magical thinking - believe that events occur due to wishes
Preoperational
___ operations (7-11 yr)
* Systematic and logical thinking
* Concrete objects and activities needed
* ___ operations
Concrete
___ operations (11yr-Adulthood)
* New ideas created
* Analysis of situations
* Abstract/futuristic thinking
* Understands logical consequences of behavior
Formal
Used by nurses when developing teaching plans of care for children
Learning geared towards child’s level of understanding. Active participants in the learning process.
Freud’s theory of psychosexual development
* Certain parts of the body assume psychological significance as foci of sexual energy
* Areas shift from one part of the body to another as the child moves through the different stages of development
* Used to determine normal sexual development and sex education
Oral stage (___)
Anal stage (___)
Phalic or oedipal electra stage (___ age)
Latency stage (___ age)
Puberty or genital stage (___)
Infancy
Toddlerhood
Preschool
School
Adolescence
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* Lifelong series of conflicts affected by social and cultural factors
> Unsuccessful resolution of conflicts leads to emotionally disabled individuals
> Used in nursing to determine regression behaviors especially when hospitalized
Erikson’s psychosocial theory
___ vs ___ & ___ (Toddlerhood)
> Control over self and body functions
Autonomy vs Shame & Doubt
___ vs ___ (Infancy)
> Trust developed with sense of good care, warm, and nurturing caregiver
> Mistrust can lead to restlessness, crying, clinging, physical dysfunctions such as vomiting and diarrhea
Trust vs Mistrust
___ vs ___ (Preschool age)
> Development of a can-do attitude about the self
> Behavior is goal-directed, competitive, imaginative
> Initiation into gender role
> Characterized by purpose
Initiative vs Guilt
___ vs ___ (Adolescence)
> Begins development of sense of “I”
> Peers become important
> Gains independence from parents
> Characterized by faith in self
Identity vs Role confusion
___ vs ___ (School age)
> Mastering of skills and tools of the culture
> Learning how to play and work with others
> Characterized by competence
Industry vs Inferiority
___ vs ___
> Characterized by care
Generativity vs Stagnation
___ vs ___
> Characterized by love
Intimacy vs Isolation
___ ___ vs ___
> Characterized by wisdom
Ego integrity vs Despair
Kohlberg’s theory of moral development
> Acceptance of values and rules of society as they shape behavior
> Although knowing what behaviors are right and wrong is important, BUT more importantly is understanding and appreciating why the behaviors should or should not be exhibited
> Used by nurses to provide anticipatory guidance to parents on expectations and discipline
Premorality or preconventional morality. Stage ___ (0-2 yr): Naivete & Egocentrism
> Based on what pleases the child
Stage 0
Premorality or preconventional morality. Stage ___ (2-3 yr): Punishment-Obedience Orientation
> Right or wrong are determined by physical consequences, so if they don’t get caught, they must be right
Stage 1
Premorality or preconventional morality. Stage ___ (4-7 yr): Instrumental Hedonism and Concrete Reciprocity
> Rules are followed out of self interest; behavior is guided by an “eye for eye” orientation
Stage 2
Premorality or preconventional morality. Stage ___ (7-10 yr): Good boy or good girl orientation
> Morality based on avoiding disapproval or disturbing conscience - socially sensitive
Stage 3
Morality of Conventional Role Conformity. Stage ___ (10-12 yr): Law and Order Orientation
> Respect for authority, obeys orders for own sake
Stage 4
Morality of Self-accepted Moral Principles. Stage ___: (Adolescence) Social Contract Orientation
> Laws for mutual good
Stage 5
Physical Growth: Infancy to 1 year
> Growth is an excellent indicator of health during infancy
> Birth weight doubles by 4-6 months, triples by 1 year
> Head’s circumference growth rate during the first year is approximately 5/10 in (1-2 cm) per month
> __ __ closes by 2 to 3 months of age
> (Larger) __ __ may remain open until 18 months
> Organ systems grow and mature more rapidly in the infant
> Organs remain very different from those of older children and adults
Posterior fontanelle
(Larger) anterior fontanelle
Physical Growth : 1-2 months
> Fast growth
> Weight 1.5 lb/month and height 1 in/month for 1st 6 months
> Primitive reflexes present
> Strong suck and gag reflex
> Posterior fontanel closes by 2-3 months
Physical Growth : 4-5 months
> Growth rate declines
> Drooling begins in preparation for teething
> Morrow, tonic neck, and rooting reflexes disappear
Physical Growth : 6-7 months
