newborn & infant development exam 1 Flashcards
When do fontanels close?
12-18 months anterior & 2-3 months posterior
Infant HR listen to
4th-5th intercostal space medial to L of midclavicular line = PMI
Parent-NB bonding 1st & 2nd step & Assessment
Nurses can positively influence the attachment of parent and child.
1st: recognize individual differences
2nd: enhance the infants development during wakeful Hrs
Assess: proximity, reciprocity and commitment and paternal engrossment fam-centered care involving siblings
Biologic development (1st 6 mo)
birth weight doubles
grows 1” per mo in length
head circumference increases 1/2” per mo
grasps as reflex, more with eyes, palmer grasp between 4-6 mo head control est.
tooth eruption begins
turns from abd to back at 6 mo
biologic development (7-12 mo)
birth weight triples by end of 1st yr
grows 1/2” per mo in length (mostly in trunk)
manipulates items: pulls to mouth, pincer grasp
head control > straightening of back > then sitting
sit alone by 7 mo and sit > explor from sitting at 8 mo
Psychosocial development
Erikson: Developing a Sense of Trust
-Acquiring trust while overcoming mistrust
Failure to learn “delayed gratification” leads to mistrust
Two oral-social stages: food intake (first 3-4 months) & grasping or biting possibly due to teething
Cognitive development
Separation: learn to separate themselves from others
Object permanence: realization object exists even if not visible (9-10 mos)
Mental representation: symbol allows infant to think of object without actually experiencing it
use of reflexes: sucking, rooting, crying, grasping
primary circular reactions: replacing reflexes with voluntary acts
secondary circular reactions: shaking or banging are done not just for the motion but for the sound (time and space)
Imitation: smiling to receive a smile
Play: pleasure at mastering a skill
Affect: manifestation of emotion and feeling, Develop sense of permanence, Critical to parent-child relationship, and Leads to stranger anxiety
the ability to know - piaget
cognition
birth to 24 mos, what phase is the infant in?
sensorimotor phase
Social development sequence and by when?
Regards faces (1 mo)
Smiles in response to other (2 mo)
Smiles at self in a mirror (4 mo)
Begins to fear strangers (6 mo)
Looks for a dropped object (6 mo)
Plays peek a boo (7 mo)
Responds to “ NO” (8 mo)
Waves goodbye (10 mo)
Plays pat a cake (10 mo)
age appropriate toys for the 1st yr
Rattles
Mobiles
Teething toys
Nesting toys
Playing with balls
Reading books
Fine motor sequence and expected age?
Brings hands together (3 mo)
Grasps rattle voluntarily (5 mo)
Plays with toes (5 mo)
Transfers hand-to-hand (7 mo)
Rakes finger food w/hand (7 mo)
Thumb-finger grasp (9 mo)
Compares two cubes (9 mo)
Nests objects (12 mo)
Turns pages of a book (12 mo)
Vocalization development
Can distinguish cry by 2month
Pleasure squeal by 3 months
Belly laugh by 4 months
May try to imitate sounds by 6 months
Dada by 7 months
Says Mama and Dada with meaning by 10 months
Should say 3-5 words by 12 months
What is colic?
vigorous crying & drawing legs to abdomen
most common < 3 months, can occur birth - 6 mos
paroxysmal abdominal pain or cramping
specific cause is rarely identified
onset usually late in afternoon
episodes last from 30 min to greater than 3 hours
between crying periods usually happy
How do you help colic?
Rule out organic causes
May try a different formula
Use of anti-spasmotics, sedatives , antihistamines or anti-fluctuents
Nursing mothers may need to change diet
Position changes
Caregiver support!!!!!
What do we know about teething?
deciduous (baby) teeth erupt between 6 -10 mos
age in months-6 = # of teeth (up to 2 years-of-age)
symptoms: irritability, difficulty sleeping, refuses to eat, drooling, chewing or biting
do not belittle beliefs & concerns or discourage home remedies unless harmful (repatterning)
firm & cold chewing objects, OTC analgesics, no aspirin
Acetaminophen
What is the infant dosage for acetaminophen?
10 - 15 mg/kg per dose-max. 5 doses/day
What is important to know about infant sleeping?
