Exam 1 - Health Promotion of the Newborn and Infant PP Flashcards
The neonate normally loses about 10% of birth weight by age 3 or 4 days.
Infant’s ability to fixate is greatest in 1st hour of life
Tracts that develop myelin first are the sensory and cerebellar tracts.
Touch is especially important and so is the most acute sense in the neonate.
All newborn senses are very acute, except for sight.
First reactivity period
30-60 minutes after delivery: alert, interested in environment
- Full-term infant may breast-feed
1-4 hours after delivery: sleepy and relatively calm
- All systems slow down, temperature falls
Second reactivity period
Occurs when infant wakes from first deep sleep
Lasts 2-5 hours: alert and responsive
Postpone erythromycin ointment immediately after birth. But must be given within two hours by law.
Ophthalmia neonatorum–
Chlamydia
Gonococcal conjunctivitis
Motor development is based on infant reflexes
Rooting Sucking Doll’s eyes Moro Palmar Step Babinski
Nutrition
Breast milk or iron-fortified formula only for first 6 months of life
Promotion of Successful Breast-Feeding
Frequent and early breast-feeding (within first hour of life is important)
Promotion of skin-to-skin contact
Correct positioning of infant at breast
Feeding-on-demand schedule
Baby-Friendly hospital initiative
Breast Milk
Newborn has deficiency of pancreatic lipase for fat absorption, making cow’s milk indigestible
Breast milk contains enzymes – lipase
-This enables the high fat content of breast milk to be easily digested by the infant’s GI tract
Breast Milk
Breast milk contains vitamin D but may not have levels sufficient to prevent rickets
Recommendation is for breastfed infants to receive vitamin D supplementation if not receiving sunlight exposure
Formula fed infants do not need vitamin D supplementation
of wet diapers
1 for each day of life until day 5 or 6
5 or 6 per day until day 14
After that – 6 – 10 per day
Stools –
Bottle feeding: 1 stool every 2 – 3 days
Breast feeding: 2 or 3 per day
Sudden Infant Death Syndrome
Occurs during first year of life, peaks at 2 – 4 months
Occurs between midnight and 9am
Increased incidence in winter
Back-to-Sleep campaign
Colic
Inconsolable crying that lasts 3 hours or longer per day and for which there is no physical cause.
Usually resolves by 3 months
Frequent burping
Formula modification
Warmth to abdomen
Cuddling and closeness
1 week/2 week visit
Weight
Feeding, peeing, pooping
Discuss how the parents are feeling and how things are going in the home.
- Postpartum depression -- - Shaken baby syndrome
Assess attachment
Colic?
Never leave infant alone with pet or sibling
Warm formula in cup of warm water, never microwave
Neonatal Normal Vital Signs
Temp: 36.3oC – 37oC (97.3o – 98.6oF) axillary
Heart rate: 120 – 160
Resp rate: 30 – 60
1 – 3 month old – Physical
Rapid weight gain – 1.5 lb/mo (for 1st 6 mo)
Ht. – gain 1 inch/mo (for first 6 months)
Posterior fontanel closes at 2 months
2 month visit
By two months smiling spontaneously – social smile
Follows past midline
Loves looking at faces.
Imitate facial expressions.
Strabismus is normal in the young infant, but should not be present after about 3 months of age.
Turns head to sounds
Coos
Two month milestones
Raises head and chest when lying on stomach and supports upper body with arms – called Head-up 450
2 month visit immunizations
DTaP – Diphtheria, Tetanus, acellular Pertussis
Hib – Haemophilus influenzae type B
Rotavirus
IPV – Polio (inactivated poliovirus vaccine)
Pneumococcal
Age appropriate toys
Birth – 2 months: Mobiles – dark and light, black and white
2 – 4 months: rattles, cradle gym
3 month cause for concern
No response to loud noises
Does not try to find speaker’s face with his eyes
Does not coo, vocalize
Constant fisted hand
Stiff legs
Does not lift head when lying on stomach
Crosses eyes most of the time
4 – 6 mo – Motor
Sits with support
Discovers hands, begins reaching and grabbing
Brings hands to midline
Begin playing with rattles, squeaky toys, etc.
4 – 6 mo – Motor
Moro, tonic neck, and rooting reflexes disappear
Tonic neck reflex disappears. Infant turns over – abdomen to back at 5 mo; back to abdomen at 6mo
4 – 6 months– Motor
Tongue thrust diminishing
Teething begins – drooling
Putting weight on feet when held upright
Fine motor – Rakes objects
Sensory/Language ( 4 – 6 mo)
Ma-ma, Da-da vocalizations
Begins consonant sounds first, then vowel
Responds to rhythms
Tracks objects with eyes– 180 degrees
Social/Emotional ( 4 – 6 mo)
Smiles and laughs
Comforting habits such as thumb sucking begins
Demands attention by fussing
Smiles at mirror image
Has increased interest and attachment to parent
Parent-Infant Attachment
Reciprocal cycle establishes trust and produces confidence in parents
Age Appropriate Toys 4 – 6 months:
Bright colored, soft toys
Small enough to grasp
Nutrition ( 4 – 6 mo)
Fetal iron stores – depleted by 4 months for term infant
By 2mo in preterm infant
Should continue BF or iron-fortified formula
Milk alternatives like rice milk are low in protein, calcium, vit D
4 mo visit immunizations
DTaP #2 Hib #2 Rotavirus #2 IPV #2 PCV (Pneumococcal) #2
6 months – Physical
Double their birth weight
Weight gain slows to a pound a month
Length ½ inch a month
Teeth eruption
6 months– Key milestones
Good head support – No head lag
Rolling in both directions
Bears weight on legs
Sitting with support– tripod sitting
Reaches for objects
Nutrition
4 – 6 months begin solids
Dental
First tooth about 6 months
Clean teeth with plain water and washcloth
{First tooth comes in at 6 months, and lose 1st tooth at 6 years}
Age of child in months minus 6 = # of teeth
Dental
Routine fluoride supplementation is not recommended for infants younger than 6 months
Fluoride supplementation if there is not adequate fluoride in the water supply
6 mo visit immunizations
Hepatitis B #3 (between 6 & 18 mo)
DTaP #3
Hib #3
Rotavirus #3
PCV #3
Infants 7 - 9 months
Developing object permanence
Strong attachment behavior. Stranger anxiety. Develops attachment to blanket, teddy bear, etc.