> Weight gain slows to 1 lb/month and length gain of 1/2 inch/month
> Birth weight doubles
> Tooth eruption begins along with chewing and biting
> Maternal iron stores are depleted
Physical Growth : 8-9 months
> Weight and length gain continues
> Patterns of bladder and bowel elimination begin to become more regular
Physical Growth : 10-12 months
> Birth weight triples and birth length increases by 50%
> Head and chest circumference are equal
> Babinski reflexes disappear
Motor Development
* Muscle growth and weight gain allow for increased control of reflexes and purposeful movement
__ months
Gross
> Can get hand to mouth
> Can lift head off bed when in prone position
> Head lag is decreasing
Fine
> Holds objects placed in hands
> ___ reflex absent
3
Grasp
__-__ months
Gross
> May lift head when against shoulder
> Head lag
Fine
> ___ grasp one month - immediately drops objects when placed in hand
> Grasp reflex 2 months - holds objects momentarily
> Hands often open due to grasp reflex feeding
1-2
Palmar
__-__ months
Gross
> Sits, leaning forward on both hands
> Lifts head off table when in supine position
> Turns from back to abdomen
Fine
> Transfers objects from one hand to another
> Picks up objects well with the whole hand
6-7
__-__ months
Gross
> Plays with feet and is able to put foot in mouth
> Bares weight when held in a standing position
> Turns from abdomen to back
Fine
> Begins reaching in grasping with palm
> Hits at objects but misses
4-5
__-__ months
Gross
> Sits steadily unsupported
> Can crawl and pull themselves up
Fine
> Pincer grasp develops
> Reaches for toys
> Can wave bye-bye and clap hands
8-9
__-__ months
Gross
> Can stand alone
> Can walk with one hand held but crawls to get to places quickly
Fine
> Releases hold on cup
> At 10 months finger-feeds themselves
> At 12 months feeds self with spoon and can hold crayons to mark on paper
> At 12 months pincer grasp is complete
10-12
How to “Baby Proof” the Home
* Keep small, sharp objects, or dangerous substances out of baby’s reach
* Put plastic fillers in all outlets
* Lock all cabinet doors
* Keep pot and pan handles turned away from stove’s edge
* Remove heavy objects sitting on a tablecloth
* Do not eat or drink hot foods with baby on your lap
* Never give baby a latex balloon
* Keep gates at the top and bottom of stairs
* Pad furniture with sharp edges
* Be sure that all windows have screens
* Keep household water temperature less than 120ºF
* Test water before bathing baby
* Never leave baby unattended near water
* Keep pools covered and gates locked
* Shorten all hanging cord appliances
* Have your home tested for lead
* Never leave baby unattended or in the care of a young child
Cognitive Development
* Profound stage of ___ - 1st 2 years of life
> Piaget’s ___ stage (Birth - 2 years)
- Experience the world through their senses and their attempts to control the environment
> Object ___ (8-12 months)
- Realize that objects exist even when out of sight
egocentrism
sensorimotor
permanence
__ months
> Follows an object with eyes
> Recognizes objects that bring pleasure such as breast or bottle
> Plays with fingers
3
__-__ months
> At __ month notices bright objects in line of vision
> At __ months begins to follow objects
1-2
1
2
__-__months
> Brings hands together at midline
> Begins to play with objects
> Recognizes familiar faces
> Turns head to locate sounds
> Shows anticipation and excitement
> Plays with favorite toys
> Memory span is 5 to 7 minutes
4-5
__-__ months
> Can fixate on small objects
> Adjusts posture to see
> Responds to their name
> Exhibits beginning sense of ___
> Recognizes parent in other clothes and places
> Is alert for 1.5 to 2 hours
6-7
object permanence
__-__ months
> Searches for hidden toys
> Explores boxes, inserts objects in containers
> Symbol recognition is developing (enjoys books)
10-12
__-__ months
> Beginning development of ___
> Object permanence continues to develop
> Uses hands to learn concepts of in and out
8-9
depth perception
Sensory Development
___
> Acuity is about 20/100 - 20/150 at birth
> Initially they show preference for high contrast colors like black and white
> Pastel colors are usually only distinguished at the age of 6 months
> Coordination of eye movements and extraocular muscle alignment occurs around 4 to 6 months
> Depth perception it appears to begin approximately 7 to 9 months
Vision
Hearing
> At birth, hearing is acute and can be seen through newborn’s reflexive, generalized reactions to noise
> At 4 months infants turn their head towards a sound coming from behind
> By 10 months they should respond to the sound of their name
