Health Promotion of Infants (2 days to 1 year)

Injury Prevention: 1. How do we prevent Aspiration of Foreign objects? 2. How do we prevent Bodily Harm? 3. How do we prevent Burns?

1. - Hold infant for feedings (do not prop bottles). - Small objects that can become lodged in throat (grapes, coins, candy) should be avoided. - Age-appropriate toys. - Clothing should be checked for safety hazards (loose buttons) 2. - Sharp objects should be kept out of reach. - Anchor heavy objects and furniture so they cannot be overturned on top of infant. - Infants should not be left unattended with any animals present. 3. - Avoid warming formula in microwave (check temp of liquid before feeding). - Temp of bath water should be checked before hand. - Hot water thermostats should be set at or below 49 C (120 F). - Working smoke detectors. - Handles of pots/pans should be kept turned to the back of stoves. - Sunscreen should be used when infant exposed to sun. - Electrical outlets should be covered.

Injury Prevention: 1. How do we prevent Motor-Vehicle injuries? 2. How do we prevent Suffocation?

1. - Infant-only and convertible infant-toddler car seat. - Infants and toddlers remain in a rear facing car seat until the age of 2 yrs or the height recommended by manufacturer. - Safest are for infant and children is the backseat - Do not place rear facing car seat in the front seat - Infants should not be left in parked cars 2. - Plastic bags should be avoided - Balloons should be kept away from infants - Crib mattresses should fit snugly - Crib slats should be no farther apart than 6 cms - Crib mobiles and crib gyms should be removed by 4-5 months - Pillows should be kept out of the crib - Infants should be placed on their backs for sleep - Toys with small parts kept out of reach - Drawstrings should be removed from jackets and other clothing .

Motor Skill Development by Age: - What are the Gross and Fine Motor Skills by... 1. 1 Month 2. 2 Months 3. 3 Months

1. 1 Month: Gross - Demonstrates head lag. Fine - Has strong grasp reflex. 2. 2 Months: Gross - Lifts head off mattress when prone. Fine - Hold hands in an open position, Grasp reflex fading 3. 3 Months: Gross - Raises head and shoulders off mattress when prone, Only slight head lag. Fine - No longer has a grasp reflex, keeps hands loosely open

Motor Skill Development by Age: - What are the Gross and Fine Motor Skills by... 1. 10 Months 2. 11 Months 3. 12 Months

1. 10 Months: Gross - Changes from a prone to a sitting position Fine - Grasps rattle by its handle 2. 11 Months: Gross - Cruises or walks while holding onto something. Walks with one hand held. Fine - Places objects into a container. Neat pincer grasp. 3. 12 Months: Gross - Sits down form a standing position without assistance. Fine - Tries to build a two-block tower *without success*. Can turn pages in a book.

Vital signs for Infants: Expected Temperature for: 1. 3 Months 2. 6 Months 3. 1 Year 4. Recommended Route for all three? 5. What is considered a fever for an Infant <3 Months old? 6. What is considered a fever for an Infant >3 Months old?

1. 3 Months: 37.5 C (99.5 F) 2. 6 Months: 37.5 C (99.5 F) 3. 1 Year: 37.7 C (99.9 F) 4. Axillary is best. - Rectal if exact measurement necessary 5. <3 Months Old: - Anything over 100.4 F or 38 C 6. >3 Months Old: - Anything over 101.3 F or 38.5 C

Motor Skill Development by Age: - What are the Gross and Fine Motor Skills by... 1. 4 Months 2. 5 Months 3. 6 Months

1. 4 Months: Gross - Rolls from back to side Fine - Grasps objects with both hands 2. 5 Months: Gross - Rolls from front to back Fine - Uses palmar grasp dominantly 3. 6 Months: Gross - Rolls from back to front Fine - Holds bottle

Motor Skill Development by Age: - What are the Gross and Fine Motor Skills by... 1. 7 Months 2. 8 Months 3. 9 Months

1. 7 Months: Gross - Bears full weight on feet. Sits, leaning forward on both hands (teetering) Fine - Moves objects from hand to hand 2. 8 Months: Gross - Sits unsupported Fine - Begins using pincer grasp 3. 9 Months: Gross - Pulls to a standing position. Creeps on hands and knees instead of crawling. Fine - Has a crude pincer grasp. Dominant hand preference evident.

