Ch 29 Nursing Care of a Family with an Infant

The mother of an infant is confused after being told by her dentist not to let her baby go to bed with a bottle of milk. She does not agree with that suggestion. Which response should the nurse prioritize when addressing this situation with the mother?

"Bottles given at bedtime can cause erosion of the enamel on the teeth." The sugar from formula or sweetened juice coats the infant's teeth for long periods and causes erosion of the enamel on the deciduous teeth. While giving water in a bottle at bedtime is acceptable and a pacifier will satisfy the sucking need, the most appropriate response is to warn of possible enamel erosion. Giving a bottle at bedtime is not a factor that leads to obesity.

A nurse is providing health promotion education to a family of an 11-month-old infant who is eating "finger foods." The nurse knows the parents understand the risk of infant choking when they state which response below?

"I can feed our baby Cheerios." Cheerios are a good choice for finger-foods to promote finger-grasp fine motor coordination and self-feeding. Ten to 12 months is a good age to promote self-eating as infants move into mostly solid foods. Popcorn, raisins, and lollipops are choking hazard foods for infants at this age.

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." 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.

After the nurse provides education to new parents about appropriate sleeping habits for infants, which statement by a parent would indicate to the nurse that teaching needs to reoccur?

"My husband gave the baby a special bear that I will place in the crib." The nurse should reinforce that stuffed animals, blankets, pillows, and soft mattresses are suffocation hazards for infants.

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." Iron-fortified rice 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.

A parent asks the nurse if the 2-month-old infant can have bananas yet. The nurse would respond and educate the parent on the nutrition stages of infants by which response?

"You can try bananas 2 or 3 months from now." The nurse will educate the parent to wait 2 to 3 months, because solid foods are not recommended for infants at 2 months of age. The age of 4 to 6 months is when it is recommended to introduce solid foods. In 1 month, the infant will be only 3 month of age. The other responses will not help the parent determine the appropriate answer.

The infant weighs 6 lb 8 oz (2,950 g) at birth. If the infant is following a normal pattern of growth, what would be an expected weight for this child at the age of 12 months?

19 lb 8 oz (8825 g) The average newborn weighs 7.5 lb (3400 g). The average newborn loses 10% of birth weight over the first week of life but regains it in about 10 to 14 days. Most infants double their birth weight by 4 to 6 months of age and triple their birth weight by the time they are 1 year old. If the newborn weighed 6 lb 8 oz (2,950 g) at birth and tripled that weight at 12 months, the infant should weigh 19 lb 8 oz (6.5 lb × 3 = 19.5 lb) or 8825 g.

The infant measures 21.5 in (54.6 cm) at birth. If the infant is following a normal pattern of growth, what would be an expected height for the infant at the age of 6 months?

27.5 in (70 cm) Infants gain about 0.5 to 1 in (1.25 to 2.5 cm) in length for each of the first 6 months of life. Therefore, a 21.5-in (54.6-cm) infant adding 6 in (15 cm) of growth would be 27.5 in (70 cm). Infants grow the fastest during the first 6 months of life and slow down the second 6 months. By 12 months of age, the infant's length has increased by 50%, making this infant 32 in (81 cm) at 1 year old.

A newborn requires skin care that includes bathing. Besides hygiene, what is another reason for bathing the newborn?

Bathing is a time for bonding with the parents. The parents can use bath time for bonding with their newborn. This can be done with talking, cooing, and singing. Bath time should be slow-paced and nonstressful. Newborns prefer interacting with parents over toys and they love to watch people's faces. Bathing can help prevent infection, but it is a secondary response. Using soaps on the skin tends to dry the skin, not moisten it. After bathing, lotion can be applied. It is soothing to the baby and keeps the skin softened.

What mineral is an important factor in tooth development?

Fluoride Fluoride is important for the growth and protection of teeth. Fluoride is available in most drinking water. If the water source does not contain fluoride, then supplements can be given as prescribed by a health care provider, beginning at 6 months of age.

What is the best nutritional supplement for an infant who is 4 months old?

Human milk is the best supplement for this child. Human milk is the optimal nutrition for an infant. This milk is easily digestible, and contains antibodies to help infants form immunities. The AAP recommends breast-feeding until at least 6 months of age for optimal nutrition. They also recommend using human milk to assist and support the child's diet until one 1 year of age.

The nurse is reviewing the diet of an 8-month-old infant with the mother who reveals she has been using evaporated milk to make the formula. Which additional ingredient should the nurse ensure she is including in the formula?

