CH.23 Alterations in Growth and Development of the Hospitalized Infant: 28 Days to 1 Year

The nurse is providing anticipatory guidance to the parent of a 2-month-old infant in relation to growth and development. Which statement from the parent demonstrates proper understanding?

- "I can expect my infant to be able to raise the head up when on the stomach within the next month." Explanation: It is expected that a 3-month-old infant can raise the head to 45 degrees while laying on the stomach. Becoming clingy around strangers occurs in the infant around 6 to 8 months of age. The infant can begin to hold a rattle around 5 months of age. At 4 to 5 months, the infant will typically begin to laugh out loud.

In working with infants, the nurse would expect the posterior fontanel to be closed in an infant who is which age?

- 3 months Explanation: The posterior fontanel is usually closed by the second or third month of life.

The parent of an infant asks the nurse when to begin brushing the infant's teeth. What would be the nurse's best response?

- as soon as the first tooth erupts Explanation: Before tooth eruption occurs, parents should clean the infant's gums after feeding with a damp wash cloth. After the first tooth erupts, parents can use a soft bristle tooth brush. Dental hygiene should be part of the infant's everyday care. The American and Canadian Dental Associations recommend the first dental checkup to occur around 1 year of age. Infants should not go to bed with bottles or sippy cups to prevent dental caries.

Discuss nutritional requirements and concerns of the infant

4 to 6 months of age: - Give breast milk or commercial infant formulas. - infant's iron supply = low (supplements of iron-rich foods are needed) 7 or 8 months of age - infant begins experimenting with finger foods and self-feeding Supplements needed for infants 1. Vitamin C 2. Vitamin D (Yogurt, Custard, Cottage cheese) .3. Iron (1-2 tbsp daily) 4. Fluoride (classification of teeth) Tip: New foods are introduced one at a time at 4-6 months, every 4 to 5 months apart - Extrusion: Baby thrusts food as if it was stuck - Protrusion: Pushes solid food out of mouth - No milk until 1 year - NO honey!!! d/t botulism

Which measures should receive priority in the care plan for an infant client who has sensitive skin?

- change diapers frequently Explanation: The infant should be changed every 2-4 hours. It is best to use unscented wipes or clear water to clean the infant with each change. Baby power should never be used as it is an aspiration risk

A 6-month-old girl weighs 14.7 pounds (6.7 kg) during a scheduled check-up. Her birth weight was 8 pounds (3600 g). What is the priority nursing intervention?

- discussing the child's feeding patterns Explanation: 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.

If the infant is following a normal pattern of dentition, the child would most likely have how many teeth by the age of 14 months?

- six to 12 teeth Explanation: The central incisors erupt between 6 and 12 months of age and lateral incisors erupt between 9 and 13 months. The other lateral incisors erupt between 10 and 16 months, so by age 14 months the infant could have up to 12 teeth.

A nurse is providing health promotion education to a family of an infant at the family birth center. The nurse knows the parents need more education when they state which response?

- "I will switch to whole milk when my infant is around 6 months of age." Explanation: An infant can be introduced to whole milk at about 1 year of age. At this stage infants' intestinal tracts should be mature enough for whole mile, and they will be less likely to have allergic reactions. Soft food, a drinking cup, and introducing foods one at a time are all correctly stated for developmental age.

A client who is breastfeeding asks the nurse if she can give the newborn a pacifier. Which nursing response is most appropriate?

- "It is recommended to wait until breastfeeding is well-established before introducing a pacifier." Explanation: It is recommended to wait to introduce a pacifier once breastfeeding is well-established, which can take about 1 month. This is to limit nipple confusion and promote an adequate milk supply. Stating other people have done this does not provide education to the client, nor does it address this specific client's situation. While the decision is up to the newborn's parents, this response does not address the client's concern. Requesting a lactation consultant come does not address the client at this moment. The nurse can provide education now, and also request the consultant for follow-up information.

The nurse is providing anticipatory guidance to a mother of a 5-month-old boy about introducing solid foods. Which statement by the mother indicates that effective teaching has occurred?

- "The cereal should be a fairly thin consistency at first." Explanation: Iron-fortified oatmeal cereal mixed with a small amount of formula or breast milk to a fairly thin consistency is typically the first solid food used. As the infant gets older, a thicker consistency is appropriate. Strained, pureed, or mashed meats may be introduced at 10 to 12 months of age. A cup is typically introduced at 6 to 8 months of age regardless of what or how much solid food is being consumed.