Infant Reflexes: Expected Findings and Expected Age 1. Sucking and Rooting reflexes 2. Palmar Grasp Reflex 3. Plantar Grasp Reflex 4. Moro Reflex

1. Elicited by stroking an infants cheek or the edge of an infants mouth. Infant turns her head toward the side that is touch and starts to suck. - Expected age: Birth to 4 Months 2. Elicited by placing an object in an infants palm. Infant grasps the object. - Expected age: Birth to 3 months 3. Elicited by touching the sole of an infants foot. The infants toes curl downward. - Expected age: Birth to 8 months 4. Elicited by allowing the head and trunk of an infant in a semi-sitting position to fall backward to an angle of at least 30 degrees. The infants arms and legs symmetrically extend, then abduct while fingers spread to form C shape. - Expected age: Birth to 4 months

Physical development: 1. Fontanel closures Anterior vs. Posterior 2. Infant Size: - Weight, Height, Head Circumference 3. Dentition - 6-8 teeth erupt by when.... - Signs of teething 4. How can we ease teething pains? 5. How should we clean infant teeth? 6. Why should bottles not be given to infants when they are falling asleep?

1. Anterior: 12-18 months. Posterior closure by 6-8 weeks of age. 2. Weight: Gain approx 680 g (1.5 lb) per month for first 5 months. Average weight at 6 months is 7.26 kg (16 lbs). - Birth weight doubled by 5 months, tripled by 12 months (avg 21.5 lbs) Height: Grow approx 2.5 cms per month first 6 months. Growth spurts after age of 6 months, and birth length increases by 50% by 12 months age. Head Circum: Increases approx 2 cms per month during first 3 months, 1 cm per month 4-6 and 0.5 cm per month during second 6 months 3. 6-8 teeth by end of 1st yr. First teeth approx btwn ages 6-8 months. - Sucking, biting on their fingers or hard objects, drooling. - Irritable, difficulty sleeping, mild fevers, rub ears, dec appetite for solid foods. 4. By using frozen teething rings or ice cube wrapped in wash cloth. Tylenol and ibuprofen can be used but not longer than 3 day period. Ibuprofen only used in children at least 6 months 5. Using cool, wet washcloths 6. Bc prolonged exposure to molk or juice can cause early childhood dental caries

Health Promotion: Immunizations: 1. What immunization do they get at birth? 2. What 6 immunizations do they get at 2 months of age? 3. What 5 do they get at 4 months of age? 4. What 6 do they get at 6 months age? 5. What do they get between 6-12 months of age?

1. At birth: Hep B, Vit K 2. 2 Months: DTaP, Rotavirus vaccine (RV), Inactivated poliovirus (IVP), Haemophilus influenzae type B (Hib), pneumococcal vaccine (PCV), and 2nd Hep B. 3. 4 Months: DTaP, RV, IPV, HiB, PCV 4. 6 Months: DTaP, IPV (again at 18 months), PCV, Hep B (again at 18 months); RV, HiB 5. Seasonal influenza vaccination yearly btwn 6-12 months

Nutrition: Feeding Alternatives: 1. _______ provides a complete diet for infants during the ________ months 2. What is an acceptable alternative to breast milk? What is not? 3. When is vit D supplements recommended and why? 4. What are recommended for infants who are being exclusively breastfed after the age of 4 months? 5. What are not needed during the first 4 months? Why? 6. After the age of 6 months, what should be limited to 4-6 oz per day?