Iron Infants who are fed home-prepared formulas (based on evaporated milk) need supplemental vitamin C and iron. Evaporated milk has adequate amounts of vitamin D, which is unaffected by heat used in the preparation of formula. Calcium and vitamin E would not be a concern in this infant's formula.

Which developmental milestone would the nurse expect an 11-month-old infant to have achieved?

Sitting independently 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.

A new mother expresses concern to the nurse that her baby is crying and grunting when passing stool. What is the nurse's best response to this observation?

"This is normal behavior for infants unless the stool passed is hard and dry." Due to the immaturity of the gastrointestinal system, newborns and young infants often grunt, strain, or cry while attempting to have a bowel movement. This is not of concern unless the stool is hard and dry. Stool color and texture may change depending on the foods that the infant is ingesting. Iron supplements may cause the stool to appear black or very dark green.

The nurse is helping the mother of a 5-month-old boy understand the importance of developmentally appropriate play. Which one of the toys best meets the needs of this child?

A yellow rubber duck for the bath The rubber duck is most appropriate. It is safe, visually stimulating while bobbing on the water, and adds pleasure to bath time. A push-pull toy promotes skill for a walking infant. Pots and pans from the kitchen cupboard are played with successfully after sitting is mastered. A 5-month-old does not have the fine motor coordination to use stacking toys.

A new mother asks for advice from the nurse about bathing her infant. Which of the following should the nurse tell her?

Be sure to wash the infant's face, hands, and diaper area daily. Except in very hot weather, an infant does not need a bath every day. If a parent is tired and would not enjoy bath time or if some days are just too rushed, a complete bath can be omitted, with only the infant's face, hands, and diaper area washed. Some infants do need their head and scalp washed frequently (every day or every other day) to prevent seborrhea, a scaly scalp condition often called cradle cap. If seborrhea lesions do develop, they adhere to the scalp in yellow, crusty patches. The skin beneath them may be slightly erythematous. The patches can be softened by oiling the scalp with mineral oil or petroleum jelly and leaving it on overnight. The crusts can then be removed by shampooing the hair the next morning. A soft toothbrush or fine-toothed comb can be used to help remove them.

The nurse is teaching a new mother about the development of sensory skills in her newborn. What would alert the mother to a sensory deficit in her child?

The newborn does not respond to a loud noise. Though hearing should be fully developed at birth, the other senses continue to develop as the infant matures. The newborn should respond to noises. Sight, smell, taste, and touch all continue to develop after birth. The newborn's eyes wander and occasionally cross, and the newborn is nearsighted, preferring to view objects at a distance of 8 to 15 inches. Holding, stroking, rocking, and cuddling calm infants when they are upset and make them more alert when they are drowsy.

The pediatric nurse is careful to monitor and assess the growth and development of all clients. Which characteristic should the nurse prepare to assess in the infants?

Grows and develops skills more rapidly than at any other time in their life. The infant grows and develops skills more rapidly than he or she ever will again. The toddler insists he or she can do things one minute and then becomes dependent the next minute. The preschool age child soaks in information and asks "why" and "how" over and over. The school-age child has a longer attention span and can become absorbed in a craft or activity for several hours.

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 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) and the booster seat for children from 40 to 80 pounds (18 to 36 kilograms).

The nurse is preparing a presentation for a health fair illustrating the major milestones of infants as they grow and develop. Which fact should the nurse point out when illustrating an infant's teeth?

The first tooth usually erupts by 6 months. The first deciduous teeth, usually the lower central incisors, erupt by 6 months of age, but may be anytime between 4 to 8 months. Swollen or inflamed gums during teething is common. A cold teething ring can help soothe the baby's discomfort. The American Dental Association recommends administration of fluoride to infants and children in areas where the fluoride content of drinking water is inadequate or absent.

The mother of a 3-month-old infant expresses concern that her infant's head is misshapen. Which would be the most appropriate question by the nurse?

"Do you use "tummy time" with the infant?" The appropriate question would be for the nurse to assess whether the mother is placing the infant in the prone position during supervised period of time. This allows for the infant to increase head and neck muscle strength and development of rolling over. It also aids in evening out misshapen or flat heads.

A first-time mother, who is breastfeeding, phones the clinic nurse because she is concerned about her 3-month-old infant's stools. Which statement by the mother would alert the nurse to further assess the situation?

