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  • Give an example of a normal sleep-wake cycle for an infant. When does an infant begin to smile? When does the infant begin to drink from a cup? Describe separation anxiety. When does it begin?
  • Why should the nurse obtain an apical pulse for 1 minute on the infant? Describe abdominal respirations.
  • How does an infant relieve tension? Why do infants need to suck? Describe non-nutritive sucking.
  • Describe the grasp reflex. What is prehension? Describe the parachute reflex. What is the pincer grasp?
  • Describe the progression of the different developmental milestones of locomotion, prehension, and perception of the infant from 1 to 8 months.
  • Describe the progression of the different developmental milestones of locomotion, prehension, and perception of the infant from 9 to 15 months.
  • Give an example of when a parent must allow for an infant to be ready for a task. How does a sense of trust promote emotional development?
  • Describe how sensory stimulation is important to the development of an infant’s cognition. Give an example of an infant’s actions which convey a recognition of warmth and affection.
  • Describe a situation in which a nurse must utilize her critical thinking skills when determining if a child is or is not developmentally delayed, if the infant does not fit into the norm.
  • Give an example of how a nurse can assist parents in providing proper care for their infant. How does the nurse influence the community regarding the infant’s health? Why is it beneficial to the community for the nurse to educate and intervene regarding the health of infants in the community?
  • Give an example of when an infant might become lethargic and shut down from a situation. How does the environment affect the irritable or lethargic infant?
  • How does the manner in which the woman is holding the infant in Figure 22-4, D, on page 490, assist the colicky infant? What other measures can soothe a colicky infant?
  • Discuss what the parent can do to teach the infant to self-soothe.
  • What are the guidelines for well-baby checks in the United States? Why are vaccinations encouraged in the United States? Give an example of anticipatory guidance. Why is skin care such an issue for infants? How might the nurse educate parents regarding skin care for the infant who has a diaper rash?
  • Describe a method in which the nurse can assess whether the infant is receiving adequate nutrition. How does the nurse determine whether the infant is receiving adequate nutrition with a mother who is breastfeeding and a mother who is bottle feeding? Describe how growth and developmental screenings assist in illness prevention. Describe an incident in which nutritional counseling would be appropriate from the nurse. Bottle versus breastfeeding was discussed in earlier chapters. It may be helpful to review specific points in this area, including how to heat formula, how to determine if infant is getting enough to eat based on number of wet diapers, ability of infant to sleep, etc.
  • Audience Response Question #1 The reason solids foods are introduced slowly in the infant is to: 1. prevent choking. 2. assess ability to swallow solids. 3. allow the infant to get used to each food. 4. assess for reactions to different foods.
  • Refer to Table 16-3 on page 400 for more detailed information on the various formulas and their nutritional components.
  • Audience Response Question #2 A breastfeeding mother is running a fever of 102 º F. She reports "nasal congestion and sore throat." Should she be instructed to delay breastfeeding her infant? 1. Yes 2. No 3. Not sure
  • Why should new foods not be introduced when an infant is ill? Why is rice cereal preferred over other cereals? Why should baby formula not be mixed with cereal or foods? Why are orange juice, fish, strawberries, chocolate, and egg whites more likely to cause food allergies?
  • Provide a rationale for providing solid foods before milk feedings in the infant. If milk or formula feedings decrease as solid foods increase, how does the nurse determine hydration status?
  • Why do infants require more calories than toddlers, preschoolers, school-age children, and adults? To maintain their rapid growth and development in the first year of life. Why are fats essential for infants?
  • Why should an infant be placed in a rear-facing car seat? What measures can be taken to prevent infant injury from a swimming pool, electrical outlets, stairs, and pets? Describe toys that are not appropriate for an infant.