1. Breastfeeding provides complete diet during first 6 months 2. Iron-fortified formula is acceptable alternative. Cow's milk is not. 3. Vit d supplements within first few days of life to prevent rickets and vit d deficiency 4. Iron supplements for exclusive breastfeeding infants after 4 months of age. 5. Alternative sources of fluid such as juice or water are not needed. Excessive intake of water could result in hyponatremia or water intoxication 6. 100% fruit juice after 6 months of age limited to 4-6 oz per day

Cognitive Development: Language Development: 1. What is the first form of verbal communication? 2. How many hrs does an infant cry each day from day 1-3 wks of age? How many hrs by week 6? - When does crying decrease? 3. When do they vocalize with a Cooing noise? 4. When do they show considerable interest in the environment? 5. When do they turn their head to the sound of a rattle? 6. When do infants laugh and squeal?

1. Crying 2. 1-1.5 hrs per day up to 3 wks of age. 2-4 hrs by 6 wks of age. - Decrease by 12 wks of age 3. Cooing noises by 3-4 months of age 4. Interest in environment by 3 months of age 5. Turn head to sound by 3 months 6. Laugh and squeals by 4 months of age

Nutrition: 1. When should breast milk/formula be decreased? 2. When are table foods that are well-cooked, chopped and unseasoned appropriate? 3. What are some appropriate finger foods? 4. When can Weaning be accomplished? 5. How should Weaning be done? 6. What feedings are the last to be stopped?

1. Decreased as intake of solid foods increases, but should remain the primary source of nutrition through 1st yr of life. 2. By 1 year of age 3. Finger Foods: Ripe bananas, toast strips, graham crackers, cheese cubes, noodles, firmly-cooked vegetables, and raw pieces of fruit (Except for grapes) 4. Weaning can be accomplished when infants show signs of readiness and are able to drink from a cup (sometime in the second 6 months) 5. Gradually replace one bottle or breastfeeding at a time with breast milk or formula in a cup with handles. 6. Bedtime feeding are the last to be stopped

Body-Image Changes: 1. Infants discover that ____ are pleasure producers 2. ____ and _____ are seen as objects of play 3. Infants discover that ____ causes other to react

1. Discover that mouths are pleasure producers 2. Hands and feet are seen as objects of play 3. Discover that smiling causes other to react.

Injury Prevention: 1. How do we avoid Drowning? 2. How do we avoid Falls? 3. How do we avoid Poisoning?

1. Drowning: - Infants should not be left unattended in bathtubs or water sources such as toilets, cleaning buckets, or drainage areas. - Secure fencing around swimming pools - Close bathroom doors 2. Falls: - Crib mattresses should be kept in the lowest position possible with rails all the way up. - Restraints should be used in infant seats - Infant seats should be placed on the ground or flood if used outside of the care, and they should not be left unattended or on elevated surfaces - Place safety gates at the top and bottom of stairs 3. - Exposure to lead paint should be avoided - Toxins and plants should be kept out of reach - Safety locks on cabinets with cleaners/chemicals - Phone number for poison control center - Meds kept in childproof containers out of reach - Working carbon monoxide detector in home

Infant Reflexes: Expected Findings and Expected Age 1. Startle Reflex 2. Tonic Neck Reflex (Fencer Position) 3. Babinski Reflex 4. Stepping

1. Elicited by clapping hands or by a loud noise. The neworn abducts arms at the elbows and hands remain clenched. - Expected age: Birth to 4 months 2. Elicited by turning an infants head to one side The infant extends the arm and leg on that side and flexes the arm and leg on the opposite side. - Expected age: Birth to 3 to 4 months 3. Elicited by stroking the outer edge of the sole of an infants foot up towards the toes. The infants toes fan upward and out. - Expected age Birth to 1 year 4. Elicited by holding an infant upright with his feet touching a flat surface. The infant makes stepping movements. - Expected age: Birth to 4 weeks

Health Promotion: Care of the Newborn After Discharge: 1. Explain the role of the car seats and how they should be used. 2. When do newborns need their first check up?

