www.healthychildren.org
Physical
Raises head & chest when on stomach
Imitates some movements & expressions
Stretches & kicks on back
Opens and shuts hands
Brings hand to mouth
Grasps and shakes toys
Social
Enjoys playing with people
More communicative
More expressive with face & body
Imitates some movements & expressions
Sensory
Follows moving objects
Recognizes familiar objects and people at a distance
Starts using hands and eyes in coordination
Prefers sweet smells
Prefers soft to coarse sensations
www.healthychildren.org
Physical:
Rolls both ways
Sits with and without support of hands
Supports whole weight on legs
Reaches with one hand
Transfers object from hand to hand
Uses raking grasp
Social skills:
Enjoys social play
Interested in mirror images
Responds to expressions of emotion
Appears joyful often
Cognitive thinking:
Finds partially hidden object
Explores with hands and mouth(sensorimotor stage, piaget)
Physical:
Gets to sitting position without help
Crawls forward on belly
Assumes hands-and-knees position
Gets from sitting to crawling position
Pulls self up to stand
Walks holding on to furniture
Social:
Shy or anxious with strangers
Cries when parents leave
Enjoys imitating people in play
Prefers certain people and toys
Tests parental response
Finger-feeds himself
Cognitive thinking:
Explores objects in different ways
Finds hidden objects easily
Looks at correct picture when the image is named
Imitates gestures
Begins to use objects correctly
Leifer ch. 6 and 7
Physical:
Can walk up stairs without support
Speaks about 15 words at 18 months
Social:
Explores world by putting objects in mouth
Toy functions understood
Cognitive:
Points at pictures in books and labels pictures with a sound
Day care can be used without damaging the mother-infant relationship, little evidence to show that daycare slows down cognitive development, recommended that mothers try to spend the first four months with their infant
Culture, religious values, child-rearing practices, language, and health practices are individual to each family, race, or ethnicity
Legislation: mortality rate for infants is an issue. Sudden infant death syndrome is one cause of death in infants(3rd leading cause of death) cause is unknown but could be due to sleeping positions, exposure to tobacco smoke, high body temp. face covered by bedding. Other causes of death are congenital defects and prematurity/low birth weight
MIC-maternity and infant care, WIC-nutritional status of mother and infant
Economics-infant mortality rate is higher in those with low socioeconomic status, those families may have more needs than they can handle and can’t take care of their infants properly
Accident prevention is very important in the care of young children.
Falls are most common after the child is 4 months or older because they are able to move more than before.
Choking and burns are also common causes of injuries.
Most likely cause of AIDS in children is from maternal transmission.
Chemical agents such as drugs left out or even common household plants can be toxic.
Motor vehicles also pose a risk. Infants should be placed in an appropriate car seat with a seat belt.
Radiation exposure could be from xrays, microwave ovens and background radiation.
Cancer is the leading cause of death in children more than 1 yr. old
Transition to motherhood: mood swings are common, there may be feelings of joy and depression(postpartum depression or blues). Usually three phases: taking in, taking hold, letting go(accept the child and new responsibilities)
http://www.cdc.gov/oralhealth/pdfs/BrushUpQuiz.pdf
False. Check with your child’s doctor or dentist about your child’s specific fluoride needs. Parents of a child older than 6 months should discuss the need for a fluoride supplement with the doctor or dentist if drinking water does not have enough fluoride to help prevent cavities.
True. Start cleaning as soon as the first tooth appears. Wipe teeth every day with a clean, damp cloth. Switch to a small, soft toothbrush as more teeth come in.
False. Parents should start using toothpaste with fluoride to brush their child’s teeth at age 2. Toothpaste with fluoride may be used earlier if the child’s doctor or dentist recommends it.
False. Young children should use only a pea-sized amount of fluoride toothpaste. Fluoride is important for fighting cavities, but if children younger than 6 years swallow too much fluoride, their permanent teeth may have white spots. Using no more than a pea-sized amount of toothpaste with fluoride can help keep this from happening.
False. Young children should use only a pea-sized amount of fluoride toothpaste. Fluoride is important for fighting cavities, but if children younger than 6 years swallow too much fluoride, their permanent teeth may have white spots. Using no more than a pea-sized amount of toothpaste with fluoride can help keep this from happening.