  • Audience Response Question #3 A newborn's birth weight was 6 pounds. What would you expect this child's weight to be at 6 months? 1. 10 pounds 2. 12 pounds 3. 18 pounds 4. 20 pounds
  • Transcript

    • 1. Chapter 16Chapter 16The InfantThe Infant
    • 2. ObjectivesObjectives• Describe the physical and psychosocialdevelopment of infants from age 1 month to12 months, listing age-specific events andguidance when appropriate.• Discuss the major aspects of cognitivedevelopment in the first year of life.• Relate the nursing responsibilities in healthpromotion and illness prevention in infants inthe first year of life.2Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 3. ObjectivesObjectives (cont.)(cont.)• Discuss the nutritional needs of growing infants.• Compare breastfeeding, bottle feeding, and thevarious infant formulas available.• Describe how to select and prepare solid foodsfor the infant.• List four common concerns of parents about thefeeding of infants.• Discuss the development of feeding skills in theinfant.3Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 4. ObjectivesObjectives (cont.)(cont.)• Compare and contrast natural, organic, andprocessed foods.• Examine nutritional counseling for the infant.• Identify the approximate age for each of thefollowing: posterior fontanel has closed,central incisors appear; birthweight hastripled; child can sit steadily alone; childshows fear of strangers.• Describe normal vital signs for a 1-year-oldinfant.4Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 5. ObjectivesObjectives (cont.)(cont.)• Discuss safety issues in the care of infants.• Discuss the approach and care of an infantwith colic.• Identify age-appropriate toys and theirdevelopmental or therapeutic value.• Discuss principles of safety during infancy.• Discuss the development of positive sleeppatterns.5Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 6. MilestonesMilestones• Describes general patterns of achievement atvarious stages– Often referred to as norms– Nurse must understand normal range formilestone achievement• Establishment of sleep-wake cycle• Social smile• Drinking from cup• Separation anxiety6Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 7. Average Vital Signs of the InfantAverage Vital Signs of the Infant7Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 8. Oral StageOral Stage• Sucking brings comfort and relief from tension• Important to hold infant during feedings• Allow sufficient time for infant to suck• Infants on IV fluid/nutrition need additionalattention and a pacifier to ensure the need forsucking is satisfied• When infants are able to use their hands moreskillfully, they will gradually derive pleasure andcomfort from other sources8Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 9. Motor DevelopmentMotor Development• Grasp reflex disappears around 3 months ofage• Prehension occurs around 5 to 6 months ofage and follows an orderly sequence ofdevelopment• Parachute reflex appears around 7 to 9months as a protective mechanism• Pincer grasp well-established by 1 year ofageElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 9
    • 10. 10Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.The Development of Locomotion,The Development of Locomotion,Prehension, and PerceptionPrehension, and Perception
    • 11. 11Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.The Development of Locomotion,The Development of Locomotion,Prehension, and PerceptionPrehension, and Perception (cont.)(cont.)
    • 12. Emotional DevelopmentEmotional Development• Consistency must be established to developtrust, which is vital to the development of ahealthy personality• Infants who are consistently picked up whenthey cry tend to have fewer crying episodes andless aggressive behavior as toddlers• Infants will easily accomplish various activities ifthey are not forced before they reach readiness• When infant shows readiness to learn a task,parents should provide encouragement12Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 13. Need for Constant Care andNeed for Constant Care andGuidanceGuidance• Sensory stimulation is essential for thedevelopment of the infant’s thoughtprocesses and perceptual abilities• A crying child should be soothed• If the infant appears hungry, do not delay thefeeding in order to adhere to a specificroutine• An infant can recognize warmth and affectionor the lack thereof13Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 14. Development and CareDevelopment and Care• Important to note that no two infants are thesame• Physical patterns cannot be separated fromsocial patterns• Abrupt changes do not take place with eachnew month of life14Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 15. Community-Based Care:Community-Based Care:A Multidisciplinary TeamA Multidisciplinary Team15Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 16. Health PromotionHealth Promotion• Nurse’s responsibilities– Guide parents and assist in the acquisition ofnecessary skills to ensure the healthy growthand development of their infant– Provide appropriate community referrals asindicated16Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 17. Coping with an Irritable orCoping with an Irritable orLethargic InfantLethargic Infant• Whether irritable orlethargic, many of thesame interventionscan be used• An irritable baby criesand may be difficultto soothe• A lethargic baby may“shut down” andsleep in order toavoid an excessivelystimulating (loud ornoisy) environment• Shield infant’s eyesfrom bright light• Sit quietly with infant;don’t talk or sing• Eliminate as muchnoise as possible• Talk in a soft voice• Swaddle snugly• Change infant’sposition slowly• Provide nonnutritivesucking17Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 18. ColicColic• Periods ofunexplainedirritability and cryingin an otherwisehealthy and well-fedinfant18Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 19. Developing Positive Sleep PatternsDeveloping Positive Sleep Patterns• Newborns sleep in 4-hour intervals– By 4 to 6 months, can be up to 8 hours• Synchronizing circadian rhythm of infant tofamily routine is a learned behavior• Position infants on their backs on a firmmattress• Infants rely on parent to soothe them back tosleep if awakened during the night– Assist infant to learn self-soothing behaviors19Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 20. Illness Prevention: ParentIllness Prevention: ParentEducationEducation• Stress importance ofperiodic health checks• Ensure infant receivesrecommendedvaccinations atappropriate times• Provide education andanticipatory guidancefor the developmentalchanges that