Health promotions of Infants: 0-1yr Flashcards
Rapid growth! - time of huge rapid growth; growing a ton
Head and trunk grow the fastest
Doubling of birth weight by age 6 months
Tripling of birth weight by age 1 year
Grow quickly
Physical development
Huge heads
Unstable
Top heavy
By 1 year, birth length has increased by 50%
Head increases 33% in first year
Cranial Sutures:
Growth in “spurts” rather than gradual pattern
Head and trunk grow the fastest
2 soft spots - front and back
Posterior fontanel (soft spots) closes at 6-8 weeks of age - same and in back
Anterior fontanel closes by 12-18 months
Moves and pulsating and normal for it to pulsate; not norm for it to sink - sign dehydration
Bulging - sign ICP
No fontanel - worried - will have surgery - cut skull open and make room for growth
See bones go over each other and form a groove - bones move and mold to fit through vagina - norm and will go away
Cranial Sutures:
Infant’s gain ~5-7oz weekly in first months
Doubling of birth weight by age 6 months
The nurse assesses a 6-month-old healthy infant who weighs 7lbs 8oz at birth, and shares with the parents that the infant should weigh approximately how many pounds?
1. 10 lbs
2. 12 lbs
3. 15 lbs
4. 21 lbs
Answer: 3
No control limbs - when have myelination (myelin develops around nerves - slow process - complete 2-3 yrs); start infancy/as soon as born - cephalocaudal and proximodistal
Myelin shealth around all nerve endings giving all control slowly
Eventually get pincer grasp due to myelination
Grasp reflex - wrap hand around finger
CNS-
Half baked - nothing at full level
Last things to develop
Born early - biggest concern is resp patterns - breathe, oxygenating appropriately
First yr typ stomach/abdominal breathers - count RR in abdominal
Toddler - chest
Increased risk for infection - tract from nose to lungs not as long and cilia not as effective
Nose breathers often
Mouth breathers - some kind obstruction in nose; young one - booger
Occluded easily
RR high - breathe quickly; 60 breaths/min
Respiratory-
HR high
Common for newborns to have murmurs at birth can be norm; CHD testing later - tell if need do further testing
Cardiac-
Not fully functioning until 5-6 months; no foods until then
Break down easiest - breast milk; break down
Needs change depend on sick
Want bond - which more imp - encourage it; not force it and not feel guilty for not doing it
Not make: vitamin K; given vit K shot
First poop - maconium
GI-
Half baked; not reuptake water - why prone to dehydration in neonatal period
Need eat 2-4 hrs ATC
Keep BG up, hydrated
Kidneys-
Good immunity first 3 months life because IgG - get some mom’s immunity first 3 months - help prevent getting sick
Gets fever first 3 months - go to doc and is an issue
Protect next 3 months - vaccines, breastfeeds - helps antibodies last longer
Immunity-
Very poor
See contrast best; black and white best
See around 12 in from face
Areola lot dark - help contrast and baby find nipple easier
Vision-
At adult level
Hearing-
Brown adipose tissue
Not have good thermoregulation - keep temp up; help keep temp up with this fat
Lose majority heat through head; bathing them head last and dry first
Not encourage hats when laying down and not supervised: SIDS
Lose brown fat quickly so must properly dress them
Thermoregulation-
1 month – has a strong grasp reflex
2 months – holds hands in an open position; grasp reflex fading
3 months – no longer has a grasp reflex; keeps hands loosely open
4 months – grasps objects with both hands
5 months – uses palmar grasp dominantly
6 months – holds bottle
7 months – moves objects from hand to hand
8 months – begins using pincer grasp
9 months – has a crude pincer grasp; dominant hand preference evident
10 months – grasps rattle by its handle
11 months – places objects into a container; neat pincer grasp (awhile for this to develop
12 months – tries to build a two-block tower without success; can turn pages in a book
Fine motor skills
1 month – demonstrates head lag
2 months – lifts head off mattress when prone
3 months – raises head and shoulder off mattress when prone; only slight head lag
4 months – rolls from back to side; can hold head up
5 months – rolls from front to back
6 months – rolls from back to front
7 months – bears full weight on feet; sits, leaning forward on both hands
8 months – sits unsupported
9 months – pulls to a standing position; creeps on hands and knees
10 months – changes from a prone to a sitting position
11 months – cruises/walks while holding onto something
12 months – sits down from a standing position without assistance; walks with one hand held; confident - holding onto something while walking
Gross motor skills
Place in order the expected sequence of fine motor developmental milestones for an infant, beginning with the first milestone achieved and ending with the last milestone achieved.
