Promoting Optimal Health during Infancy

Promoting Optimal Health during Infancy

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Objectives

By the end of this discussion you will be able to:

• Assess the nutritional status of infants

• Discuss the introduction of solid food for infants

• Discuss the sleep patterns among infants

• Discuss the dental care for infants

• Discuss Safety promotion and Injury Prevention during infancy

Mother should decide the method of optimum nutrition for infant in

prenatal period

Mother should have an adequate balanced amounts of protein, vitamins

and minerals which have an impact on the growth of fetus

Nutrition

Nurses should encourage and teach parents about an appropriate

feeding method before delivery date

Human milk is the most desirable complete diet for the infant during

the first 6 months

Nutrition

The normal infant receiving breast milk from a well-nourished mother

usually requires no specific vitamin and mineral supplements

Daily supplements of vitamin D and vitamin B12 may be indicated if

the mother's intake of these vitamins is inadequate

Nutrition

The American Academy of Pediatrics recommendations:

• All infants (including those exclusively breastfed) receive a daily

supplement of 400 IU of vitamin D beginning in the first 2 months of

life to prevent rickets and vitamin D deficiency

The First 6 Months

• Fluoride supplementation is not required for exclusively breast fed

infant in the first 6 months unless mothers water supply does not

contain required amount of fluoridation

The First 6 Months

• Iron supplementation to exclusively breast-fed infants after 4 to 6

months should be given to:

• Compensate the decrease in iron available in human milk at this time

• Enhance erythropoiesis

The First 6 Months

• Employed mothers can continue breast-feeding with guidance and

encouragement .

• Pumping milk away from home may be needed every 3 to 4 hours to

maintain adequate supply.

The First 6 Months

• Breast milk expressed by hand or pump (manual or electric) should be

stored in an appropriate air-tight glass or plastic container..

• Expressed breast milk may be stored in the refrigerator (4 c) without

danger of bacterial contamination for up to 5 days, and may be frozen (0

F{-18c}or lower) for up to 6 months

The First 6 Months

• Mothers need child care by a trusted individual or agency and support and

assistance from significant others.

• Maternal fatigue is considered the biggest threat to successful breast-feeding in

employed mothers

• Employed women must have proper nutrition and rest for adequate lactation.

The First 6 Months

• Human milk or formula continues to be the primary source of nutrition

• Fluoride supplementation should begin, depending on the infant's intake of

fluoride

• If breast-feeding is discontinued, a commercial iron-fortified formula should be

substituted.

The First 6 Months

• Commercial iron-fortified formula is an acceptable alternative to breast-

feeding

It supplies all of the nutrients needed by the infant for the first 6 months.

The First 6 Months

• low-fat cow's milk, skim milk, other animal milks are not acceptable as a

major source of nutrition for infants because of:

* Poor digestibility

* An increased risk of contamination

*A lack of components needed for appropriate growth such as

essential fatty acids

The First 6 Months

The First 6 Months

• Pasteurized whole cows milk should not be given before 12 month of

age for the following reasons:

• It lack of iron, zinc, and vitamin C

• It has a high renal solute load (AAP, 2014)

The First 6 Months

• The number of feedings per day vary among infants

• Infants on demand feeding usually determine their own feeding schedule

• Infants may need a more planned schedule based on average feeding

patterns to ensure sufficient nutrients.

The First 6 Months

Developmentally, infants are not ready for solid food before 4 to 6 months of age for

the following reasons:

• The extrusion (protrusion) reflex is strong and causes food to be pushed out of the mouth.

• Solid foods are not compatible with the ability of the gastrointestinal tract and nutritional needs

of the infant.

The First 6 Months

Developmentally, infants are not ready for solid food before 4 to 6 months of age for the following reasons:

• It increases the risk of developing food protein allergy.

• Their limited motor ability make infants to be unable to deliberately avoid

food which may lead to excessive weigh gain

The First 6 Months

EBP

• Food known to be allergenic such as eggs, fish, peanuts, and seafood

should not be introduced before 9 month of age according to the child

risk of atopy (hypersensitivity) (Heinrich, Koletzko,& Koletzko, 2014)

The First 6 Months

Non nutritive drinks such as fruit-flavored drinks or carbonated beverages (eg., soda) should be avoided because THEY:

• Do not provide sufficient intake of calories for infant younger than 12 months old

• May replace the nutrients in breast milk or formula milk and lead to growth and health problems

The Second 6 Months

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By this time, physiological and developmental readiness includes:

• The gastrointestinal tract has matured sufficiently to handle more complex

nutrients and is less sensitive to potentially allergenic foods.

