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INFANTSHealth Promotion and Disease Prevention
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Health Promotion of the Infant
and Family
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PROMOTING OPTIMUMGROWTH AND DEVELOPMENT
Growth - an increase in the physical sizeof a whole or any of its parts
Cephalocaudal- head to toe
Proximodistal- central to peripheral
Same general pattern and sequence
Individual rate and timing for range of normal
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Proportional changes
5 to 7 ounces of weight gain every week
Double birth weight by age 5-6 months
Triple birth weight by age 1 year Height increases by 1 inch per month for 6
months
Growth in spurts rather than gradually
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Assessment of Growth
Height
Weight
Head Circumference Anterior Fontanel 12-18 months
Posterior Fontanel 2-3 months
Developmental Milestones Motor Skills
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Maturation of Systems
Respiratory R 40-60 Abdominal Breathers Respiratory Rate Progressively Slows Risk for Respiratory Complications
Immunologic Decrease ability to produce Immunoglobulin (Ig) A in the lungs
Cardiovascular HR 120-150 HR Progressively Slows
Hematopoietic changes Fetal Hemoglobin
Fetal Iron Stores
Digestive processes - Meconium 24-48 hours later Variation of Stools Immature Liver
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Maturation of Systems Thermoregulation
Adipose Fat
Renal
Loss of body water
Risk for dehydration
5%-10% of water loss the first 5 days of life
Secrete 15-60 ml/kg/24 hours of urine output
Less than 0.5ml/kg/hr after 48 hrs consideredoliguria
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Maturation of Systems
Sensory
Vision - focus on 2-3 months
Hearing
Refer to Pages 466 in Wong Text
Box 12-2 and 12-3
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Focus on Visual Objects
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Fine Motor Development
Grasps object, age 2 to 3 months
Transfers object between hands, age
7 months Pincer grasp, age 10 months
Removes objects from container, age
11 months Builds tower of two blocks, age 12 months
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Crude Pincer Grasp
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Neat Pincer Grasp
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Gross Motor Development
Head control
Rolls overage 5 to 6 months
Sits aloneage 7 months Moves from prone to sitting positionage
8-10 months (attempts at 6 months)
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Head Control
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Development of Sitting
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Locomotion
Cephalocaudal direction of development
Crawlingage 6 to 7 months
Creepingage 9 months Walk with assistage 11 months
Walk aloneage 12 months
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Development of Locomotion
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Psychosocial Development
Eriksons phase Ideveloping a sense oftrust
Trust vs. mistrust
Importance of caregiver-childrelationship
Delayed gratification Importance of consistency of care
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Cognitive Development
Piaget
Sensorimotor phase
Birth to 1 monthreflex stage
1 to 4 monthsprimary circular reactions
4 to 8 monthssecondary circularreactions
Imitation
Play
Affect
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Finding Hidden Object
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Language Development
Crying is first verbal communication
Vocalizations
Three to five words with meaning by age1 year
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Development of Body Image
Concept of object permanence
By end of first year, recognize that theyare distinct from parents
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Viewing Own Image
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Development of Gender Identity
Hormonal influences
Infant
Parental influences on development ofsexuality
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Common Parental Concerns -
Infant Separation Anxiety Fear of Strangers 6 months of age
Spoiled Child Limit-Setting/Discipline
Child Care Arrangements
Thumb Sucking/Pacifier Teething
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Coping with Common ParentalConcerns
Separation and stranger fear
Stranger fear and separation anxiety are not signs ofundesirable, antisocial behavior, but are part of astrong, healthy, parent-child attachment
Accustom the infant to new people
Provide opportunities to safely experience strangers
Clinging, dependent behavior by the child is healthy,desirable, and necessary for the childs optimal
emotional development
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Stranger Fear
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Coping with Common ParentalConcerns
Parents can reassure the child in their presence,talking to the infant when leaving the room, talking onthe telephone, and use of a transitional objectreassures the child of the parents continued
presence Strangers should talk softly, meet the child at eye
level, maintain a safe distance from the infant, andavoid sudden, intrusive gestures
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Temperament
Revised Infant TemperamentQuestionnaire
Childrearing practices related totemperament
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Limit Setting and Discipline
Need for setting safe limits to preventinjury
Need for age-appropriate discipline
Time-out
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Coping with Common ParentalConcerns
Spoiled Child
Infants cannot be spoiled by picking them up
Research shows that infants who are not
responded to promptly cry more
Spoiled child syndrome
excessive self-centered and immature behavior,
resulting from the failure of parents to enforceconsistent, age-appropriate limits
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Alternative Child Care Arrangements
Types of child care
Guiding parents in selecting child care
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Thumb Sucking and Use of Pacifier
Importance of sucking in infancy
Relationships between pacifier use andfrequency and adequacy of feedings
Safety considerations with pacifier use
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Teething
During the first 2 years of lifeAge of child in months 6 = Number of teeth
Exampleat 8 months of age8 6 = 2
(An 8-month-old should have two teeth.)
