Newborns and infants- 7 Flashcards
Vision: least-developed sense
infants are attracted to bright colors and black and white because of limited vision; objects appear two-dimensional with poor peripheral vision until 2 to 3 months of age
Smell:
well-developed sense; especially recognizes smell of own mother
Taste:
well-developed sense; sweet tastes are preferred
Hearing:
can hear beginning in the womb and can identify mother’s voice; differentiates between male and female voices; hearing is critical for language development
Touch:
Touch is extremely important for the newborn; gentle touch or massage is calming and pleasurable. Pain is a protective device; the infant responds by extending and retracting the extremities and crying.
Soothing Odors
Studies have shown that biologically meaningful odors such as amniotic fluid, colostrum, and breast milk are soothing to infants, particularly when obtained from the infant’s own mother.
Hearing Screening at Birth`
Any infant who does not pass the newborn hearing screening has the potential for a developmental emergency (AAP, 2016c). Initial newborn hearing screening occurs in the hospital setting by specially trained nursing staff with any necessary follow-up testing recommended in the pediatric medical home
Language Acquisition
partly innate and partly learned process
language is learned through socialization within the family context.
favorable responses to speech encourage the infant to communicate.
Discipline
discipline at this age should focus on setting limits for the child’s safety and well-being.
discipline what to do
At 6 months of age, when the child is more mobile, use distraction to keep the child away from dangerous areas.
Temper tantrums are the infant’s way of expressing frustration, hunger, anger, illness, or fatigue.
Reward good behavior.
Remain calm, firm, and consistent.
Maintain a set routine.
Corporal Punishment
such as spanking or hitting, has been found to have negative consequences and is less effective than other forms of discipline, such as the withdrawal of positive reinforcement
Colic ( disappears by about 12 to 16 weeks of age)
great deal of intestinal gas, resulting in frequent crying
Paroxysms of irritability, fussing, or crying that start or stop without obvious cause
Crying is turbulent and dysphonic, with a higher pitch
Episodes last 3 hours or longer and occur 3 days a week for at least 2 weeks, peaking at 6 weeks of age
Infant thriving
Diagnosis of exclusion
Care of the Infant With Colic
Swaddle infant.
Place in a safe area.
Remove yourself from the infant for a 10-minute break once the child is secured in a safe place.
Educate caregivers that colic is not a reflection of their caregiving skills.
Realize that it is a heightened time of stress for caregivers.
Simethicone drops have been prescribed to ease intestinal gas, but never give an infant an over-the-counter medication without consulting the child’s pediatrician.
play
how infants learn about the world and themselves. Infants are primarily sensorimotor focused, so play should involve sensory stimulation. Infants explore the world with their mouths and imitate those around them.
Breastfeeding and Zika
No cases of Zika virus transmission have been associated with breastfeeding.
The CDC and WHO recommend that the benefits of breastfeeding outweigh the risks of Zika virus transmission through breast milk
breastfeeding
until the age of 6 months and to continue until the age of 2 years, with no supplementation of water, formula, or solids prior to this point
Nutrition infants between 6 months and 1 year of age:
Sufficient protein is needed to support growth and development.
Fats are needed to provide calories and support brain development.
Carbohydrates are needed to provide energy.
Infants need 100 to 116 kcal/kg/day for basic growth and development.
Adequate fluid and electrolyte intake is necessary.
Fluids, mainly water, should total 120 to 150 mL/kg/day for infants.
Supplemental iron is not necessary for breastfed infants before 6 months of age.
All infants 6 months or older require iron supplementation. Iron can be supplied through lean red meats, fortified infant cereals, spinach, broccoli, green peas, or beans.
Do not feed cow’s milk until after 1 year of age.