"The stools are foamy and smell terrible." Stools from a breastfed infant are different than from those of a formula-fed infant. The breastfed infant has more frequent bowel movements, the stools appear yellow and seedy, and there is little or no odor to the stool. Foamy or foul-smelling stools may indicate a digestive problem or illness. The health care provider or nurse practitioner should be contacted. All the other statements describe normal stooling for this infant.

A home visit nurse is providing health promotion on safety to a family of a 1-week-old infant. Which of the following statements by the parents indicates the need for further teaching?

"We will position our infant on his side for sleeping." Infants should be placed on their backs for sleeping to reduce the risk of SIDS. All other choices are safe infant practices.

The caregivers of an infant state that their child cries when her mother leaves for even a short amount of time. What might the nurse suggest as a way to console the infant and develop a sense of security when the child's primary caregiver is out of sight?

Play peek-a-boo with the child when happy. For the infant, self-assurance is necessary to confirm that objects and people do not cease to exist when out of sight. This is a learning experience on which the infant's entire attitude toward life depends. The ancient game of "peek-a-boo" is a universal example of this learning technique. It is also one of the joys of infancy as the child affirms the ability to control the disappearance and reappearance of self. In the same manner by which the infant affirms self-existence, she learns to confirm the existence of others, even when they are temporarily out of sight.

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 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.

The nurse is assessing a 12-week-old infant in the clinic at a well-baby visit. Which assessment finding does the nurse predict to assess in this healthy infant?

Smiles at significant others By 12 weeks of age the infant smiles at his or her mother and significant others. The other choices are seen in the infant who is about 20 weeks of age.

What action shows an example of Erik Erikson's developmental task for the infant?

The infant cries and the caregiver picks the child up. Erikson's psychosocial developmental task for the infant is to develop a sense of trust. The development of trust occurs when the infant has a need and that need is met consistently. Crying with a wet diaper without a change of the diaper leads to an unmet need. Playing peek-a boo and smiling are developmental tasks that indicate a normal healthy, happy baby. These would be attributed to Piaget theory.

The nurse is conducting a physical examination of a 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). 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 12-month-old seen at a walk-in clinic weighed 8 pounds 4 ounces (3750 g) at birth. Weight now is 20 pounds 8 ounces (9300 g). The nurse determines:

the child weighs less than expected for age. Birth weight should triple by 12 months. The child should weigh near 24 pounds 12 ounces (11250 g). The child is underweight for age.

A parent calls the clinic nurse asking for recommendations on comfort measures for the infant who is teething. What recommendation(s) will the nurse make? Select all that apply.

topical oral anesthetic teething rings The nurse should recommend teething rings that can be refrigerated and use of a topical oral anesthetic. If used, parents should apply the anesthetic correctly to the gums, avoiding the lips, as these products cause numbing. Occasionally, oral acetaminophen or ibuprofen may be given to relieve pain acetaminophen dosed by the health care provider. All other items create a choking hazard for the infant.

In providing anticipatory guidance related to choking hazards for infants, what should the nurse include in the teaching? Select all that apply.

Propping a bottle Raw carrots Plastic bags 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.

A mother is concerned about her infant's spitting up. Which suggestion would be most appropriate?

"Keep the baby sitting up for about 30 minutes afterward." Keeping the baby upright for 30 minutes after the feeding, burping the baby at least two or three times during feedings, and feeding smaller amounts on a more frequent basis may help to decrease spitting up. Positioning the infant in an infant seat compresses the stomach and is not recommended.

The nurse is assessing a 1-year-old at the well-child annual visit and notes the child is meeting the growth parameters. After noting the birth weight was 8 pounds (3.6 kg) and length was 20 inches (50.8 cm) long, which measurements reflecting height/weight would the nurse expect to document for this visit?

24 pounds (10.8 kg) and 30 inches (75 cm) By 1 year of age, the infant should have tripled his or her birth weight and grown 10 to 12 inches (25 to 30 cm). If this infant was 8 pounds (3.6 kg) at birth, at 1 year, this child should weigh 24 pounds (8 x 3 = 24) and grown to 30 to 32 inches (20 + 10 to 12 = 30 to 32 inches). Most of the growing occurs during the first 6 months with the infant's birth weight doubling and height increasing about 6 inches (15 cm). Growth slows slightly during the second 6 months but is still rapid.

The nurse conducting a 6-month well-baby check-up assesses for the presence/absence of the asymmetric tonic neck reflex. At this age the reflex:

should have disappeared. This primitive (not protective) reflex should be present at birth and disappear around age 4 months.