The best way for an infant's parent to help the child complete the developmental task of the first year is to:

- respond to the infant consistently. Explanation: The developmental task of an infant is gaining a sense of trust. The infant develops this sense from the caretakers who respond to the child's needs, such as feeding, changing diapers, being held. It is a continuous process. A sense of trust is difficult to learn if things are constantly changing. Consistently responding to an infant's needs helps to build a sense of trust. An infant is too young to have variability in caretakers. This causes mistrust. The parents or caretakers do not need a special time to talk to the infant each day. It should be done with each interaction. Providing too much stimulus before the infant develops gross motor skills causes frustration from the child and not enjoyment.

Describe the health promotion and maintenance of the infants immunization: - What 12 immunizations do they get? - What 4 contraindications post pone immunizations? - What are 4 vaccine remedies?

Immunization: 1. Hepatitis B virus 2. Diphtheria 3. Tetanus 4. Pertussis 5. Rotavirus 6. Haemophilus influenzae type B 7. Polio 8. Measles, Mumps, Rubella 9. Varicella (chickenpox) 10. Pneumococcal disease 11. Meningococcal disease 12. Hepatitis A virus * Do not give if child is: 1. febrile 2. receiving corticosteroids 3. radiations 4. chemotherapy Vaccine Remedies: 1. Acetaminophen for fever 2. Cool compresses on injection site 3. Drink more fluids 4. Holding/cuddling

The caregiver of 7-month-old twins tells the nurse that she has noticed that both of her children enjoy playing with a toy by moving the object back and forth between their hands over and over again. Which statement made by the nurse most accurately explains this behavior?

- "This is one of the ways that infants develop their fine motor skills." Explanation: Transferring objects is one of the manifestations of fine motor skills development, which is not fully mastered by this early age. References to nerve endings do not address the parent's query.

Describe the fear of strangers seen in infants and the age this usually appears

- Between ages of 6 & 7 months Tip:- As the infant matures enough to recognize the mother or primary family caregiver, the infant becomes fearful when this person disappearsBECAUSE...- To the infant, out of sight means out of existence, and the infant cannot tolerate this therefore when their mother leaves, they think she no longer exists - Game of Peekaboo reassures baby that even when things are gone they still exist

Describe the health promotion and maintenance of the infant including routine check-ups

- Includes growth/development checks, immunizations, parent teaching & safety prevention Well baby checks at : - 2 wks - 2 mos. - 4 mos. - 6 mos - 9 mos - 12 mos.

The nurse is assessing Julie, a 3-month-old infant. Which developmental milestone would the nurse expect?

- Julie can hold her head erect and steady. Explanation: When an infant matures and grows they move through different developmental milestones. A 3-month-old rolls over from back to side and holds the head erect and steady and begins to replace the reflex grasp with voluntary grasping. Sitting without support occurs around 6 months. Grasping a toy at will occurs at about 6- to 7-months of age. Playing pat-a-cake is characteristic of an 8- to 9-month-old.

A nurse is educating a client being discharged with her newborn baby. What is the highest priority item that must be included in the teaching plan?

- Restrain the baby in a car seat. Explanation: The client should restrain the baby in a car seat when driving. Infants are especially vulnerable to injuries resulting from falls from changing tables or being unrestrained in automobiles. Locking the cabinets and giving warm bottles of formula to the baby are secondary teachings.

Explain the major developmental task of the infant according to Erikson. How is this task met?

- TRUST vs. MISTRUST 1. To develop a Sense of trust 2. When the needs of the infant are consistently met by caregivers, they then develop a sense of trust

A new parent asks the nurse what she should look for when the baby starts to teethe. What should the nurse explain to the parent?

- The child's gum line will be tender. Explanation: Gums are sore and tender before a new tooth breaks the surface. As soon as the tooth is through, the tenderness passes. A high temperature is not a normal expectation with teething and should be reported to the health care provider. The child may resist chewing because of the sore gum; however, it may not last for 2 days. Playing may or may not be affected. Constipation is not an expectation with teething.

The nurse is conducting a physical examination of an 8-month-old infant. Which observation may be cause for concern about the infant's neurologic development?

- The infant displays an asymmetric tonic neck reflex (fencing reflex). Explanation: The tonic neck reflex normally disappears by between 4 and 7 months, the palmar grasp reflex by between 3 and 6 months, and the Babinski reflex (fanning of toes when sole of foot stroked) between 12 and 24 months. Retaining these primitive reflexes may indicate a neurologic abnormality. The anterior fontanel (fontanelle), which remains open for brain growth, closes between 12 and 18 months of age.

A mother of a 9-month-old 18-pound (8.2 kg) infant asks the nurse about choosing the best car seat. What should the nurse recommend?

- a rear-facing 5-point harness restraint Explanation: An infant until 2 years of age should be in a rear-facing car seat. The 5-point harness seat is made for children up to 40 pounds (18 kilograms) The booster seat for children from 40 to 80 pounds (18 to 36 kilograms).