Nonnutritive Sucking
Nonnutritive sucking is a self-soothing or comforting measure used by infants.
imit the use of the pacifier as the infant gets older to prevent creating a habit
Breastfeeding
Should begin within the first hour after birth during the initial period of reactivity
Infant should be fed on demand throughout the day and night
Reduces costs and preparation time
Promotes positive bonding between infant and mother
Decreases risk for obesity
Stage one:
Colostrum, a yellowish fluid, is present in the first 2 to 3 days after birth and has higher concentrations of protein and lower levels of fat, carbohydrates, and calories than mature milk.
It contains large amounts of IgA and IgG, and assists in the passage of the infant’s first stool, known as meconium
Stage two:
The milk transitions from colostrum to more mature milk at about 3 to 10 days after birth. It consists of increasing fat, carbohydrates, and calories
Stage three
Mature milk begins 10 days after birth. This mature milk has approximately 23 calories per ounce and is composed of foremilk and hind milk.
Foremilk
is produced and released at the beginning of the feeding; it has a higher water and lactose content and a lower fat content.
The hind milk
released at the end of the feeding and has a higher fat content.
letdown reflex
forces milk into the lactiferous ducts of the breast. The letdown reflex is responsible for milk ejection
breastfeeding hormones
estrogen and progesterone are eliminated and prolactin becomes the predominant hormone
Oxytocin produces the letdown reflex
letdown reflex triggers
sexual stimulation, when hearing a baby cry, or when thinking of the infant
letdown reflex inhibited
anxiety, stress, fatigue, and pain
how long to breastfeed
feedings should last between 10 and 30 minutes
recommended one year
6 months of age
ready for solid foods some breastfeeding no fruit juice spoon not bottle baby rice cereal
8 months
strained fruit, vegetables, and strained meats can be introduced.
one food at a time
single ingredient food
Self-feeding
when infants can sit up alone
hold their necks steady
draw in their lips when food is introduced into the mouth
keep the food in their mouths and not push it back out.
1 year
double handed cup
nighttime feeding is last when weening
no cow milk til 1
Avoiding Clostridium botulinum Contamination
infants younger than 1 year should never be given honey or corn syrup
spores are found in improperly stored foods, home-canned foods, processed foods such as potato salad, restaurant-prepared foods, and bottled garlic
newborns sleep
average 8 to 9 hours per day and 8 hours at night.
substantial time in rapid eye movement (REM) sleep indicative of rapid brain growth
3 months of age sleep
REM sleep decreases and non-REM sleep occurs
Sudden infant death syndrome (SIDS)
leading cause of death from 1 month to 1 year of age, peaking between 2 and 4 months
These are infant fatalities from an unknown cause and are not associated with infection, choking, vomiting, or abuse.
Bumper Pads
bumper pads never be used in the cribs of infants.
SLEEP PATTERNS THROUGH AGING
Infants’ increase in sleep patterns is tied to growth spurts
Infants, like adults, progress through REM and non-REM sleep cycles.
Infant Sleep and Parental Behavior
There are links between infant sleep and parental behaviors, cognitions, emotions, and relationships, as well as psychopathology. Parental behaviors are closely related to infant sleeping patterns
Sucrose solution
provides analgesia for minor procedures.
Circumcision
removal of the prepuce of the penis performed for religious, cultural, hygienic, or social reasons
no medical reason
done before discharge unless problem
warning signs circumcision
Persistent bleeding or blood on diaper (more than quarter-sized)
Increasing redness
Fever
Other signs of infection, such as increased swelling or discharge, or the presence of pus-filled blisters
Not urinating normally within 12 hours after the circumcision
Umbilical cord blood banking
fee-for-service option that stores cord blood obtained at the time of delivery to provide possible future reimplantation through the cryostorage of stem cells from the cord blood
Pediatric Medical Hom
This model delivers “primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and cultural effective for every child”
taking temp
no rectal
take if fever suspected
no mercury
axillary
Signs of Illness in the Newborn and Infant
Axillary temperature greater than 99.3°F or rectal temperature greater than 100.3°F
Vomiting
Decrease in the number of wet diapers
Sunken or bulging fontanels
Loss of appetite
Foul odor or bleeding from the cord or circumcision
Decreased level of consciousness; lethargy
Increased irritability
Blue or cool hands and feet
Skin rash
Drooling not associated with teething
Refusal to lie down if 8 months of age or older
sibiling rivalry education
- attend sibiling classes
- include siblings in the supervised care of the infant as appropriate.