1. Federally approved car seat at 45 degree angle to prevent slumping and airway obstruction. Seat placed rear facing in the rear seat and secured using seat belt. Shoulder harnesses are placed in the slots at or below the level of the infants shoulders. Harness should be snug and the retainer clip placed at the level of the infants armpit. 2. First check up within 72 hrs of discharge. Esp important for breastfed newborns to evaluate weight and hydration status.

Psychosocial: Social Development: 1. What initially influences social development? 2. When is attachment seen? 3. When does Separation-Individuation occur? 4. When does Separation Anxiety begin? 5. When is Stranger fear evident? 6. What does Reactive attachment disorder result from?

1. Initially influenced by infants reflexive behaviors and includes attachment, separation, recognition/anxiety and stranger fear. 2. Attachment seen when infants begin to bond with their parents. Developed within the 1st month, but actually begins before birth. Process enhanced when infants and parents are in good health, have positive feeding experiences, and receive adequate rest. 3. Separation-individuation occurs during the 1st yr of life as infants first distinguish themselves and their caregiver as separate individuals at the same time that object permanence is developing (9-10 months of age) 4. Separation anxiety begins around 4-8 months of age. Infants will protest when separated from parents. By 11-12 months of age, infants are able to anticipate the mothers imminent departure by watching her behaviors 5. Stranger fear is evident btwn 6-8 months of age when infants have ability to discriminate btwn familiar and unfamiliar people. 6. Results from maladaptive or absent attachment btwn infant and caregiver and continues thru child and adulthood.

Vital Signs for Infants: BP systolic and diastolic range for... 1. Neonate 2. Infant 1 month 3. Infant 3 months 4. Infant 6-12 months

1. Neonate: SBP = 60-90. DBP = 20-60 2. Infant 1 Month: SBP = 70-98. DBP = 40-65 3. Infant 3 Months: SBP = 76-104. DBP = 40-64 4. Infant 6-12 Months: SBP = 80-106. DBP = 41-67

Vital Signs for Infants Pulse rates and RR rates for: 1. Newborn (<1 month) 2. Infant (1 month-12 months)

1. Newborn: HR: 80-180/min 2. HR 110-180 (avg 120) - RR: 30 - 60 breath per min

Sleep and Rest: 1. When is Nocturnal sleep pattern established? 2. Infants sleep _________ hrs daily and _________ at night around the age of 4 months. 3. Infants sleep through the night and take one to two naps during the day by age ________

1. Nocturnal sleep pattern established by 3-4 months of age. 2. Infants sleep 14-15 hr daily and 9-11 hr at night around the age of 4 months 3. Infants sleep through the night and take one to two naps during the day by the age of 12 months

Age-Appropriate Activities: 1. Play should provide _________ and ________ 2. Infants have ______ spans and will not _________ 3. What are 10 appropriate toys and activities that stimulate the senses and encourage development?

1. Play should provide interpersonal contact and educational stimulation 2. Infants have short attention spans and will not interact with other children during play (solitary play) 3. Rattles, Soft stuffed toys, Teething toys, Nesting toys, Playing pat-a-cake, Playing with balls, Reading books, Mirrors, Brightly colored toys, Playing with blocks

Cognitive development: - Piagets 1. What stage? 2. Infants progress from ____ to _______ to _______ 3. What 3 important tasks accomplished at this age frame? (2 days-1 yr)

1. Sensorimotor Stage 2. Progress from reflexive to simple repetitive to imitative activities 3. - Separation: Infants learn to separate themselves from other objects in the environment - Object Permanence: Occurs approx 9-10 months of age. This is the process by which infants learn that an object still exists when it is out of view. - Mental Representation: The ability to recognize and use symbols

Cognitive Development: Language Development: 1. When do infants make single vowel sounds by? 2. When are consonants added to their speech? 3. When do infants begin speaking 2 word phrases and progress to speaking 3 word phrases? 4. When are infants able to say 3-5 words by? 5. When do infants comprehend the word "No" by and obey single commands accompanied by gestures?