> The American Academy of Pediatrics (AAP) and the CDC recommended all newborn infants be screened for hearing impairment either as neonates or before __ month of age
> Newborn hearing screening is usually done before hospital discharge
one
Language Development
__-__ months
> Crying becomes differentiated
> Babbling and cooing more common
> At four months begins consonant sounds: h, n, g, k, p, b
> At five months makes vowel sounds: ee, ah, ooh
4-5
__-__ months
> At birth strong cry
> Reflexive smile at first, becomes more voluntary, reciprocal smiling with parent
> Cooing
1-3
__-__ months
> Strings consonants and vowels together
> Begins to understand and obey commands
> First few words begin to have meaning - mama, dada, bye-bye, baby
> Begins to understand and obey simple commands like “wave bye-bye”
> Responds to “no”
> Shouts for attention
8-9
__-__ months
> Produces vowel sounds and chain syllables
> Begins to imitate sounds
> Belly laughs
> Calls for help
6-7
__-__ months
> Vocabulary of 2 to 3 words
> Begins to differentiate between words
> Uses gestures to communicate
> Speech development may slow when walking begins
> Knows their own name
9-12
Psychosocial Development - Erikson’s Stages
* Infancy is period that develops the foundation of personality
* Struggles to establish a sense of basic trust rather than mistrust
* Most important aspect of psychosocial development is parent/infant attachment
> A sense of belonging with one another
> Creating a bond
> Should be initiated immediately after birth
___ occurs by 6-7 months when infants are able to differentiate between caregivers and strangers
> Anxiety, crying, clinging, and turning away from a stranger occurs with separation of caregiver
> Is a normal sign of healthy attachment and occurs because of cognitive development (object permanence)
Stranger anxiety
Physical Assessment
General Approaches to Physical Assessment
> Quiet, private, safe, warm environment
> In infants - complete quiet tasks first like pulses and respirations (best to do when infant is not crying)
> In ages 6-12 mos may distract by giving infant a toy
> Comfortable position (parent’s lap) while feeding or sleeping
> Alter exams to developmental stage or needs
Vital Signs - Infant
Temperature: ___-___ (axillary)
Pulse (beats/min): __-__
Respiratory (breaths/min): __-__
Blood Pressure (mm Hg): __-__/__-__
Oxygen saturation: >97% room air
97.7-99.3º
80-150
25-55
65-100 / 45-65
__ temperature is “golden” standard for infants = core temperature
__ temperature for children starting 5-6 years of age
__ is not recommended for children under 2 years of age
Rectal
Oral
Tympanic
__ for children 3-18 years of age
__ pulse for children younger than 2 years or who have irregular HR or congenital heart disease
In infants note pulsating anterior fontanel
Irregular HR are not uncommon in children influenced by emotion and exercise
Temporal
Apical
Health Promotion - Immunizations
> Effective in decreasing or eliminating childhood diseases
___ immunity a serum that contains a disease-specific antibody is transferred to child parenterally or through placenta (mother to infant) - short protection
___ immunity occurs when the body has been exposed to an antigen, through illness or immunization, and the immune system creates antigens against the particular antigen - lifelong protection
> Infants are especially vulnerable to disease due to their immature immune systems
Passive
Active
* Term neonates are protected from infection by ___ immunity from their mothers
> This is effective for 3 months only
* Breastfed infants receive additional immunoglobulins - ___ immunity
passive
passive
Barriers to Immunizations
* Appointment-only clinics
* Excessively long waiting periods
* Inconvenient scheduling
* Inaccessible clinic sites
* Need for formal referral
* Language and cultural barriers
* Cost
* Common misconceptions
* Lack of awareness
* Lack of healthcare worker education
* Inaccurate record keeping
Health Promotion - Immunizations
> Administration of vaccines
* Know recommended vaccination schedule
* Assess parent’s understanding of vaccines
* Careful history to determine precautions and contraindications
* Administer using recommended sites
* Review common side effects
* May administer acetaminophen for discomfort
* Document - parent consent, date, manufacturer, lot #, exp date, admin site, any side effects, signature of person administering
> Precautions and contraindications - fever and local irritation usually common
> Immunocompromised children - no live bacterial or viral vaccines
> Education for parents
Preventing Vaccine Reactions
As all vaccines have the potential to cause ___, it is imperative that the nurse ask about allergies and previous reactions before administering any vaccine!
