Chapter 15: Care of the Newborn and Infant

The nurse is reinforcing teaching with a group of caregivers related to the nutritional needs of the infant. One caregiver asks why the 6-month-old infant needs to have solid foods when breast milk is such a good source of nutrition. What would be the best response by the nurse? A. "Milk will not fully provide the child's needs for iron, which is found in solid foods." B. "By this age the child becomes interested in trying new skills." C. "The extrusion reflex must be developed and feeding solid foods will help the child to develop this reflex." D. "Breastfeeding will become painful when the child gets more teeth, so the infant needs to eat solid foods."

ANS: A Rationale: At about 4 to 6 months of age, the infant's milk consumption alone is not likely to be sufficient to meet caloric, protein, mineral, and vitamin needs. In particular, the infant's iron supply becomes low, and supplements of iron-rich foods are needed. It is also around 4 to 6 months when the infant is able to swallow solids effectively and has the necessary enzymes necessary to digest them. It is true that the child becomes interested in new skills, but this is not the primary rationale for introducing solids. Few parents will understand the "extrusion reflex" so using that term is not effective in teaching. The nurse should, however, describe the reflex to the parents. Breastfeeding does not become painful when the child develops teeth. Many mothers nurse for long after their infants develop teeth.

A new mother, when asked by a nurse, explains that her 4-month-old infant has been nursing regularly every 3 to 4 hours and seems satisfied. However, the mother recently introduced solid food in the form of unbuttered popcorn to the baby as a supplement, to "get her used to eating solid food." She felt that the popcorn would be safe because it is soft on the baby's gums. What should be the primary nursing diagnosis in this situation? A. Risk for aspiration related to feeding the infant an inappropriate food B. Imbalanced nutrition, less than body requirements, related to introduction of a low nutritive food C. Readiness for enhanced nutrition, related to the age of the infant D. Imbalanced nutrition, more than body requirements, related to introduction of a high-calorie food

ANS: A Rationale: Children under about 5 years should not be offered popcorn or peanuts because of the danger of aspiration. This should be the primary nursing diagnosis because aspiration is the greatest danger to the infant in this scenario. Because the infant is receiving all the nutrition she needs from breastfeeding and because unbuttered popcorn is not a high-calorie food, imbalanced nutrition is not really a concern here. There is not a strong indication at this point that the infant is ready for enhanced nutrition, as the breast milk provides all of the nutrients she needs and as she appears to be satisfied after her feedings.

Which developmental milestone would the nurse expect an 11-month-old infant to have achieved? A. Sitting independently B. Walking independently C. Building a tower of four cubes D. Turning a doorknob

ANS: A Rationale: Infants typically sit independently, without support, by age 8 months. Walking independently may be accomplished as late as age 15 months and still be within the normal range. Few infants walk independently by age 11 months. Building a tower of three or four blocks is a milestone of an 18-month-old. Turning a doorknob is a milestone of a 24-month-old.

The nurse is assessing a 6-month-old child. The mother asks when the soft area in her child's head will go away. What is the best response by the nurse? A. "The area is called the anterior fontanel and typically closes anytime up to 18months of age." B. "Soft spots on the child's head should have closed by now." C. "The area is called a fontanel. They remain open to allow for rapid brain growth in the first months of life." D. "The soft spots may stay open until your child is two or three years old."

ANS: A Rationale: The anterior fontanel typically closes by the age of 9 to 18 months. Fontanels are soft areas on the skull that remain open in infancy to allow for rapid brain growth in the first months of life. This answer is a true statement but does not answer the mother's question.

A 5-month-old infant being assessed was born at 32 weeks. The nurse doing the well-child check-up should compare the baby to what norms? A. The development of a 3-month-old B. The development of a 10-week-old C. The growth of a 2-month-old D. The growth of a 5-month-old

ANS: A Rationale: The infant was born 8 weeks early. Two months are subtracted from the present age of 5 months. Both growth and development should be assessed using 3-month norms.

Patty calls the hospital nursing hotline and asks, "My 8-week-old daughter cries 8 hours a day, and she is hard to console, is that normal?" What should the nurse's response be to this mother? A. "Let me ask you some more questions to see if there are symptoms of colic." B. "Yes, infants cry all the time at that age." C. "No, call your doctor." D. "Yes, maybe she is just tired."

ANS: A Rationale: The nurse should seek more information to assess the infant's symptoms. The symptoms suggest colic, which is characteristic of an infant who cries more than 3 hours a day and is fussy and hard to console. The other responses are non-therapeutic and do not seek further information to gather a history.

