Ch 10 - Health Promotion of the Infant and Family

The nurse is assessing a 6-month-old healthy infant who weighed 3.2 kg at birth. The nurse would expect the infant to now weigh approximately how many kilograms?

6.3 kg Birth weight doubles at about ages 5 to 6 months. At 6 months, a child who weighed 3.2 kg at birth would weigh approximately 6.3 kg. The infant would have gone from the 50th percentile at birth to below the 5th percentile; 5.2 kg is too little. The infant would have tripled the birth weight by 6 months; 8.7 kg to 9.6 kg is too much.

What behavior indicates that an infant has developed object permanence?

Actively searches for a hidden object During the first 6 months of life, infants believe that objects exist only as long as they can see them. When infants search for an object that is out of sight, this signals the attainment of object permanence, whereby an infant knows an object exists even when it is not visible. The ability to understand cause and effect is part of secondary schema development, which is a later developmental task. Between ages 8 and 12 weeks, infants begin to respond differentially to their mothers. They cry, smile, vocalize, and show distinct preference for the mother. This preference is one of the stages that influences the attachment process but is too early for object permanence. Recognizing familiar objects is an important transition for the infant, but it does not signal object permanence.

A mother tells the nurse that she is discontinuing breastfeeding her 5-month-old infant. What does the nurse recommend based on the American Academy of Pediatrics?

Commercial iron-fortified formula For children younger than 1 year, the American Academy of Pediatrics recommends the use of breast milk. If breastfeeding has been discontinued, then iron-fortified commercial formula should be used. Cow's milk should not be used in children younger than 12 months. Maternal iron stores are almost depleted by this age; the iron-fortified formula will help prevent the development of iron-deficiency anemia.

The nurse is assessing a 6-month-old infant who is noted to have head lag. What is the appropriate response documentation in the chart related to this finding?

Developmental, neurologic evaluation referral Most infants have only slight head lag when pulled from a lying to a sitting position at 4 months of age. By 6 months, head control should be well established. Developmental neurologic evaluation is indicated to determine why the child is not achieving an expected milestone. The head lag is suggestive of a developmental delay. It does not provide information about cognitive status. As part of normal development, interventions cannot be done until a cause is identified.

What information would the nurse give a mother regarding the introduction of solid foods during infancy?

Foods should be introduced one at a time at intervals of 5 to 7 days. One food item is introduced at intervals of 5 to 7 days to allow the identification of food allergies. Iron-fortified cereal should be the first solid food introduced into the infant's diet. Mixing solid foods in a bottle has no effect on the transition to solid food. Solid foods can be introduced earlier than 8 to 10 months. The extrusion reflex usually disappears by age 6 months.

The nurse is providing information to parents asking about selecting a daycare facility for their child. What does the nurse instruct the parents as important to consider when making the selection?

Health practices of the facility Health practices should be most important. With the need for diaper changes and assistance with feeding, young children are at increased risk when hand washing and other hygienic measures are not consistently used. A structured learning environment is not the highest priority for a child this age. The socioeconomic status of the children should have little effect on the choice of facility. Cultural similarities may be important to some families, but the facility's health care practices are more important.

Sara, age 4 months, was born at 35 weeks of gestation. She appears to be developing normally, but her parents are concerned because she is a "more difficult" baby than their other child, who was full term. What response by the nurse is appropriate?

Infants become less difficult if they are kept on scheduled feedings and structured routines. Children perceived as difficult may respond better to scheduled feedings and structured caregiving routines than to demand feedings and frequent changes in routines. Infant temperament has a strong biologic component. Together with interactions with the environment, primarily the family, the biologic component contributes to the infant's unique temperament. Sara's temperament has been created by both biologic and environmental factors. The nurse should provide guidance in parenting techniques that are best suited to Sara's temperament.

The clinic is loaning a federally approved car seat to a 4.5-kg (10-pounds) infant's family. Where does the nurse teach the family is the most appropriate location to place the infant car seat?

Middle of the back seat facing rearward. The rear-facing car seat provides the best protection for an infant's disproportionately heavy head and weak neck in the event of an accident. The middle of the back seat is the safest position for the child. Severe injuries and deaths in children have occurred from air bags deploying on impact in the front passenger seat.

What reflexes appear at about 7 to 9 months of age?

Parachute The parachute reflex appears at 7 to 9 months of age and persists indefinitely. The Moro reflex is one of the primitive reflexes present at birth. Neck righting appears at 3 months of age and persists until 24 to 36 months. Labyrinth righting appears at 2 months and is strongest at 10 months.

The parent of a 10-week-old infant tells the nurse, "She cries sometimes when nothing is wrong—for example, when she is dry and has recently been fed." What is the appropriate response by the nurse?

Reassure the parent that periods of "unexplained fussiness" can be normal A crying infant can be a source of great distress for parents. There is great variability in the amount of crying that can be expected from an infant. Parents should be reassured that some crying without apparent cause is normal. Persistent and inconsolable crying may need further attention. Reassuring the parent that nothing is wrong negates the parent's concern about the child. The parent is responding to cues from the infant by feeding and changing diapers. There is no evidence that an attachment issue exists. The parent is seeking information about how to care for the infant.

The parents of a 3-month-old girl complain to the nurse that they are exhausted because she still wakes up as often as every 1 to 2 hr during the night. When she awakens, they change her diaper, and her mother nurses her back to sleep. What would the nurse suggest to help them deal with this problem?

Start putting her to bed while still awake and while the parent is present Current research suggests that parents be present at bedtime until the child is drowsy. The child should then be allowed to fall asleep alone. This encourages self-soothing behaviors. Children who learn to fall asleep on their own have longer sustained sleep periods than those who fall asleep with parents present. Letting the child cry herself back to sleep is difficult to implement for many parents. Co-bedding could be unsafe at this age. The type of feeding will not affect the child's sleep pattern.

The nurse is assessing a 7-month old infant during a well baby exam. What does the nurse anticipate for fine motor development for this infant?

Transfer objects from one hand to the other The ability to transfer objects from one hand to another occurs at about age 7 months. The infant can use one hand for grasping and hold a cube in the other at the same time. A crude pincer grasp develops by ages 8 to 9 months. The ability to hold a crayon and mark on a piece of paper develops between ages 12 and 15 months. Infants can release a cube into a cup at ages 9 to 12 months.

What is the primary task of development in infancy, according to Erikson's stages?

Trust During the first year of life, the infant focuses on the task of developing a sense of trust of self, of others, and of the world. This presents challenges for infants who are separated from parents or consistent caregivers. Industry is the focus of school-age children. Preschoolers are engaged in acquiring initiative. Autonomy is a developmental task during the toddler years.