True. Children usually do not have the skill to brush their teeth well until around age 4 or 5. Parents should brush their young child’s teeth thoroughly twice a day until the child can handle the toothbrush alone.
False. Fluoride mouth rinses have a high concentration of fluoride. Children younger than 6 years should not use fluoride mouth rinses unless the child’s doctor or dentist recommends it. Young children tend to swallow rather than spit, and swallowing too much fluoride before age 6 may cause the permanent teeth to have white spots.
American Academy of Pediatrics
http://www.cdc.gov/fluoridation/safety/infant_formula.htm
You may use fluoridated water to prepare infant formula. The risk is when your child is exclusively consuming infant formula reconstituted with fluoridated water, there may be an increased chance for dental fluorosis.
Determining if a child needs fluoride supplements is not our call. Refer to the dentist or pediatrician if the water is not fluoridated in the community. Our job is to determine the caries risk of the infant and then refer if needed.
Nutritive sucking is a reflex that allows the baby to feed properly, it is an instinct. Non-nutritive sucking however, is more for comfort and security. Children who suck on pacifiers generally discontinue the habit earlier than children who suck on their thumb. We discourage non-nutritive sucking after age 3 in order to prevent dental malformations.
Can you estimate the age that each of these teeth are seen in the mouth? Can anyone tell me at what age the first tooth erupts in the mouth?
American Academy of Pediatric Dentistry:
18% of American children annually
Used to be called “nursing bottle mouth” but now we know that it is more than an than just from going to bed with a bottle of milk at night. It is an interaction of factors.
ECC is a disease that can unfortunately spread very quickly. Some people do not even view it as a disease, they only see it as a normal part of childhood. But the CDC say that it is the most prevalent infectious disease in our nation’s children. Healthy People 2020’s goal is to reduce ECC’s incidence to 11%
Dental hygienists are in unique position to assess, plan, implement, and evaluate programs to prevent ECC
Did you know that cavitated lesions may occur as early as 10 months of age?
Starting Out Right-Dimensions of Dental Hygiene 2009
Starting Kids Off on the Path to Oral Health-Dimensions of Dental Hygiene, 2008
Research shows a direct correlation between the mother’s oral health status and the oral health of the child. Why do you think this is? Mothers that have a high level of MS are more easily able to transmit the bacteria to the child. The earlier MS is introduced into oral cavity, higher risk for acquiring ECC
MS prefer to colonize on newly erupted teeth – avoid competition with other bacterium.
More erupted teeth present= rise in MS.
Prevention efforts well before 1st birthday a must!
Enamel hypoplasia – incomplete formation of enamel- more prone to decay
Why is breastfeeding on demand a risk factor for developing ECC?
The hygienist is in a position to educate patients about ECC. Many times parents do not make the connection between giving juice or milk at night to a risk of tooth decay. They may not even know that they need to clean primary teeth. Never assume that the patient knows these basic principles. We are not here to judge, only to inform and motivate them to adopt health behaviors (health promotion).
Both the American Academy of Pediatric Dentistry and the Academy of Pediatrics now recommend the first oral health exam at 1 yr old. In 1986, the American Academy of Pediatric Dentistry adopted a position on infant oral health recommending that the first visit occur within 6 months of the eruption of the first primary tooth.3 This bold recommendation was based on the recognition that many children by age 3 years had already experienced dental caries and, more troubling, that those who had experienced caries remained prone to recurrent decay, even with subsequent preventive intervention(Pediatric Dentistry Infancy through Adolescence) The technique will usually be a knee to knee exam where the parent will hold the child in his/her knees and the child’s head will lay on the knees of the hygienist or dentist. Examine the teeth for demineralization or dark spots, do a toothbrush prophy with smear amount of fluoride toothpaste or use prophy cup with fine paste if child will allow. Talk with the parent about diet (limit sugar to mealtime, 4-6 oz juice daily and not in a sippy cup, limit cookies, crackers, and chips) show parents how to brush their teeth and discuss fluoride recommendations with parent and dentist.
Only recommend this to children at high risk for ECC
Smear size versus pea size
Bring juice box to show—4-6oz of juice
Example: mother allows child to drink 1 case of capri sun daily. His father has a hx of diabetes. How can we use motivational interviewing to direct change for the child?