1. Puts objects into a container
2. Builds a tower of 2 blocks
3. Voluntary palmar grasp
4. Reflex palmar grasp
5. Neat pincer grasp
Answer: 4, 3, 5, 1, 2
Piaget
Sensorimotor phase (0-24 months)
Cognitive development
- Reflexive stage
Sucking, rooting, grasping, crying
Start off by having reflexes - Primary circular reactions stage
Simple repetition- coordinating movements
Reflexive behavior is replaced with voluntary acts
Grabbing something
Reflexes slowly turn into grabbing - hold onto longer or reach for it - Secondary circular reaction stage
Imitation of familiar behaviors
Separation from environment
Make things make sounds - Coordination of secondary schemas
Intentional, goal-directed behavior
Object permanence - Around 12 months; not see something does not mean not there
Intentional with what doing
Sensorimotor phase (0-24 months)
Substage 1:
Substage 2:
Substage 3:
Substage 4:
Piaget’s six substages of the sensorimotor stage
Simple reflexes: first month of life: during this period, the various reflexes that determine the infant’s interactions with the world are at the center of its cognitive life.
Substage 1:
First habits and primary circular reactions: from 1 to 4 months: at this age infants begin to coordinate what were separate actions into single, integrated activities
Substage 2:
Secondary circular reactions: from 4-8 months: during this period, infants take major strides in shifting their cognitive horizons beyond themselves and begin to act on the outside world.
Substage 3:
Coordination of secondary circular reactions: from 8-12 months: in this stage, infants begin to use more calculated approaches to producing events, coordinating several schemes to generate a single act. They achieve object permanence during this stage.
Substage 4:
Erikson
Trust vs Mistrust
Can we trust environment
Infants trust that their comfort needs will be met
Mistrust
Task/Goal: Attachment to primary caregiver
*Children who learn to trust caregivers in infancy will be more likely to form trusting relationships with others throughout the course of their lives.
Psychosocial development
Trust needs met
Feeding, Comfort, Tactile Stimulation
Infants trust that their comfort needs will be met
Occurs when gratification of needs is delayed - HOURS; not let newborns cry it out; cannot sleep train a newborn - cause mistrust environment; want single to us need something - not teach trust - confuses them; not feed baby until show signs are hungry; trust when give signal going feed them, held, comforted, put to bed; trust environment based on our actions
Can occur from too much or too little frustration (control of environment)
Mistrust
Based on if can trust them
Fail - lot trouble trusting and building relationships later in life
Successful: Trust. Faith/hope in environment and future
Unsuccessful: Difficulties relating to people effectively, suspicion, fear of future
Task/Goal: Attachment to primary caregiver
Human contact is huge! - touch; sense being touched; kangaroo care/skin to skin
Attachment by 6 months, infants have clear preference for their primary caregiver - 4 months - get first smile if primary caregiver
Separation anxiety begins around 4-8 months - not have object permanence; not want to leave; compounded when afraid of strangers
Stranger fear begins around 6-8 months - lasts through toddlerhood
Language development
Social development
3-4 months: coos/babbles
5-6: “talk back” (realization that speech influences others)
8-9 months: Begin to understand simple commands like “wave bye-bye” - introduce sign language
10-12 months: says around 5 words
If not doing these - checked hearing first; not babble/coo - may not hear
Language development
Concept of object permanence is acquired - not realize separate from environment/caregiver - everything connected; learn by manipulating environment - play super imp
Development of body image parallels sensory motor development
Anesthetic and tactile experiences are children’s first perceptions of their bodies
By end of first year, children recognize that they are distinct/separate from parents
Peek a boo so funny - gone and back
Development of body image
Solitary play
Games: peekaboo and pat-a-cake
Verbal repetition and imitation of gestures
Although solitary play dominates, the child may choose with whom they prefer to interact
Types of toys:
Limit television and videos- why?
Age-appropriate activities
Playing by self
Not playing with other infants
Primarily narcissistic and revolves around own body
By 3-6 months, infants show more discriminant interest in stimuli and begin to play alone with rattle or soft toy - interested in toys - moving things to mouth;
6 months-1 year, play involves sensorimotor skills - touching things; careful because everything in mouth; careful with toys and things around the house
Solitary play
Rattles
Soft, stuffed toys
Blocks
Mirrors
Balls
Nesting toys
Books
Good for sensory motor development
Types of toys:
This age learning how read people - environment separate from; expect come soothe us; confusing if happy on TV and baby is sad - wrong interpretation what feeling and impacts self-esteem and question and impairs trust
No TV before 2 yrs
Limit television and videos- why?