Crawling
Motor : 7 – 9 mo
Crawls vs Creeps
Fine motor – rake objects initially, progressing to crude pincer grasp
Feeds self cheerios
Transfers objects from hand to hand
Motor: 7 – 9 mo
Goes from tripod sitting to sitting alone (about 8th month),
to pulling to stand
Stands while holding onto something
Nutrition – Beginning to feed self
Raking to crude pincer grasp
Continue introducing foods slowly– soft mashed table foods
No egg white until after 1 year of age
Foods NOT to feed a baby
Honey Hot dogs Grapes Hard candies Raw carrots Popcorn Nuts Peanut butter Cow’s milk of any kind before 1 year of age
Sensory/Language 7 – 9 mo.
Babbles contentedly to self on waking
Responds to simple commands
Understands “no-no”
Depth perception developing
Sensory/Language 7 – 9 mo.
Object permanence – Playing peek-a-boo is associated with development of object permanence
Identify causal relationships
Motor activity is necessary for cognitive development
Age Appropriate Toys 6 – 9 months
Large toys with bright colors and moveable parts and noise makers
Pots and pans, nesting containers
Physical – 10 – 12 months
Triple birth weight by 1 year of age
Head and chest circumference are equal
Length increases by 50% from birth length
Babinski reflex disappears
Lordosis evident during walking
Fine Motor: 10 – 12mo
Neat Pincer grasp by 11 mo.
Feeding self with spoon
Wave bye-bye
Sensory Language
Says “dada”, “mama” specifically
Responds to simple verbal requests
Knows own name
Uses simple gestures like shaking head for “no”
Says simple words to communicate needs – about 5 word vocabulary
Nutrition
Wean from bottle to cup
Whole milk after 12 months
Eating 3 meals and snacks
No egg white until after 1 year of age
Dental
Toothbrushing – Use a non-fluoride tooth paste until they are able to swish and spit
“Bottle-mouth” – caries in primary teeth from sleeping with bottle in mouth
Age Appropriate Toys 9 – 12 months
Books with large pictures,
push-pull toys, teddy bears,
balls
Causes for concern – 10 – 12 mo
Not crawling
Not pulling to stand
Says no single consonant sounds (da-da,ma-ma)
Does not use gestures
Does not respond to baby
games like “Pat-a-cake” or “Peek-a-boo”
Poison prevention
Most victims of poisoning are under 5 yr. age Everything up and locked Never store non-edible things in containers that are meant for edible things Adult meds Alcohol Plants Ashtrays 1-800-222-1222
12 month visit
Lead screening
Hematocrit screening
4th dose of HIB and PCV 13
Lead Blood Levels
Blood test done if infant is at risk at any time
Universal Lead Serum Test is done at 1 year and 2 years
Lead Poisoning
The Blood Lead Level (BLL) for people living in the U.S. dropped from 12.8 mcg/dl in 1980 to 1.9 mcg/dl in 1999.
The level of concern for an elevated BLL has dropped from 80 mcg/dl in 1950 to 5 mcg/dl today.
Lead poisoning – Nursing Interventions
Family education for preventing childhood exposure to lead
Wash toys and pacifiers frequently
Make sure that home exposure is not occurring from parental occupations or hobbies
Hot water dissolves lead, so use only cold water for consumption (drinking, cooking, making baby formula
Lead poisoning – Nursing Interventions
Assist family to obtain sources of help for removing lead from the environment
Family education for preventing childhood exposure to lead
Do not vacuum hard-surfaced floors or windowsills or window wells in homes built before 1960, because this spreads dust
Wash and dry child’s hands and face frequently, especially before eating
New immigrant communities have a higher risk of lead poisoning
Ayurvedic medicines from India
Eye makeup (surma) from India
Greta, Azarcon from Mexico (home remedies)
Day Tway from Thailand (digestive aid)
Ba-baw-san from China
Car Seat
Continue rear facing car seat until child out-grows rear facing car seat by reaching the top height or weight limit allowed by your car seat’s manufacturer.
Psychosocial Development Erikson
Infancy 0 – 12 months
Trust vs. Mistrust
Require consistent, predictable, reliable care to accomplish this developmental task
Hope
Hospitalization– Infant
Major fears:
Separation, strangers
Interventions:
Provide consistent caretaker
Attachment object
Minimize separation from parents and significant others
Stages of Separation Anxiety
Stage 1 – Protest
Stage 2 – Despair- depressed signs
Stage 3 – Detachment- appears happy but is faking it
Communication with Infants
Touch
Soft voice
Responsive to crying
Take turns in baby conversation
Develop from babbling & cooing to single word production
Normal Infant Vital Signs
Temp: 36.5oC – 37.5oC (97.6o – 99.8oF) axillary
Heart Rate: 110 – 160
Respiratory Rate: 30 – 60