anaphylaxis
CDC Immunization Schedule (Birth to 15 Months)
* Hepatitis B
* Rotavirus
* Diphtheria, tetanus, and acellular pertussis
* Pneumococcal conjugate
* Inactivated poliovirus
* Influenza (IIV) or Influenza (LAIV4)
* Measles, mumps, rubella
* Varicella
Health Promotion: Continuing Assessment Questions
Nutrition: How much is your child eating? How much? How often?
Elimination: How many wet diapers? How many stools? Consistency of stools?
Safety: Use of car seats? Gun violence? Smoking in the home?
Hearing/Vision: Any concerns?
* Can you tell me about the times when you feel it would be necessary to call the doctor?
* How is the family adjusting to the baby?
* Getting enough time alone and time together?
* Change in the household or family lifestyle?
* Financial questions?
* Any other questions or concerns?
Feeding and Nutrition
* American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for the first __ months of life for all infants
Factors influencing choice of feeding method
> Breast milk provides complete nutrition
> Breastfed infants are less likely to be at risk for overweight or obesity
> Breastfed infants have less risk of dying from SIDS
6
Feeding and Nutrition - Reasons for choosing formula feeding
> Chemotherapeutic agents
> Untreated active TB
> HIV infection in mother
> Galactosemia
> Illegal drug use by the mother
Feeding and Nutrition
___ - replacing breast or bottle feedings with drinking expressed breast milk or formula from a cup
> Readiness to > - throwing bottle down, chewing on nipple, taking only a few ounces of formula, refusing the breast
> Gradual process
Weaning
Juices and water
> Juice no more than 4 oz/day of 100% fruit juice
> Never younger than __ months and not at bedtime (why? = ___ )
Solid foods
> When to introduce (around 4-6 months)
> One at a time in small amounts, pureed
> Around 9 months can eat chopped foods
6
tooth decay
Feeding and Nutrition
* Finger foods : 8-10 months
> Bite-size pieces and soft, not round
* Snacks
> Introduced when child has three full meals/day
* Food allergies
> Most common allergens cow’s milk, egg, soy products, fish, peanuts, chocolate, corn, and wheat
Dental Care
* Teething
> Deciduous or “baby teeth” erupt __-__ months
> Discomfort is normal
> Parents need suggestions for coping
* Cool liquids and hard foods (toast, popsicles)
* Cold solid teethers
* Assessment of dental risk
> Frequent snacks
> No dentist
* Cleaning teeth
> After 6 months - 2x/day
* Fluoride supplementation
> Begins at 6 months with no access to fluoridated water
5-9
Sleep & Rest
* Newborns
> Sleep as many as 17-20 hours per day
* 3-4 months of age
> Sleep for longer periods at night
* Regulation of sleep-wake cycles
> Readiness for sleeping through the night begins when the infant is between 6 weeks and 3 months old
> Ability to self-console
> Not picking up child as soon as they start crying rather speak to them softly
Sleep & Rest
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> Supine position for first year
> In parent’s room rather than in their bed
> Firm mattress
> No soft or loose bedding
> Avoid overheating
> Young infants should not be put to sleep in car seats
> Avoid smoking
> Breastfeed infants for at least 6 months
SUID (sudden unexpected infant death)
Safety
Motor vehicle safety
> Automobile crashes constitute the single greatest risk to an infant’s life
> Restraining seats are the only practical means of risk reduction
