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  • 1. Chapter 16Chapter 16The InfantThe Infant

2. ObjectivesObjectives Describe the physical and psychosocialdevelopment of infants from age 1 month to12 months, listing age-specific events andguidance when appropriate. Discuss the major aspects of cognitivedevelopment in the first year of life. Relate the nursing responsibilities in healthpromotion and illness prevention in infants inthe first year of life.2Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 3. ObjectivesObjectives (cont.)(cont.) Discuss the nutritional needs of growing infants. Compare breastfeeding, bottle feeding, and thevarious infant formulas available. Describe how to select and prepare solid foodsfor the infant. List four common concerns of parents about thefeeding of infants. Discuss the development of feeding skills in theinfant.3Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 4. ObjectivesObjectives (cont.)(cont.) Compare and contrast natural, organic, andprocessed foods. Examine nutritional counseling for the infant. Identify the approximate age for each of thefollowing: posterior fontanel has closed,central incisors appear; birthweight hastripled; child can sit steadily alone; childshows fear of strangers. Describe normal vital signs for a 1-year-oldinfant.4Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 5. ObjectivesObjectives (cont.)(cont.) Discuss safety issues in the care of infants. Discuss the approach and care of an infantwith colic. Identify age-appropriate toys and theirdevelopmental or therapeutic value. Discuss principles of safety during infancy. Discuss the development of positive sleeppatterns.5Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 6. MilestonesMilestones Describes general patterns of achievement atvarious stages Often referred to as norms Nurse must understand normal range formilestone achievement Establishment of sleep-wake cycle Social smile Drinking from cup Separation anxiety6Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 7. Average Vital Signs of the InfantAverage Vital Signs of the Infant7Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 8. Oral StageOral Stage Sucking brings comfort and relief from tension Important to hold infant during feedings Allow sufficient time for infant to suck Infants on IV fluid/nutrition need additionalattention and a pacifier to ensure the need forsucking is satisfied When infants are able to use their hands moreskillfully, they will gradually derive pleasure andcomfort from other sources8Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 9. Motor DevelopmentMotor Development Grasp reflex disappears around 3 months ofage Prehension occurs around 5 to 6 months ofage and follows an orderly sequence ofdevelopment Parachute reflex appears around 7 to 9months as a protective mechanism Pincer grasp well-established by 1 year ofageElsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 9 10. 10Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.The Development of Locomotion,The Development of Locomotion,Prehension, and PerceptionPrehension, and Perception 11. 11Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.The Development of Locomotion,The Development of Locomotion,Prehension, and PerceptionPrehension, and Perception (cont.)(cont.) 12. Emotional DevelopmentEmotional Development Consistency must be established to developtrust, which is vital to the development of ahealthy personality Infants who are consistently picked up whenthey cry tend to have fewer crying episodes andless aggressive behavior as toddlers Infants will easily accomplish various activities ifthey are not forced before they reach readiness When infant shows readiness to learn a task,parents should provide encouragement12Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 13. Need for Constant Care andNeed for Constant Care andGuidanceGuidance Sensory stimulation is essential for thedevelopment of the infants thoughtprocesses and perceptual abilities A crying child should be soothed If the infant appears hungry, do not delay thefeeding in order to adhere to a specificroutine An infant can recognize warmth and affectionor the lack thereof13Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 14. Development and CareDevelopment and Care Important to note that no two infants are thesame Physical patterns cannot be separated fromsocial patterns Abrupt changes do not take place with eachnew month of life14Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 15. Community-Based Care:Community-Based Care:A Multidisciplinary TeamA Multidisciplinary Team15Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 16. Health PromotionHealth Promotion Nurses responsibilities Guide parents and assist in the acquisition ofnecessary skills to ensure the healthy growthand development of their infant Provide appropriate community referrals asindicated16Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 17. Coping with an Irritable orCoping with an Irritable orLethargic InfantLethargic Infant Whether irritable orlethargic, many of thesame interventionscan be used An irritable baby criesand may be difficultto soothe A lethargic baby mayshut down andsleep in order toavoid an excessivelystimulating (loud ornoisy) environment Shield infants eyesfrom bright light Sit quietly with infant;dont talk or sing Eliminate as muchnoise as possible Talk in a soft voice Swaddle snugly Change infantsposition slowly Provide nonnutritivesucking17Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 18. ColicColic Periods ofunexplainedirritability and cryingin an otherwisehealthy and well-fedinfant18Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 19. Developing Positive Sleep PatternsDeveloping Positive Sleep Patterns Newborns sleep in 4-hour intervals By 4 to 6 months, can be up to 8 hours Synchronizing circadian rhythm of infant tofamily routine is a learned behavior Position infants on their backs on a firmmattress Infants rely on parent to soothe them back tosleep if awakened during the night Assist infant to learn self-soothing behaviors19Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 20. Illness Prevention: ParentIllness Prevention: ParentEducationEducation Stress importance ofperiodic health checks Ensure infant receivesrecommendedvaccinations atappropriate times Provide education andanticipatory guidancefor the developmentalchanges that occur Stress importance ofchanging diaper when itbecomes wet or soiled Monitor growth of infantby documentingmeasurements on agrowth chart Ensure adequate fluidand nutrition areprovided20Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 21. Illness Prevention: PhysicalIllness Prevention: PhysicalExaminationExamination Physical examination in the clinic setting atleast five times in the first year Hearing and vision assessments as indicated Screening tests administered as required Growth grids and developmental screening Immunizations Nutritional counseling Provide appropriate education and/orexplanations to the parents21Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 22. ImmunizationsImmunizations Stress repeatedly importance ofimmunizations and timing of administration Delays can lead to increased risk of seriousillness or even death22Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 23. Nutrition CounselingNutrition Counseling Solid food can slowly be added beginningaround 6 months of age The tongue extrusion reflex has completelydisappeared GI tract is mature enough to digest food Between 4 and 6 months, sucking is moremature, and munching or an up-and-downchewing/chomping motion ensues23Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 24. Parental ConcernsParental Concerns Prior to teaching about infant nutrition, thenurse should assess Parental knowledge Infant developmental behavior, readiness Parent-child interaction Cultural and ethnic practices24Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 25. Breastfeeding and Bottle FeedingBreastfeeding and Bottle Feeding Human milk is best for infants younger than 6months Formulas that are cows milk based and iron-fortified are recommended by the AAP Whole cows milk not given until after 1 yearof age25Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 26. Absolute Contraindications toAbsolute Contraindications toBreastfeedingBreastfeeding Galactosemia Phenylketonuria HIV-positive mother Chemotherapy Radioactive isotope therapy Illicit drug use Active, untreated pulmonary tuberculosis26Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 27. Prebiotics and ProbioticsPrebiotics and Probiotics Prebiotics Nondigestible foodingredient Indirectly stimulatesgrowth or activity ofbifidobacterium (amicroorganism) Assures balance ofbacteria ismaintained Probiotics Protective to GItract Used to treatdiarrhea27Elsevier items and derived items 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 28. Safe Bottle FeedingSafe Bottle Feeding Check expiration date on container Follow i