Infant Care and Nutrition Flashcards
What is Diaper dermatitis?
-diaper rash
-fussiness, agitation, and irritability
What are the factors that contribute to skin breakdown when wearing diapers?
-Perineal region skin is thin
-occlusion, moisture, microbes, GI tract proteolytic
enzymes, urine, feces, and friction
Signs of Diaper dermatitis
-ink to red to bright red rash
-Shiny, wet-looking patches or lesions
-Sensitivity of affected area
-Dry raised bumps (papules) possible
-Rapid onset
-Severe – maceration, oozing, ulceration,
pustules
Contributing factors of Diaper dermatitis
-Diaper type
-Diet (breastfed babies with less dermatitis, due to softer poo -> better absorbed by the diaper)
-Allergic reactions (soap, clothes)
-Chemicals
How to treat Diaper rash?
A: Air the region - let the baby run naked
B: Barrier - provide barrier coverage
C: Cleansing - use smooth, non-alcoholic wipes, rinse with warm water, air dry, and limit cleansing only when stool present
D: Diaper
E: Education
When to cleanse the perianal area?
Only when stool is present, to avoid irritation
Treatment to relieve symptoms and clear the rash
-Oral analgesics
-Skin protectants: Zinc oxide, petrolatum, lanolin, glycerin, talc/cornstarch
-the greasier the better
What type of diaper is appropriate/not appropriate to use?
Best: absorptive
Avoid: diaper with dye
Patient Education
-Apply skin protectants liberally
-Reapply often – with each diaper change
-Do not remove protectant from previous application – minimize irritation
-Rash improves drastically within 24 hours of applying or making changes
When to refer
Bleeding, oozing, or pus
Hasn’t resolved in 7 days
Fever, diarrhea, vomiting
Rash or skin lesions beyond the diapering area
What is a Preakly heat?
-Heat rash caused by Blocked/clogged sweat glands
-Sweat can’t leave gland -> dilation and rupture of the pore à stinging, burning, itching
-Very fine, pinpoint, red-raised rash
-rapid onset, clears away rapidly
Treatment of Preakly heat?
depends on the symptoms
-itching -> antipruritic
-Burning/stinging? – soothers, moisturizers
Don’t use greasy, oily products, we don’t want to block the glands -> use water-based products
NO hydrocortisone for infants
How is Colic defined?
-more than 3 hours a day, for more than 3 days a week, for at least 3 weeks
-peaks at e 2-6 weeks, declines by age 3-4 months
Potential trigger for Colic
-Gas
-Lactose intolerance
-“Maternal tension”
-Oversensitivity or overstimulation (light, noise)
-Discomfort
-Boredom
-CNS dysregulation
Signs of Colic
-Uncontrollable crying
-Postural changes
Pulling legs to the abdomen
Clenches fingers
Nonpharmacologic treatment for Colic
-Change mother’s diet or formulation (but unlikely to be related to that)
-Smaller, more frequent meals (smaller amounts of air intake)
Upright positioning during/after feedings
Motion (walking, swinging, rocking, holding)
Pacifier
Swaddling
Bathing
Singing/background noise
Pharmacologic treatment for Colic
Simethicone drops (Mylicon, Little Tummys)
-helps with gas, and bloating -> give after a meal or at bedtime
-shake well
-place in the infant’s mouth, towards the cheek
-do not exceed 12 days per day
-have not shown to be effective, but no risk with using
Pharmacologic treatment #2 for Colic
Gripe water
-Contains proprietary mix of ginger, fennel, chamomile, caraway, peppermint
-no studies!
Presentation of Teethening
6+ months of age (could be sooner)
Irritability
Drooling (watery mouth)
Red gums, swollen gums
Gum rubbing, chewing/gnawing
Low-grade fever -> Tylenol (Ibuprofen from 6m)
Eruption cysts
NONPHARMACOLOGIC Treatment
-Gum massage/rubbing
-Teething rings or toys
-Wet or frozen cloth
-If old enough to chew food, something crunchy
-Mesh teether with frozen fruit
Pharmacologic Treatment
-Systemic Analgesics
Acetaminophen, Ibuprofen drops
Natural products
-Chamomile
-Lemon peel
-Clove oil
-Sugar
What are the recommendations for infant nutrients?
American Academy of Pediatrics – breast is best
Pediatricians/parents everywhere – fed is best
solid food from 5-6 mo -> just to get babies used to chewing
-main dietary for babies is milk for year 1
How does the amount of food intake change for infants?
-As they age they amount of food intake and the frequency goes down
-the overall food intake stays quite the same
When do babies need Vitamin D supplements?
-Exclusively breastfed babies
-when food intake is less than 32 oz
-4000IU of Vitamin D daily
What are common breastfeeding issues for women?
-Sore nipples
-Breast engorgement (swollen)
-plugging milk ducts
-low breast milk supply
-overabundant milk supply
How to treat sore nipples
-Protectants & Lubricants
What does All-Purpose Nipple Ointment consist of?
3 OTC agents
-Polysporin ointment (antibiotic)
-Hydrocortisone cream
-Clotrimazole cream (antifungal)
What may cause pain in the breast ducts?
-Engorgement: Milk build-up due to not emptying the ducts (no time: work) -> RICE-like therapy for breasts
-Clogged ducts -> Soy or Sunflower Lecithin: may prevent clogged ducts by decreasing the viscosity of breastmilk
3600-4800 mg lecitihin per day
Patient counseling
-Breastfeeding pumping should NOT be painful - if it is look for a lactation specialist
-Engorgement happens if breastmilk comes in or the feeding pattern changes
-Clogged ducts can progress to mastitis (inflammation of breast tissue) - requires antibiotics
Products that boost the milk supply
-Alfalfa: boosts milk supply, increases fat content
-Fennel: boosts milk production
-Fenugreek: galactagogue (promotes lactation)
-Boosts milk production:
-Goat’s Rue
-Milk thistle
-Moringa
Counsel on Breast supply
Breastmilk supply is built early on
Demand controls supply - it regulates after 6-12 weeks
-there is a limit on how much you can boost the milk production
Formulations of Infant nutrients
Powder: mix with water (concentration is adjustable) not sterile, but it is cheaper -> for older babies
Liquid concentrate: liquid mixed with water, sterile, more expensive
Ready-to-feed: no mixing required, sterile, most expensive: for little babies
Where are most milk products for babies derived from?
Cows milk
the other ones are specialized formulations with more dissolved (smaller molecular size) amino acids (easier to digest)