1. Single vowel sounds by 2 months age 2. Consonants added by 3-4 months 3. 2 word phrases and 3 word phrases by 1 yr 4. 3-5 words by 1 yr of age 5. Comprehends "No" by 9-10 months age

Nutrition: Solids 1. When are solids introduced? 2. What are some indicators for readiness of solid foods? 3. What is typically introduced first and why? 4. How should new foods be introduced? 5. When are vegetables and fruits started? 6. When are citrus fruits, meat, and eggs started?

1. Solids introduced around 4-6 months of age 2. Interest in solid foods, voluntary control of the head and trunk and disappearance of the extrusion reflex. 3. Iron-fortified cereal first due to high iron content 4. New foods introduced one at a time, over a 5-7 day period, to observe for signs of allergy or intolerance which may be fussiness, rash, V/D, and constipation. 5. Veggies or fruits started first between 6-8 months. After both have been introduced, meats may be added. 6. Citrus fruits, meat and eggs not started until after 6 months of age.

Psychosocial: - Eriksons: 1. What Erikson stage? 2. How can infants achieve this task? 3. What leads to mistrust? 4. How is trust developed? 5. When is mistrust developed?

1. Trust vs. Mistrust 2. Achieving this task is based on the quality of the caregiver-infant relationship and the care received by the infant. 3. Infants begin to learn delayed gratification. Failure to learn delayed gratification leads to mistrust. 4. Trust is developed by meeting comfort, feeding, stimulation and caring needs. 5. Mistrust develops if needs are inadequately or inconsistently met, or if needs are continuously met before being vocalized by the infant.

General Measurements: 1. Average head circumference? 2. Crown to rump length? 3. Head to heel length? 4. Weight

1. avgs 33-35 cms 2. Avgs 31-35 cms, approx equal to head circumference. 3. Avgs 48-53 cms 4. Avgs 2,700 - 4,000 grams (6-9 lbs) - Newborns will lose up to 10% of birth weight by 3-4 days of age due to fluid shifts, loss of meconium, and limited intake esp in breastfed infants. Birth weight is usually regained by the 10th-14th day

2. A nurse is performing a developmental screening on a 10-month-old infant. Which of the following fine motor skills should the nurse expect the infant to perform? (Select all that applies): A. Grasp a rattle by the handle B. Try building a two-block tower C. Use a crude pincer grasp D. Place objects into a container E. Walks with one hand held

A and C (Grasp rattle by handle and use crude pincer grasp) - Trying to build a two-block tower is at 12 months - Placing objects into a container by 11 months - Walk with one hand held at 12 months

1. A nurse is assessing a 12-month-old infant during a well-child visit. Which of the following findings should the nurse report to the provider? A. Closed anterior fontanel B. Eruption of 6 teeth C. Birth weight doubled D. Birth length increased by 50%

C. - By the age of 12 months, the infants birth weight should have tripled, not doubled

4. A nurse is providing education about introducing new foods to the parents of a 4-month-old infant. The nurse should recommend that the parents introduce which of the following foods first? A. Strained yellow vegetables B. Iron-fortified cereals C. Pureed fruits D. Whole milk

B

5. A nurse is providing teaching about dental care and teething to the parent of a 9-month-old infant. Which of the following statements by the parent indicates an understanding of the teaching? A. "I can give my baby a warm teething ring to relieve discomfort" B. "I should clean my baby's teeth with a cool, wet wash cloth" C. "I can give advil for up to 5 days while my baby is teething" D. " I should place diluted juice in the bottle my baby drinks while falling asleep"

B

3. A nurse is conducting a well-baby visit with a 4-month-old infant. Which of the following immunizations should the nurse plan to administer to the infant (select all that applies): A. MMR B. Polio (IPV) C. Pneumococcal (PCV) D. Varicella E. Rotavirus (RV)

B, C, and E - First MMR is given between the ages of 12-15 months - First varicella vaccine given at a minimum age of 12 month