Sleep/rest
Dental
Health promotion
Sleep patterns vary among infants
2-month-olds need around 15 hours of sleep total
12-month-olds need around 13-hours of sleep
Newborn - 20 hrs/day; not consistent sleep
Safe sleep
By ages 3 to 4 months, night sleep lasts 9 to 11 hours - long stretches through night
Lots of Napping - infants napping day
Around 1 - switching to 1 nap but need them
Infants are naturally active - not worry about them in this stage; not worry about movement for them - later ages
Sleep/rest
Cleaning: Begins when primary teeth erupt - start cleaning; teeth erupt dental visits imp
6-8 months – teething! - bottom two teeth first
Prevention of dental caries when teeth erupt - clean off
No bottle propping - milk pool and sit around teeth
No milk in bed - put to bed with bottle - staying on teeth - pool in mouth
No fruit juices - nothing with sugar before bed; should not give juice until 1 yr
Before 1 yr - nothing except formula or breastmilk
Dental
Schedule
First given - most education; tons well-visits - mainly so get immunized
Immunizations
Hepatitis B: 3 doses beginning at birth
Birth:
Rotavirus: 2 doses beginning at 2 months
DTAP: 3 doses beginning at 2 months
Haemophilus influenza B: 3 doses beginning at 2 months
PCVB: 4 doses beginning at 2 months
Polio: 3 doses beginning at 2 months
Two months:
Influenza: annually beginning at 6 months
Six months:
MMR: 2 doses beginning at 1 year
Varicella: 2 doses beginning at 1 year
Hepatitis A: 2 doses beginning at 1 year
One year:
First 6 months of life: Human milk/formula
Supplements
> Second 6 months
Nutrition
Formula prep (recipe, water temp) - need know how make properly; too little: impacts electrolytes and nutrition
Never put bottle in microwave (hot spots) - warm water, bottle warmer or just get used to room temp if on formula; warming not required
First 6 months of life: Human milk/formula
Vitamin D - moms body make Vit D and not well passed on so given supplement
Iron - formula fed - no iron; breastfeeding - all iron stores passed onto baby in last 4 weeks pregnancy (36-40 weeks) last about 4 months; might not need to bridge anything; typ draw labs; if born premature not get all iron stores - supplemented; higher risk anemic and need supplements
Supplements
Introduction of solid foods - infant cereal (mix in milk/water), puree - must have good head control, able sit up, show interested in food - follow you and open mouth; cereal to puree - vegetable puree first - veggie puree new q3-4days - identify if any rxn to food, not tolerating it, stomach ache; do veggies then fruits; learn grasp - give soft foods to try and eat - bananas
No hard food until teeth - foods that take mastication/chewing - wait until have all molars
Weaning from breast or bottle (around yr) - before first birth - formula, breastmilk, water - no cow milk before 1 year - nutrition; main source nutrition - breastmilk/formula - where want get it
Overfed cow’s milk - not eat enough food/salt - not nutritious enough to give everything needed
Nut butter is fine - 7-8 months; eggs fine
No list before 1 year-
> Second 6 months
Cow’s milk
Raw Honey - botulism
No nuts - no teeth
Hard candy
Popcorn - kernels
Anything choke easily on - hot dogs - perfectly occlude airway; small bits and gum down but careful shape
No list before 1 year-
Lot edu
Crib at highest setting - when kid more mobile lower crib - never leave unsupervised
Motor vehicle safety
Burns (electrical, water)
Aspiration
Falls
Poison
Drowning
Nurse’s role in injury prevention
Injury prevention
Back seat, rear facing - first two yrs
Motor vehicle safety
Sticking stuff in sockets
Water being too hot - water heaters changed - have kids - need turned down so not burned
Burns (electrical, water)
Small products
Things in mouth cannot chew
Aspiration
Fall of things; not understand fear
Falls
Put everything in mouth and can open it will do it - if left open; make sure things locked away; toddlers and climb on things want things locked away
Ingests something poisonous - call poison control then to doc - not encourage induce vomiting
Poison
Drown smallest amount of water - get stuck
Never leave infant alone by water
Drowning
Ensuring safety in the home - teach what need to do to make house safer
Teaching infant CPR
Number to poison control
What ER to go to if emergency
Triage lines open in middle night
Anticipatory Guidance—care of families
Nurse’s role in injury prevention