> Infant safety in motor vehicles depends entirely on adults
> Parents must be educated regarding car seat safety
> Car safety seats should be placed in back seat, center if possible
> Car seat until 4 feet 9 inches tall (8-12 years)
Providing a Safe Home Environment
* Burn prevention
* Safe baby furnishings
* Preventing falls
* Preventing asphyxiation
* Preventing lead exposure
Crib Safety
* Slats or mesh slides
* Snug mattress with no gaps
* No decorative enhancements
* Short corner posts
* Secure drop sides
* Splinter-free wood surfaces
* No missing hardware or broken slats
Concerns During Infancy
* Patterns of crying
> A mode of communication for infants
* Specific strategies
> Holding
> Talking softly or humming
> Massage
* The infant with colic
> Stressful for parents
> Care must be individualized
Health Promotion Review: 2-week-old to 1-month-old infant
* Immunizations
> ___ #1 at birth and #2 at 1-2 mos
* Nutrition
> Breast milk at least every 2-3 hours
> Iron-fortified formula 2-3 oz every 3-4 hours
> Place on right side after feeding
* Elimination
> __ wet diapers
> Stools related to feeding method
* Sleep
> Back to sleep
> __ or more hours
> By one month begins to establish nighttime routine
Hep B
6
16
Health Promotion Review: 2-month-old
* Immunizations
> ___ #1, ___ #1, ___ #1, pneumococcal #1, rotavirus #1
* Nutrition
> Breastfeed on demand
> Formula 4-6 oz 6x/day
* Elimination
> __ wet diapers
> Stools related to feeding method
* Sleep
> Back to sleep
> Play time while awake on tummy
DTaP, IPV, Hib
6
Health Promotion Review: 4-month-old
* Immunizations
> ___ #2, ___ #2, ___ #2, pneumococcal #2, rotavirus #2
* Nutrition
> Breastfeed on demand
> Formula 5-6 oz 5-6x/day
* Elimination
> __ wet diapers
> Stools related to feeding method
* Sleep
> Sleeps __-__ hours
> Back to sleep
> Play time while awake on tummy
DTaP, IPV, Hib
6
15-16
Health Promotion Review: 6-month-old
* Immunizations
> ___ #3, ___ #3 (6-8 mos), ___ #3, pneumococcal #3, rotavirus #3, and ___ #3
* Nutrition
> Begin introducing solid foods one at a time by spoon
> Use iron-fortified cereals
> Begin to use a cup
* Elimination
> Stools darken and become more formed as solids are introduced
* Dental
> Tooth eruption begins with lower incisors
> May have some pain and low-grade fever and may be fussy
* Sleep
> Sleeps 12-16 hours/day
> Back to sleep
> Sleeps all night it may take 2-3 naps per day
DTaP, IPV, Hib, Hep B
Health Promotion Review: 9-month-old
* Immunizations
> ___ #3 if not given earlier (between 6-18 mos)
* Nutrition
> Breastfeed
> Formula 16-32 oz/day
> Use iron-fortified cereals
> Begin to introduce various soft, mashed, or chopped table foods
* Elimination
> Urinary and bowel patterns consistent
* Dental
> __ teeth
> May brush with soft toothbrush and a rice-sized amount of fluoridated toothpaste and water
* Sleep
> Back to sleep
Hep B
4
Health Promotion Review: 12-month-old
* Immunizations
> ___ #1 and ___ #1
> Influenza vaccine annually
* Nutrition
> May begin whole milk (2-3 cups daily)
> Offer various table foods from different groups
* Elimination
> Remains dry for longer periods of time
> Bowel movements decrease in number and become more regular
* Dental
> __ teeth
> May brush with soft toothbrush and a rice-sized amount of fluoridated toothpaste and water
* Sleep
> Back to sleep
> Sleeps through the night and has one or two naps a day
MMR, varicella
8