State the cause of early childhood caries and discuss ways to prevent them

- aka bottle mouth caries, can occur when an infant is given a bottle at bedtime - The sugar from the formula causes erosion of the tooth enamel Prevent them by: - NO milk/formula at bedtime - a bottle of plain water - a pacifier for sucking can be given at bedtime - Oral hygiene with a clean, damp cloth & Plain water - Pedodontist

Anticipatory guidance for an infant for the 4th month should include the fact that the infant will be able to achieve which developmental milestone?

- be able to turn over onto the back Explanation: At four months of age, the infant is able to lift the head and look around. The infant can roll from prone to supine. When being pulled up, the head leads. The 4-month-old infant can make simple vowel sounds, laugh aloud, and vocalize in response to voices. A fear of strangers does not occur until the child is older; a 4-month-old infant has not developed emotionally to have "moody" periods and is dependent on parental care.

The nurse in a community clinic is caring for a 6-month-old infant and parent. Which nursing intervention is priority?

- monitoring the infant's weight and height Explanation: Monitoring the infant's weight and height is the priority intervention. Ongoing assessments of growth are important so that too-rapid or inadequate growth can be identified early. With early identification, the cause can be diagnosed and the potential for further appropriate growth maximized. Encouraging a more frequent feeding schedule, obtaining the infant's current feeding pattern, and recommending higher-calorie solid foods are interventions that would be used should assessment show that the client's nutrition level does not meet body requirements.

The nurse assesses a 4-month-old child during a well-child visit (above). Which assessment finding should the nurse report to the primary health care provider?

- not smiling or tracking faces Explanation: Preterm infants should be assessed developmentally based on their corrected age. For a 2-month-old infant, corrected waking at night, spitting up, and not rolling over are all normal findings. Not smiling or tracking faces are concerning findings that could indicate problems with vision. This requires follow-up by the health care provider.

The nurse is visiting a mother who has a 3-month-old infant who has been hospitalized for cardiac problems. Which nursing diagnosis should the nurse use to guide care for this family at this time?

- risk for impaired parenting related to hospitalization of infant Explanation: The diagnosis appropriate for the family whose infant has been hospitalized would be risk for impaired parenting related to hospitalization. There is no evidence to suggest that the mother is not adjusting to parenthood. There is no information about the infant's feeding schedule. There is no information to suggest the mother has a knowledge deficit regarding normal infant growth and development.

Describe 7 Physical growth and development that occurs during the first year of life

1. Vitals: - Average BP 85/60 - Apical pulse one full minute (90-170) - Oral/Temporal: * 36.4°C to 37.4°C * 97.6°F to 99.3°F * Axillary always lower * Rectal always higher - RR (30-45). 2. Weight: - doubles by 6 months - height increases by 6 inches - Weight triples by 1 yr - Has grown 10-12 inches 3. Head circumference - Birth: 35 cm & larger than chest - Chest & abdomen measure the same - 1 year: HC grows 47 cm - Chest grows rapidly then catches up to HC at 5-7 months/chest exceeds HC 4. Fontanels: - Posterior: 2-3 months closes - Anterior: Increases slightly during first few months and begins to decrease at 6 mos. - Closes 12-18 mos. 5. First deciduous teeth: - 6-8 months lower central incisors erupt 6. RBCs: - decrease until age 3 mos. 7. Positions: 1 month: Turns head when lying prone 3 months: Pushes up from prone position 5 months: Sits up but tilts forward for balance 8 months: Pincer grasp to pick up a piece of cereal 8 months: Crawling 10 months: Walking 8. Motor: - Nerve cells mature - Fine muscles Coordinate

Describe the health promotion and maintenance of family teaching: - Bathing the infant - Caring for the diaper area/dry skin - Dressing the infant - Promoting sleep - Dental care - Accident prevention

Bathing: - Not needed everyday - Wash hair to prevent seborrheic dermatitis (cradle cap) caused by a collection of seborrhea (yellow crusty patches of lesions on the scalp) - Don't use powder after the bath (Can be inhaled and cause skin irritation) Diapers/Dry skin: - 6-7 diaper changes per day as baby can lose heat through convection - A & D ointment and lanolin - Don't use oil, can block pores and cause infection Dressing infant: - Put same amount of clothing on that's comfortable for an adult. Promoting Sleep: - 10-12 hrs. at night - 2-3 naps per day Dental: - 6 months: use a damp cloth to rub on gums - Use a soft brush toothbrush once several teeth have erupted - Do not use toothpaste, as will swallow Educate Parents on accidents: - aspiration/suffocation - falls - MVA - Drowning - Burns - Poisoning