The parents of an 8-month-old boy voice concern to the nurse that their child is not developing motor skills as he should. What question would be appropriate for the nurse to ask in determining if their fears are warranted? A. "Does he move a toy back and forth from one hand to the other when you give it to him?" B. "Does he place toys into a box or container and take them out?" C. "Is he able to drink with a cup by himself?" D. "Is he able to hold a pencil and scribble on paper?"

ANS: A Rationale: Transferring an object from one hand to the other is expected at 7 months of age, so this would be expected of an 8-month-old. The other options are not expected until later months, so questioning the parents about these skills would not help in determining if he was at the motor skill developmental level that should be expected.

A group of nursing students are reviewing information about growth and development during infancy. The students demonstrate understanding of the information when they identify which of the following as characteristic of a 10-month-old infant? Select all that apply. A. Understands the word "no" B. Tilts head backward to see up Stands alone C. Exhibits stranger anxiety D. Waves hands

ANS: A, B, C Rationale: A 10-month-old understands the word "no," is able to tilt the head backwards to see up, and can stand alone. Stranger anxiety occurs around 6 months of age. The ability to wave the hand occurs around 7 to 9 months of age.

The nurse is assessing the parents interacting with their infant. Which of the following would indicate to the nurse that attachment is occurring? Select all that apply. A. Parents make eye-to-eye contact. B. Parents hold the baby close to the body. C. Parents talk to the baby while holding the baby D. Parents refrain from inspecting the baby's body. E. Parents avoid snuggling with the baby.

ANS: A, B, C Rationale: Attachment is the emotional bond that creates an important foundation for the relationship between the parent and the infant. Certain identifiable behaviors—eye-to-eye contact, physical contact, and communication—indicate that attachment is occurring.

In providing anticipatory guidance related to choking hazards for infants, what should the nurse include in the teaching? Select all that apply. A. Propping a bottle B. Raw carrots C. Shape sorter D. Plastic bags E. Stuffed animals

ANS: A, B, D Rationale: The nurse should include teaching related to propping a bottle; foods that are choking hazards such as raw carrots, peanuts, hot dogs, and grapes; and plastic bags and balloons. Any toy or object that the infant can put in their mouth should be considered a choking hazard.

The nurse is assessing the respiratory system of a newborn. Which anatomic differences place the infant at risk for respiratory compromise? Select all that apply. A. The nasal passages are narrower. B. The trachea and chest wall are less compliant. C. The bronchi and bronchioles are shorter and wider. D. The larynx is more funnel shaped. E. The tongue is smaller. F. There are significantly fewer alveoli.

ANS: A, D, F Rationale: In comparison with the adult, in the infant, the nasal passages are narrower, the trachea and chest wall are more compliant, the bronchi and bronchioles are shorter and narrower, the larynx is more funnel shaped, the tongue is larger, and there are significantly fewer alveoli. These anatomic differences place the infant at higher risk for respiratory compromise. The respiratory system does not reach adult levels of maturity until about 7 years of age.

The nurse is admitting a 12-month-old to the medical unit. During the admission process the parents tell the nurse that their child is very advanced because he says "ball" when he picks up a football. How should the nurse respond? A. "He really isn't any more advanced than most 12-month-old children." B. "That is great that he is recognizing objects and is able to name them. He is right on target for language skills." C. "If he were advanced in language skills he would be putting several words together to form short sentences." D. "Parents usually think their child is far more advanced than other children."

ANS: B Rationale: Recognizing the parents' excitement about their child's language skills while still letting them know that this is what the expected level is for language is a polite and accurate way to respond. The other responses do not give notice to the parents' pride and would likely make the parents feel defensive about their child's skill.

The infant weighs 7 lb 4 oz (3,248 g) at birth. If the infant is following a normal pattern of growth, what would be the expected weight for this child at the age of 12 months? A. 14 lb 8 oz (6.6 kg) B. 21 lb 12 oz (9.9 kg) C. 25 lb (11.3 kg) D. 28 lb 4 oz (12.8 kg)

ANS: B Rationale: The average weight of a newborn is 7.5 lb (3400 g). The infant gains about 30 g each day. By four months of age, the infant has doubled the birthweight. By 1 year of age, the infant has tripled the birthweight and has grown 10 to 12 in (25 to 30 cm). 7.25 lb 3 = 21.75 lb or 21 lb 12 oz

The mother of a 1-month-old infant voices concern about her baby's respirations. She states they are rapid and irregular. Which information should the nurse provide? A. The normal respiratory rate for an infant at this age is between 20 and 30 breaths per minute. B. The respirations of a 1-month-old infant are normally irregular and periodically pause. C. An infant at this age should have regular respirations. D. The irregularity of the infant's respirations are concerning; I will notify the physician.