- dont leave infant alone with young sibling
- foster bonding
- quality alone time w parent and sibling
Milestone Concerns or Red Flags
No attempts by the infant to lift head when lying facedown
No improvement in head control
Does not respond to loud noises
Extreme floppiness
Lack of response to sounds or visual cues, such as loud noises or bright lights
Inability to focus on a caregiver’s eyes
Poor weight gain
Does not crawl by 12 months
Fostering Positive Parenting Skills
Talk to the infant.
Respond to infant’s sounds by repeating and adding words.
Read to the infant; this helps to develop and foster understanding of language and sounds.
Sing to or play music for the infant.
Praise the infant and give the infant attention.
Spend time cuddling and holding the infant so that the infant feels cared for and secure.
Play with the infant when he or she is alert and relaxed. Watch for signs of being tired or fussy so that the infant can take a break
Pain in infants
- painful to adult=painful to infant
- facial expressions such as bulged brow, eyes squeezed shut, open mouth, and quivering chin.
- increased heart rate, respiratory rate, elevated systolic blood pressure, and decreased oxygen saturation.
- depression of the immune system through the depletion of mature white blood cells because of heightened stress responses.
- Gastric acid production increases.
- Dilated pupils and sweating may be observed.
Pain relief
should be intravenous or oral; if administering opioids, closely monitor respiratory rate and pulse oximetry
Use EMLA cream or similar topical anesthetics when starting IVs
Nonpharmacological Pain-Prevention Methods
Breastfeeding Nonnutritive sucking Kangaroo care Swaddling Limiting environmental stimuli Attention to behavioral cues
Infant Massage
Stimulates organized sleep patterns
Enhances growth
May assist with colic in infants
Promotes bonding with caregiver
Music Therapy
improve sucking, weight gain, sleep, and recovery from painful procedures, especially in premature infants
Respiratory syncytial virus (RSV)
acute infection limited to the lower respiratory tract and sometimes accompanied by fever in most healthy full-term infants
Prematurity
primary reason for low birth weight and carries a high risk for developmental and motor delay.
shaken baby syndrome
Most victims are infants younger than 1 year; the average age is between 3 and 8 months.
Pay special attention when choosing a babysitter.
Research suggests that teenage fathers are more likely to cause shaken baby syndrome.
Contrecoup, injuries to the opposite side of the head, are common.
Detached retinas may result.
Permanent brain damage may result.
Death may result.
Warning signs of sexual abuse in infants include
Stained or bloody diapers
Genital or rectal pain, swelling, redness, or discharge
Bruises or other injuries in the genital or rectal area
Difficulty eating or sleeping
Excessive crying
Withdrawing from others
Failure to thrive
Warning signs of physical abuse in infants include:
Unexplained or repeated injuries such as welts, bruises, burns, fractured skull, and broken bones, especially spiral fractures
Injuries in the shape of an object (e.g., belt buckle, electrical cord, cigarette)
Injuries that are unlikely given the age or ability of the child, such as broken bones in a child too young to walk or climb
Disagreement or inconsistency in parent/caregiver explanation of the injury
Unreasonable explanation of the injury
Fearful or detached behavior by the infan
An infant may be subject to emotional abuse in the presence of these warning signs:
Aggressive or withdrawn behavior
Shying away from physical contact with parents or adults
Basic needs of food, warmth, and cuddling not met
Infant neglect may be indicated by:
Consistent failure to respond to the child’s need for stimulation
Actively refusing to respond to the child’s needs
Parents/caregivers expressing the fact that they are not going to spoil the baby or referring to the baby as evil
Infant with malnourished appearance
Obvious neglect of the child
Failure to provide necessary medications for chronic condition
Delays in calling for help or taking infant to the doctor