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PROMOTING OPTIMUM HEALTH DURINGINFANCY
Nutritionbreast milk is best for first 6months of life
Introduction of solid foods
Introduce foods at intervals of 4 to 7 days toallow for identification of food allergies
Weaning from breast or bottle
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Neonates/Infants0-1 Year
Preterm Infants (Less than 37 weeksgestation, Wt. < 2500 g)
Require 50-60 kcal/kg/day (Parenteral), 75
kcal/kg/day orally
Breast milk is recommended/formula fine
Formula available in many calories/oz
Caloric needs with illness
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Neonates/Infants0-1 Year
Birth to 1 year
Breast milk or formula
4-6 months, Iron-fortified cereal (rice Cereal)
6-8 months-yellow vegtables, fruits
8-10 months- meats
Foods delayed until after 1 year:
Eggs, whole milk, strawberries, wheat, corn, fishand nut products
Before 1 year may cause allergies
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Breast Milk
Excellent nutritionalbalance
Promotes GI Function Immune defenses
Promotes bonding Free Can feed on demand May need Iron
Supplements until foodintroduced
Lowers incidencesOtitis Media; otherinfections
Type 2 DM
CV Disease/Obesity
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MEMORIZE THIS TABLE
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Facts about Formula
Do not use Soy formula in infants with congenitalhypothyroidism
May use tap water to mix with powder Must be refrigerated Discard what baby does not drink. Dont re-
refrigerate Do not use well-water unless tested & safe Older homes /Lead pipes-be aware/cold water
only
Do not use microwave to warm bottle Never prop bottle in bed
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So Why Not Cows Milk the First
Year? Can cause GI
Bleeding
Anemia (Low ironcontent)
Interferes withabsorption of somenutrients
High soluteconcentration-Hardon the kidneys
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Figure 8-6 Early childhood caries. This child has had major tooth decay related to sleeping as an infant and toddlerwhile sucking bottles of juice and milk. Source: Courtesy of Dr. Lezley Mcllveen, Department of Dentistry, ChildrensNational Medical Center, Washington, DC.
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Sleep and Activity
Back to Sleep campaign
Sleep problems
Sleeping arrangements
Concept of graduated extinction
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Dental Health
Initial dental care includes wiping teethand gums with damp cloth; progress totoothbrushing
First dental visit1 year of age
Fluoride supplementation
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Immunizations
Recommendations provided by
Advisory Committee on ImmunizationPractices (ACIP) of the Centers for Disease
Control and Prevention (CDC) Committee on Infectious Diseases of the
American Academy of Pediatrics (AAP)
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Current Recommendations
http://www.cdc.gov/nip (NationalImmunization Program from the CDC)
http://www.aap.org
AAP Report of the Committee onInfectious Diseases (The Red Book)
CDC Morbidity and Mortality WeeklyReport (MMWR)
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Injury Prevention
Aspiration of foreign objects
Suffocation
Motor vehicle injuries
Falls
Poisoning
Burns Drowning
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Infant Car Restraint
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Health Problems During Infancy
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NUTRITIONALDISTURBANCES
Vitamin disturbances
Mineral disturbances
Vegetarian diets
RDAs
MyPyramid
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Mineral Disturbances
Macrominerals
More than 100 mg daily requirement
Include calcium, phosphorus, magnesium,
sodium, potassium, chloride, and sulfur
Microminerals (trace elements)
Less than 100 mg daily requirement
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Deficiencies in VegetarianDiets?