• Tooth eruption is beginning and facilitates biting and chewing

• Swallowing is more coordinated to allow the infant to accept solids easily.

The Second 6 Months

The Second 6 Months

• Head control is well developed, which permits infants to sit with support

• Voluntary grasping and improved eye-hand coordination gradually allow

infants to pick up finger foods and feed themselves

• Increase sense of independence is evident in their desire

to try to "help" during feeding or to hold the bottle.

The Second 6 Months

• Human milk or formula continues to be

the primary source of nutrition

• The major change in feeding habits is

the addition of solid foods to the infant's

diet

http://cdn3-www.momtastic.com/assets/uploads/2014/11/feeding-baby-first-solid-food-pink-spoon.jpg

Introduction of Solid Foods

• See Family Centered Care Table Page 321

• Introduce solid when infant is hungry.

• Begin spoon feeding by pushing food to back of

tongue because of infant's natural tendency to thrust

tongue forward.

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• One food item is introduced at intervals of 4 to 7 days to allow for

identification of food allergies

• New foods are fed in small amounts, from 1 teaspoon to a few tablespoons.

• As the amount of solid food increases, the quantity of milk is decreased to less

than 1 L daily to prevent overfeeding

Introduction of Solid Foods

Selection and Preparation of Solid Foods

Iron-fortified infant cereal is generally introduced

first because of its high iron content

Rice is usually suggested as an initial food

because of its easy digestibility and low

allergenic potential

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Commercial cereals are combined with fruit (not

used) for the following reasons:

• Lack of nutritional benefit from these preparations

• They are more expensive

• Risk of developing allergy

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New foods should be added one at a time

Infant cereal (iron fortified) is mixed with formula until whole milk is

given.

If the infant is breast-fed, the cereal is mixed with expressed breast milk or

water.


After 6 months of age:

Fruit juices can be mixed with the dry cereal (the vitamin C content of the juice

enhances the absorption of iron in the cereal).

Infant cereals should be continued until the child is 18 months of age, because

of their benefit as a source of iron


• Fruit juice can be offered from a cup for its rich source of vitamin C and as a

substitute for milk for one feeding a day

• White grape juice is reported to be well absorbed and safe for infants without

causing gastrointestinal distress


• Large quantities of certain juices (e.g., apple, pear, sweet cherry,

peach, grape) are avoided because they may cause abdominal

pain, bloating, or diarrhea in some children



AAP (2014) recommended that:

• Juices not be given to infants less than 4 to 6 months old

• Juices is not warmed, because vitamin C is naturally destroyed by heat

• Juice containers are always kept covered and refrigerated to prevent vitamin

loss.

• A common sequence is to introduce fruits followed by vegetables and, finally, meats

Some clinicians prefer to add vegetables before fruit.

• Citrus fruits, meats, and eggs are delayed until after 6 months of age because of potential allergy.



At 6 months:

• Foods such as a cracker can be offered as a type of finger and teething

food.


By 8 to 9 months

• A cooked vegetable, raw pieces of fruit (except grapes), or cheese can be

given.

By 1 year

• Well-cooked table foods are served.https://www.google.jo/search?biw=1366&bih=662&tbm=isch&sa=1&ei=ZJr2WbTwLIySaeXPuqAL&q=infant+food+after+6+months&oq=infant+food+after+6+months&gs_l=


• Commercially prepared baby foods

can be relatively expensive

• An alternative is to prepare baby foods

at home

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• Fruits and vegetables can be steamed

in a small amount of water ,then, blended

• Some food such as banana

can be mashed fine with a fork.

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• The process of giving up one method of feeding for another

• Its usually refers to relinquishing the breast or bottle for a cup

• There is no one time for weaning that is best for every child, but generally

most infants show signs of readiness during the second half of the first

year

• The nighttime feeding is usually the last feeding to be discontinued

Weaning

• Infant have learned that good things come from a spoon.