occur• Stress importance ofchanging diaper when itbecomes wet or soiled• Monitor growth of infantby documentingmeasurements on agrowth chart• Ensure adequate fluidand nutrition areprovided20Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 21. Illness Prevention: PhysicalIllness Prevention: PhysicalExaminationExamination• Physical examination in the clinic setting atleast five times in the first year– Hearing and vision assessments as indicated– Screening tests administered as required– Growth grids and developmental screening– Immunizations– Nutritional counseling– Provide appropriate education and/orexplanations to the parents21Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 22. ImmunizationsImmunizations• Stress repeatedly importance ofimmunizations and timing of administration• Delays can lead to increased risk of seriousillness or even death22Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 23. Nutrition CounselingNutrition Counseling• Solid food can slowly be added beginningaround 6 months of age– The tongue extrusion reflex has completelydisappeared– GI tract is mature enough to digest food• Between 4 and 6 months, sucking is moremature, and munching or an up-and-downchewing/chomping motion ensues23Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 24. Parental ConcernsParental Concerns• Prior to teaching about infant nutrition, thenurse should assess– Parental knowledge– Infant developmental behavior, readiness– Parent-child interaction– Cultural and ethnic practices24Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 25. Breastfeeding and Bottle FeedingBreastfeeding and Bottle Feeding• Human milk is best for infants younger than 6months• Formulas that are cow’s milk based and iron-fortified are recommended by the AAP• Whole cow’s milk not given until after 1 yearof age25Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 26. Absolute Contraindications toAbsolute Contraindications toBreastfeedingBreastfeeding• Galactosemia• Phenylketonuria• HIV-positive mother• Chemotherapy• Radioactive isotope therapy• Illicit drug use• Active, untreated pulmonary tuberculosis26Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 27. Prebiotics and ProbioticsPrebiotics and Probiotics• Prebiotics– Nondigestible foodingredient– Indirectly stimulatesgrowth or activity ofbifidobacterium (amicroorganism)– Assures balance ofbacteria ismaintained• Probiotics– Protective to GItract– Used to treatdiarrhea27Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 28. Safe Bottle FeedingSafe Bottle Feeding• Check expiration date on container• Follow instructions on how to mix, store, andgive formula to infant• Always use clean containers to mix/storeformula• Do not heat bottle in microwave• Do not save formula that is left from afeeding; can lead to diarrhea28Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 29. Adding Solid FoodsAdding Solid Foods• Do not introduce new food if infant is ill, asadverse effects such as allergic reactionsmay not be appropriately identified• Rice cereal is recommended as first food• Do not mix cereal or baby food with formula• Introduce one food at a time in small amounts• Delay introduction of foods known to causeallergic responses, such as orange juice, fish,nuts, strawberries, chocolate, and egg whitesElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 29
    • 30. Nursing TipNursing Tip• New solid foods should be introduced beforethe milk feeding to encourage the infant to trythe new experience• As solid food intake increases, the amount offormula or milk should decrease to avoidoverfeeding30Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 31. Recommended Fat Intake DuringRecommended Fat Intake DuringInfancyInfancy• Infants require almost three times more caloriesper kilogram of weight than adults• Easily digestible fats are needed for growth anddevelopment, including brain development• By age 6 months, the digestive tract has theability to digest fats present in food• A well-balanced diet provides appropriate fat andcholesterol intake• A low-fat diet should not be given to infants under2 years of ageElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 31
    • 32. Health PromotionHealth Promotion• Encourage breastfeeding• Discourage overfeeding• Teach recognition of signs of satiety• Prevent early introduction of solid foods32Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 33. WeaningWeaning• Signs of readiness include– Infant eagerly looks forward to new tastes andtextures found on the spoon– May not want to be held close during feedings– May start to “bite” the nipple as teeth erupt– Imitates parents/siblings• Should be gradual, start with daytime thenprogress to nighttime33Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 34. Organic and Natural FoodsOrganic and Natural Foods• Do not contain any additives– Strict guidelines/regulations on soil, fertilizers,herbicides/pesticides– If animal, no drugs or hormones are used priorto processing• Nutritive value has not been shown byevidence-based research to be superior tononorganic foods• Stress importance of reading food labels34Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 35. Infant SafetyInfant Safety• Car safety– Rear-facing for infants younger than 1 year or 22 lb• Fall prevention– Never leave an infant unattended on a flat surface– Crib rails should be raised and securely locked– Protect from stairways and pools• Toy safety– Should be appropriate for stage of development– No small or removable parts that can be easily swallowed– A child’s response to a toy may indicate readiness to learnnew skillsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 35
    • 36. Summary of Major DevelopmentalSummary of Major DevelopmentalChanges in the First YearChanges in the First Year• Weight doubles by 6months of age and triplesby 1 year of age• Head and chestcircumference are equalby 1 year of age• Maternal iron storesdecrease by age 6months• Depth perception beginsto develop at age 9months• Infants older than 4months can voluntarilyroll over• By age 1 year, infants cantake some independentsteps• Primitive reflexes arereplaced by voluntarymovements• Tooth eruption begins atage 6 months, when“biting” activities beginElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 36
    • 37. Question for ReviewQuestion for Review• What is the best way to reduce the incidenceof sudden infant death syndrome (SIDS)?37Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
    • 38. ReviewReview• Objectives• Key Terms• Key Points• Online Resources• Review Questions38Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

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