Co-sleeping may have cultural significance
AAP recommends:
baby sleep in close proximity in own bed, avoid soft bedding, smoking, overheating, prone position, baby sleeping on couch or armchair
newborn sleeps 16-20 hrs, awake 6 x to feed
1-3 month: 10-16 hrs in 30 min-3hr periods
3-6 month: 14 hrs, longer at night + 2-3 day naps
6-12 month: 12-14 hrs with 1-2 day naps
What is important to know about daycare?
records available to public (including periodic evaluations of facility)
teacher qualifications
nurturing characteristics of workers
child-staff ratio
discipline policy
environmental safety precautions
provision of meals
What is important to know about abuse?
Family violence within home
May occur across economic & educational backgrounds
Physical, sexual, emotional, neglect
Mandatory reporting laws require nurses to report suspected abuse (civil and criminal penalties)
At risk: under 3 yrs of age, &/or physically disabled – of unwanted pregnancy – trait making him vulnerable
Almost always-perpetrator felt child was different
What is important to know about injury prevention?
suffocation: plastic, pillows, crib slats, bath tub
falls: rails up, carseat, gates on stairs
poisoning: lead, toxins & plants, lock cabinets, meds
burns: bath water, smoke, stove, cords, electrical sockets
motor vehicles: rear-facing carseat in backseat
abuse: give caregiver education & allow them to say they are tired/frustrated/at risk, give support
Nutritional development (1-6 mo)
Support breastfeeding efforts
Vitamin D (200 IU/day)
Infants do not require additional fluids
Teach iron-fortified formula preparation (do not microwave)
Feed formula 6 x daily
Cereal – rice low allergy – 4-6 mos – iron fortified
Nutrition development (6 mo)
Formula or breastmilk 4-5 x daily
Fruits & veggies: 6-8 mos
Meat, fish, poultry: 8-10 mos, commercial low protein, include organ meat high iron
Finger foods: 6-7 mos –teething cracker, fruit/veggie
Chopped table or junior foods: 9-12 mos
Introduce when hungry-one at a time
Spoon feed pushing food to back of tongue
What is protein-energy malnutrition (PEM)?
chronic illnesses such as CF, renal dialysis, GI malabsorption, anorexia
What is Kwashiorkor?
High starch diet, fed only rice beverage diet, parental ignorance, cow’s milk intolerance=muscle wasting, skin depigmentation, blindness due to Vit A deficiency
What is food allergy/hypersensitivity or intolerance?
Cow’s milk, lactose, wheat, nuts (lactose intolerance use probiotics)
What do you need to know about kids with feeding disorders?
Regurgitation vs spitting up
Failure to thrive
organic- physical cause
nonorganic FTT – unrelated to disease (usually social)
idiopathic FTT – unexplained by the usual organic/environmental etiologies
Factors leading to NFTT: poverty, beliefs, knowledge deficit, stress, resistance, or insufficiency
What is failure to thrive?
in infants or children is manifested as inadequate growth resulting from inability to obtain or use calories required for growth.
It is usually described in an infant or child who falls below the 5th percentile for weight (and possibly for height) or has persistent weight loss.
What do you need to know about feeding the child w/ FTT?
Consistent “primary” caregiver
Non-stimulating atmosphere
Maintain calm, even temperament
Talk to the child giving directions about eating
Be persistent
Maintain face-to-face posture
Introduce foods slowly
Follow the child’s rhythm
Develop structure
What is sudden infant death syndrome?
SIDS
death of child under 1 yr with unexplained etiology after postmortem exam
unknown etiology
risks:
maternal smoking (12%)
co-sleeping
prone sleeping in soft bedding –overheating
infant was apparently healthy
not caused by suffocation –no identifiable cause
SIDS risk factors?
Maternal health during pregnancy
Twins
Preemie
SGA
Persistent apnea
BPD (bronchopulmonary dysplasia)
Family history of SIDS
Environment
What is apnea and what are the causes?
20 sec or more cessation breathing
causes: sepsis, seizures, neurologic disorders, upper or lower respiratory infection, GE reflux, hypoglycemia, metabolic problems
What is apparent life threatening event (ALTE)?
possibly apnea, gagging, or coughing possibly requiring CPR
head injury (abusive), intentional suffocation, Munchausen by proxy, ½ the cases = no cause identified
What is the management of apnea?
Depends on cause
CP monitor at home
Medications like theophylline or caffeine
CPR training for parents