The mother of an infant questions the nurse about her baby's teething. The nurse provides client education. Which statement by the mother indicates understanding of the information provided?

"The first teeth that will likely appear are the lower incisors." Teeth will begin erupting between 6 and 8 months. Traditionally, the first teeth to erupt will be the lower incisors, followed by the upper incisors. By the age of 12 months, the infant will have between 4 and 8 teeth, if progressing normally.

The English-speaking nurse is assessing a 12-month-old child with an English-speaking father and a Spanish-speaking mother. The child does not use words like "drink" "dog" or "ball." What is the nurse's priority intervention?

Asking the mother if the child uses Spanish words for those items Infants in bilingual families may use some words from each language. Therefore, the priority intervention in this situation would be to ask the mother if the child uses Spanish words. There is not enough evidence to warrant performing a developmental evaluation or referring the child to a developmental specialist. Encouraging the parents to speak only one language to the child is unnecessary if the child is progressing with both.

A breast-feeding mother asks the nurse about when she can begin feeding her 5-month-old infant some solids and vitamins. Which information provided by the nurse would most accurately address this mother's concerns?

The first food offered to an infant is iron-enriched rice cereal and can be started now. Additionally, the infant needs to receive Vitamin D and iron. Breast-feeding is the best method for feeding infants, according The Academy of Pediatrics Committee on Nutrition. However, by 4 to 6 months of age, breast-fed infants need supplements of iron and vitamin D. Solids are introduced at the same age and begins with iron-fortified rice cereal. The infant may also have diluted fruit juice in small portions.

An infant who is 4 months old continues to be seen at doctor visits for illness prevention. What would be the next scheduled appointment that this infant should attend to be evaluated?

The next visit would be at 6 months. The routine schedule for newborn visits within the first year of life is at 1 week, and then at 1, 2, 4, 6, 9, and 12 months of age. The above infant should be seen at 6 months of age for follow-up care and instructions.

The nurse is examining an 8-month-old girl for appropriate development during a regular check-up. Which observation points to a developmental risk?

Uses only the left hand to grasp Favoring one hand over the other may be a warning sign that proper motor development is not occurring in the other arm or hand. Grasping small objects with the entire hand is common at 8 months and precedes the pincer grasp, which is used about 2 months later. Crawling with stomach down and being unable to pull to standing are abilities that may not occur for another 4 to 8 weeks.

A staff nurse is talking about Piaget's theory with a nursing student. Infants are in the sensorimotor stage of cognitive development during which object permanence is mastered. An example of an infant displaying this ability is:

looking for a toy in her crib at the last place she saw it. Looking for the toy where it was last seen indicates object permanence. The infant knows the object still exists even though she cannot see it. All the rest of the infant's behaviors show use of her senses and motor activity but do not illustrate object permanence.

The nurse in a community clinic is caring for a 6-month-old infant and parent. Which intervention is the priority to promote adequate growth?

monitoring the infant's weight and height Monitoring the infant's weight and height is the priority intervention to promote adequate growth. Encouraging a more frequent feeding schedule, obtaining the infant's current feeding pattern, and recommending higher-calorie solid foods are interventions when the client's nutrition level does not meet body requirements.

A mother asks the nurse where the microwave is so that she can warm up breast milk to feed her baby. What is the best response by the nurse?

"You should warm the milk under warm water instead." A microwave can heat unevenly and cause burns and therefore should never be used to heat breast milk or formula for an infant. In addition, it can change the immune properties of the breast milk.

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?

"This is a common reaction. Give your child acetaminophen, cuddle him, and apply a cool compress to the injection site." 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 nurse is preparing a list of abilities of 10-month-olds to use in teaching a parenting group. Which ability should appear at this age?

Cruises around furniture At 10 months, this ability appears and is practiced often in preparation for later independent walking. All the rest of the skills take an additional 2 months to develop and appear around age 1 year.

A nurse is talking to and making facial expressions at a 9-month-old baby girl during a routine office visit. What is the most advanced milestone of language development that the nurse should expect to see in this child?

The infant says "da-da" when looking at her father By 9 months, an infant usually speaks a first word: "da-da" or "ba-ba." The other answers refer to earlier milestones in language development. In response to a nodding, smiling face, or a friendly tone of voice, a 3-month-old infant will squeal with pleasure or laugh out loud. By 4 months, infants are very "talkative," cooing, babbling, and gurgling when spoken to. At 6 months, infants learn the art of imitating. They may imitate a parent's cough, for example, or say "Oh!" as a way of attracting attention.