Allow the parents to talk about their baby, don’t judge or tell them what they are doing is wrong. Ask open ended questions like how important is keeping tommy’s teeth healthy? Allow parents to express their frustrations and question them about their own dental experiences as children and what they hope for their child. Reluctance to change established, traditional behaviors = traditional health education is ineffective in changing behavior patterns
May reject health care provider’s best intended efforts
Parents often don’t see behavior as a problem
Ease of application
Brush on 30-60 seconds
Hardens on contact
Can rinse immediately
Teeth can be brushed in 6 hrs.
Lengthy retention time
Low ingestion potential
Talk with her about early childhood caries, diet, toothbrushing techniques, dental visits etc. Consider adding this to the motivational interviewing practice….?
Wilkins p. 787
So as a review, this is a list of some oral pathology findings that you may see in infants. Can anyone describe one of these conditions?
Candidiasis: seen as whitish plaques that wipe off
Congenital epulis: max anterior ridge, a pink smooth pedunculated mass
Bohns nodule: mucous gland remnant, smooth translucent nodule
Epstein’s pearls:
Dental lamina cysts:
Bifid uvula: uvula split in two
Ankyloglossia: “tongue-tied” high frenum attachment
Natal teeth: teeth that are present at birth
Neonatal teeth:
Congenital Epulis of the Newborn
This benign submucosal lesion presents at birth, predominantly in females, and is frequently located in the maxillary anterior area. It is a localized, pedunculated, spongy mass with a smooth surface. A congenital epulis may be the same color as the surrounding mucosa. This condition may cause feeding or respiratory problems. The lesion may spontaneously regress, or excisional biopsy may be necessary. Recurrence is rare.
www.dentalcare.com
Congenital Epulis of the Newborn
This benign submucosal lesion presents at birth, predominantly in females, and is frequently located in the maxillary anterior area. It is a localized, pedunculated, spongy mass with a smooth surface. A congenital epulis may be the same color as the surrounding mucosa. This condition may cause feeding or respiratory problems. The lesion may spontaneously regress, or excisional biopsy may be necessary. Recurrence is rare.
Natal Teeth
Natal teeth (present at birth), or neonatal teeth (erupting shortly after birth), are prematurely erupted teeth. In 85% of the cases, natal or neonatal teeth are normal primary teeth and should be allowed to remain in place unless they are quite mobile.
Riga-Fede disease is an ulcer on the ventral surface of the tongue that is caused by the tongue moving over the sharp edges of natal or neonatal teeth. The infant may experience pain that discourages feeding. The treatment of Riga-Fede disease consists of smoothing the sharp edges of the teeth or removing the teeth as a last resort. The ulcers then heal spontaneously.
Epstein’s Pearl
An Epstein’s pearl is a white pearl-like lesion that is found along the midpalatal raphe. It is thought to be an epithelial remnant along the fusion line of the palatal halves.
A Bohn's nodule is a lesion believed to be related to salivary gland remnants. It appears as a raised area located on the lateral portion of the alveolar Dental Lamina Cyst
A dental lamina cyst is believed to be a remnant of the dental lamina, the embryologic precursors of teeth. It is epithelial in origin. It is found on the alveolar ridge of the maxilla and mandible. No treatment is necessary as the cyst usually disappears after three months.
ridge or between the midpalatal raphe and alveolar crest in the maxilla.
An eruption hematoma presents as a bluish swelling over an erupting tooth and is usually asymptomatic. The follicle surrounding the erupting tooth becomes filled with blood-tinged fluid. Eruption hematomas usually rupture spontaneously and require no treatment. Treatment is indicated when eating is impaired by the size of the hematoma or if pain is present.
Eruption cysts: bluish cyst where tooth erupts
Mucocele: bluish cyst usually seen at the lower lip, trauma to a salivary gland
Traumatic ulcer
Primary herpetic gingivostomatitis: first exposure to herpes virus
Geographic tongue-
Verruca vulgaris-oral wart
Enamel hypoplasia-weakening of the enamel
Fluorosis-usually seen in 8 year olds
White spot lesions-demineralized areas on teeth
Gemination-teeth fused together