• Imitation becomes a powerful motivator by age 8 or 9 months, and they enjoy

using a cup or glass like others do

• It is advisable never to begin allowing a child to take a bottle of milk to bed—this

is a major cause of nursing caries in deciduous teeth

Weaning

• If breast-feeding is terminated before 5 or 6 months of age, weaning should be to a bottle to provide for the infant's continued sucking needs

• If discontinued later, weaning can be directly to a cup, especially by age 12 to 14 months.

• Any sweet liquid, such as fruit juice, should be given in a cup

Weaning

•Most infants are naturally active and need no encouragement to be mobile

The total daily sleep is approximately

• By 2 months: 15 hours

• By 6-12 months: 13 hours

• By 12 months: Most infants have developed a nocturnal (night-time) pattern of

sleep that lasts at least 8 hours

Sleep and Activity

Sleep and Activity

• Breast-fed infants usually sleep for less

prolonged periods, with more frequent

waking, especially during the night, than do

formula-fed infants.

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Problems of using devices such as playpens, and mobile walkers are:

• Restrict movement and prevent infants from exploring and developing gross motor skills dangerous if tipped over or placed near stairs.

Sleep and Activity

https://www.aliexpress.com/item/33019629284.htmlhttps://www.healthychildren.org/English/safety-prevention/at-home/Pages/Baby-Walkers-A-Dangerous-Choice.aspx

Dental Health

Good dental hygiene begins with appropriate maternal dental health before and during pregnancy and counseling during infancy regarding oral hygiene

https://www.nycsmilespa.com/blog/2017/4/12/the-baby-teeth-guide-how-to-care-for-your-infants-teethhttps://beffadental.com/preventing-tooth-decay-in-babies-and-infants/

Dental Health

Practices that increase the risk for poor dental health which include:

• Giving milk bottle in the bed

• Giving fruit juice in a bottle (especially before 6 months of age)

• This practices may cause enamel erosion المينا تآكل

and childhood caries

Dental Care

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Dental Health

As the primary teeth erupt, good dental hygiene begins as soon.

The teeth and gums are initially cleaned by wiping with a damp cloth; tooth brushing is too harsh for the tender gingiva.

• Oral hygiene can be made pleasant by singing or talking to the infant

• Its recommended that the infant has an oral health examination by 6 months of age from a qualified pediatric health practitioner.

Dental Health

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Dental Health

• It is recommended that a small, soft-bristled toothbrush be used as

more teeth erupt and the infant adjusts to the routine of cleaning

• Water is preferred to toothpaste, which the infant will swallow

Dental Health

AAP (2014) recommendation:

• “Smear” of toothpaste for children younger than 2-3 years

• Pea size amount for children 3-6 years

• Fluoride is needed beginning at 6 months of age if the infant does not receive water with an adequate fluoride content

Dental Health

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Dental Health

• Coating of pacifiers with honey or using commercially available hard-

candy pacifiers is discouraged because:

• This may be cariogenic

• Honey may cause infant botulism,

Safety promotion and Injury Prevention

(Table 9-2 page 325,326)

• Injuries are a major cause of death during infancy, especially

for children 6 to 12 months old.

• The three leading cause of accidental death injury among

infants are:


(Table 9-2 page 325,326)

• Suffocation

•Motor vehicle related injuries

•Drowning (Center of Disease Control and Prevention, 2012)

(CDC,2012)


• The task of injury prevention begins to be appreciated only when the

potential environmental dangers to which infants are vulnerable are

considered

• Two thirds of all injuries to children occur at home, therefore the

importance of safety cannot be overemphasized


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SAFETY: FIRE, ELECTRICAL, BURNS

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• SAFETY: FIRE, ELECTRICAL, BURNS

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SAFETY: FIRE, ELECTRICAL, BURNS

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• SAFETY: SUFFOCATION AND ASPIRATION


SAFETY: POISONING

Safety promotion and Injury Prevention• SAFETY: FALLS

SAFETY: BODILY INJURY

Take Care of Me Please--

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References

Hockenberry, M. J.,Wilson, D. & Rodgers, C., (2017). Wong's Essentials of Pediatric Nursing (10th ed.). St. Louis, MO: Elsevier Mosby

Promoting Optimal Health during Infancy

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