ANS: B Rationale: The normal respiratory rate for a 1-month-old infant is 30 to 60 breaths per minute. By 1 year of age the rate will be 20 to 30 breaths per minute. The respiratory patterns of the 1-month-old infant are irregular. There may normally be periodic pauses in the rhythm.

A new mother reports that she is exhausted and that the little sleep she gets is determined by her baby. Which suggestion should the nurse prioritize to help the mother establish healthy sleeping patterns in her infant? A. Put the baby to bed at various times of the evening. B. Let the baby cry during the night and she will eventually fall back to sleep. C. Use the crib for sleeping only, not for play activities. D. Wake the baby from afternoon naps after 1 hour to ensure she is sleepy by nighttime.

ANS: C Rationale: A consistent bedtime routine is usually helpful in establishing healthy sleeping patterns and in preventing sleep problems. Using the crib for sleeping only helps the child associate the bed with sleep. Depriving the baby of sleep during the afternoon or evening will make the baby over-tired and less able to establish a healthy sleeping pattern. While letting a baby cry for a while is acceptable, this does not promote consistency in the baby's sleeping pattern.

The nurse takes a call from a concerned mother whose infant received routine immunizations the day before and now has a temperature of 101oF (38.3oC), is fussy and pulling at the injection site. The mother wants to know what she should do. Which is the best response from the nurse to this mother? A. "You need to bring the baby to the emergency department to be sure he is not having an allergic reaction." B. "All babies have similar reactions but you should call back if he is still fussy in 24 hours." C. "This is a common reaction. Give your child acetaminophen, cuddle him, and apply a cool compress to the injection site." D. "You can give your child ice cold fluids and cover the injection site so that he doesn't scratch the site and get it infected."

ANS: C Rationale: Adverse reactions vary with the type of immunization but usually are minor in nature. The most common adverse reaction is a low-grade fever within the first 24 to 48 hours and possibly a local reaction such as tenderness, redness, and swelling at the injection site. The child may be fussy and eat less than usual. These reactions are treated symptomatically with acetaminophen for the fever and cool compresses applied to the injection site. The child is encouraged to drink fluids but not necessarily ice cold fluids. Holding and cuddling are comforting to the child. These reactions may last longer than 24 hours and should subside. These are not signs of an allergic reaction. There is no need to cover the site.

The mother of a 3-month-old baby is concerned because the child is not able to sit independently. How should the nurse respond to this mother's concern? A. Most babies sit steadily at 3 months. B. Most babies sit steadily at 4 months. C. Most babies do not sit steadily until 8 months. D. Sitting ability and the age of first tooth eruption are correlated.

ANS: C Rationale: An 8-month-old child can sit securely without any additional support. Babies are not able to sit steadily at age 3 or 4 months. Sitting ability does not correspond with tooth eruption.

The nurse is assessing a 6-week-old infant in the clinic. Which characteristic represents normal language development for this age? A. Cooing B. Laughing out loud C. Babbling D. Producing noises when spoken to

ANS: C Rationale: Cooing begins in the first 4 weeks of life, productions of noises when spoken to and laughing out loud are seen in older infants. Infants begin to babble around 6 weeks of age.

The nurse is providing anticipatory guidance to a mother to help promote healthy sleep for her 3-week-old baby. Which recommended guideline might be included in the teaching plan? A. Place the baby on a soft mattress with a firm, flat pillow for the head. B. Place the head of the bed near the window to provide fresh air, weather permitting. C. Place the baby on his or her back when sleeping. D. If the baby sleeps through the night, wake him or her up for the night feeding.

ANS: C Rationale: Sudden infant death syndrome (SIDS) has been associated with prone positioning of newborns and infants, so the infant should be placed to sleep on the back. The baby should sleep on a firm mattress without pillows or comforters. The baby's bed should be placed away from air conditioner vents, open windows, and open heaters. By 4 months of age night waking may occur, but the infant should be capable of sleeping through the night and does not require a night feeding.

A 6-month-old girl weighs 14.7 pounds (6.7 kg) during a scheduled check-up. Her birth weight was 8 pounds (3.6 kg). What is the priority nursing intervention? A. Talking about solid food consumption B. Discouraging daily fruit juice intake C. Increasing the number of breast-feedings D. Discussing the child's feeding patterns

ANS: D Rationale: Assessing the current feeding pattern and daily intake is the priority intervention. Talking about solid food consumption may not be appropriate for this child yet. Discouraging daily fruit juice intake or increasing the number of breastfeedings may not be necessary until the situation is assessed.