Well-planned vegetarian diets are adequate for allstages of the life cycle and promote normal growth
Requires knowledge of specific nutritional elements
Major deficiencies may occur Inadequate protein for growth
Inadequate calories for energy and growth
Poor digestibility of many of the bulky natural, unprocessedfoods, especially for infants
Vitamin B6, B, niacin, riboflavin, vitamin D, iron, calcium, andzinc
May require supplements
P t i d E M l t iti
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Protein and Energy Malnutrition(PEM)
AKA Severe childhood undernutrition (SCU)
Worldwide health problem for childrenyounger than age 5
Adequate food Lack of sanitation (death from diarrhea)
Occasionally seen in United States Chronic illness (CF, Renal dialysis, cancer, and
GI malabsorption) Elderly with chronic malnutrition
Untreated anorexia nervosa
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Most ExtremeProtein and Energy Malnutrition(PEM)
Kwashiorkor Deficient protein but adequate calorie intake
Edema and muscle wasting
Large abdomen due to ascites Marasmus
General malnutrition of both calories and protein
Often seen with drought conditions in
underdeveloped countries No edema, but loose wrinkled skin + small head
size
F d S iti it
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Food Sensitivity
Includes all adverse reactions to foodor food additives
AKA food sensitivity, hypersensitivity,
allergy, and intolerance
Cows milk allergy
Lactose intolerance
Cli i l M if t ti f F d
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Clinical Manifestations of FoodHypersensitivity
SystemicAnaphylactic, growth failure
GIAbdominal pain, vomiting, cramping,diarrhea
RespiratoryCough, wheezing, rhinitis,infiltrates
CutaneousUrticaria, rash, atopicdermatitis
American Academy of Pediatrics, 2009
M t C All
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Most Common Allergens
ChildrenEggs, cows milk, andpeanuts
AdultsSoy, wheat, corn, tree nuts,
shellfish, and fish allergies
AtopyAllergy with a hereditarytendency
S i F d All M t
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Serious Food Allergy Management
For children who have risk of anaphylaxisfrom food allergies
Rapid onset of airway difficulties
EpiPen
Liquid diphenhydramine
MedicAlert bracelet
Emergency plan
Caution for biphasic response
CONDITIONS RELATED TO
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CONDITIONS RELATED TOFEEDING
F di Diffi lti
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Feeding Difficulties
Regurgitationand spitting up
Reflux/GERD
Colic (paroxysmal abdominal pain)
Th C li C
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The Colic Carry
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Failure to Thrive (FTT)
Weight
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Calculating Required Calories
kcal/kg required =RDA for weight age (kcal/kg) Ideal weight for height
Actual weight
Ideal weight for height is the medianweight for the childs height based on
the current National Center for Health
Statistics weight-for-height growthcharts.
A Consistent Nurse in Nonorganic FTT
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A Consistent Nurse in Nonorganic FTT
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SKIN DISORDERS
Diaper Dermatitis
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Diaper Dermatitis
Principal factors in development
Therapeutic management
Nursing considerations
Seborrheic Dermatitis
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Seborrheic Dermatitis
Chronic, recurrent, inflammatory reactionof the skin
Scalpcradle cap
Eyelidsblepharitis
External earotitis externa
Cause unknown
Nursing considerations
Atopic Dermatitis
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Atopic Dermatitis
Also called eczema
Is a category of dermatologic diseasesand not a specific etiology
Pruritic
Usually associated with allergy
Hereditary tendency (atopy)
Therapeutic Management
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Therapeutic Management
Hydrate the skin
Relieve pruritus
Reduce inflammation
Prevent and control secondary infection
Nursing considerations
DISORDERS OF UNKNOWN
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DISORDERS OF UNKNOWNETIOLOGY
Sudden infant death syndrome (SIDS)
Apparent life-threatening events (ALTEs)
Back to Sleep campaign
Increased incidence of plagiocephaly
Infants at Risk for SIDS
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Infants at Risk for SIDS
Infants with one or more severe ALTEsrequiring CPR or vigorous stimulation
Preterm infants experiencing apnea at
time of discharge from hospital
Sibling of two or more SIDS victims
History of central hypoventilation
Risk Factors for SIDS
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Risk Factors for SIDS
Low birth weight Low Apgar scores
Recent viral illness
Siblings of two or more SIDS victims Male sex
Infants of Native American or African-
American ethnicity
Research Findings SIDS
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Research FindingsSIDS Practices that may reduce the risk of SIDS
Avoid smoking during pregnancy and near the infant
Breast-feeding
Supine sleeping position
Avoid soft, moldable mattresses, blankets, andpillows
Avoid bed sharing
Avoid overheating during sleep
Vary infant head position to prevent plagiocephaly
Apnea of Infancy
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Apnea of Infancy
DefinitionUnexplained respiratory pauselasting 20 seconds or more OR
Less than 20 seconds accompanied by
pallor, cyanosis, bradycardia, orhypotension (term infant)
Many possible causes to be explored
Apnea of Prematurity
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Apnea of Prematurity
Cessation of breathing longer than 20seconds, or any period with bradycardiaand cyanosis not associated with any
predisposing conditions Therapeutic management Theophylline, caffeine
Home apnea monitors
Family support
CPR training
ALTE
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ALTE
Apparent life-threatening event
May be with ORwithout accompanyingapnea
Apnea Monitoring
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Apnea Monitoring
Complementary and
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Complementary andAlternative Medicine (CAM)
Misuse or overuse of vitamins/megavitamintherapy
Herbs known to have adverse effects in children Ephedra
Comfrey
Pennyroyal
Herbal therapy with questionable safety forchildren
St. Johns wort
Dong quai
Kava
Complementary and
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Complementary andAlternative Medicine (CAM)contd
Other concerns
May counteract or potentiate Rx meds
Little research about safety of herbal
medicines
Various herbal therapies have been a partof medicine since early days and some are
beneficial
Breast-Feeding Mothers:
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Breast Feeding Mothers:Galactogogues
To increase milk supply Fenugreek
Blessed thistle
Fennel Chaste tree
Few studies support the efficacy or safetyof these herbs in breast-feeding infants
Adverse effects may include colic anddiarrhea in breast-feeding infants