When the infant is born they have a cheesy substance called Vernix Caseosa over their body. They may also have birthmarks. Between 48-72 hours after birth, the infant may experience Jaundice which is a yellow coloring of the skin. It is the result of the build up of Bilirubin. It usually requires no treatment and goes away on its own. The sooner the infant is fed and has a bowel movement, the soon Jaundice goes away. It is also important to educate the parents on the appearance of the baby after delivery because most times its not what they expect.
The Apgar test is tested 1 and 5 mins after birth. For each of the 5 categories, they can have a score of 0-2 0 being very poor and 2 being excellent. Just for an example, lets take the heart rate and discuss it. A score of 0 means the HR is absent, a score of 1 means it is slow less than 100 BPM and a score of 2 means its over 100 bpm. If after testing all 5 categories the infant has a score between 0-3 they are in severe distress . If the score is between 4-6 they are in moderate difficulty adjusting to extra uterine life and if the score is between 7-10 they are having no problems adapting.
Child also -lifts head momentarily when prone. -Gains 5 to 7 ounces weekly for 6 months. -Displays tonic neck, grasp, and Moro reflexes.
Child also: -Pays attention to speaking voices. -Assumes less-flexed position when prone -Vocalizes: distinct from crying -Turns from side to back. -Begins to have a social smile. Page 461
Other stages: Page 464
During this developmental stage, the infant learns to trust the primary caregiver. When the infant is hungry, it trusts the caregiver to feed them. The infant develops trust if they are receiving consistent loving care. Mistrust develops when the basic needs are not being met consistently. Therefore it is important to teach parents the importance of responding to the needs of the infant and not to be afraid of “spoiling the child” by responding to their needs.
Its important to educate the mom and setting up a feeding schedule for the infant before being discharged. Infants usually get hungry every 2-3 hours and should not be left more than 4 hours without food.
Breast feeding is also -Cheaper and more convenient than formula -Provides a unique bonding experience for both infant and mother. -Assists in process of uterine involution for mother. -Promotes weight reduction for new mother. Page 474
Skin to skin contact also acts as an insulator keeping baby warm. This picture shows that the father of the child can also be involved in skin to skin contact.
Allows for only skin to skin contact. ASK THEM ABOUT THE BENEFITS!!!!! BENEFITS: Mothers report having an increase output of Breast milk and fewer feelings of helplessness. Infants maintain body temperature and oxygen level. Infants also have fewer episodes of crying and apnea. They are more alert and have higher heart rates.
The newborn sleeps approx 16-18 hours a day and there are 6 states of sleeping. There are deep sleep, light sleep, drowsy, quiet alert, active alert and crying.
TEMP: The room temp should be 24 and the area should be free of drafts. Bathe the infant quickly and only expose necessary areas at a time. GATHER SUPPLIES: Be sure to gather all clothing diapers, unscented mild soaps, cotton balls, towels receiving blanket etc BEFORE HAND. BATHING: Water should be 36-37, don’t hold infant under running water because of change, wash hair after body to prevent heat loss. Cleanse eyes from inner canthus outward using different parts of cloth. Clean the creases under chin, arm, groin. Cleanse ears and nose with twisted moistened cloth. TUB BATH ONLY WHEN UMBILICUS FALLS OFF. CLEANSING HANDS AND FEET: Be sure to wash and dry between fingers and toes CLEANSING GENITALS: Make sure to cleans daily and after voiding and BM. For FEMALES: separate labia and wash from pubic area to anus. For MALES: Do not force foreskin back and cleanse tip with warm water.
At St. Martha’s Hospital, babies receive a full bath in water and then the area is dried when and alcohol applied.
MECONIUM: infants first bowel movement. Occurs first 24-48 hours. Its appearance is black tary. TRNASITIONAL STOOLS: Usually occur around three days after initial feeding. The color ranges from greenish-yellowish to yellowish-brownish, thin and less sticky then meconium MILK STOOL: Usually appears around the 4 th day. In breastfeeding infants it should be yellow to golden, pasty and have an ordor similar to sour milk. In formula fed infants its pale yellow to light brown and must firmer and has a more offensive odor. The infant should also have wet diapers approx 6-10 times a day. SHOW VIDEO....we like to call the video Baby 101...... http://www.youtube.com/watch?v=F6pnTNmveRE
Can anyone name any of the reflexes that are present in the newborn??
The rooting reflex deals with feeding. When the infant is touched on the cheek, lip or corner of mouth with a nipple of finger, they turn their head towards the stimuli and open their mouth.
This reflex is also for survival. If you gently stroke the tounge with a nipple, the infant starts sucking.
When you place you finger in the palm of the infant, they grasp it. Parents really enjoy this reflex because it allows for bonding. This reflex diminishes between 3 and 4 months.
For the Babinski reflex, you stroke the sole of the feet starting at the heel and proceed towards the toes. The infant responds by hyperexting their toes.
The stepping reflex is normally present for the first 3 to 4 weeks. When you hold the infant in a walking position, their feet begin to move as if they are going to walk.
The moro relfex can also be called the startle reflex. If an infant in laying down and they hear a loud noise, they swing their arms and legs outward.
During the tonic neck reflex, when the infant has their head turned to the right, their arm and leg on the same side are extended. This reflex disappears around 3-4 months. FOR OTHER REFLEX PLEASE SEE PAGES 703-706 IN WONG BOOK. VIDEO:http://www.youtube.com/watch?v=gyVLD0hl0XY
The newborn can distinguish sounds frequencies and turns toward a voice or another sound.
You have already seen how sensitive to touch the infant is in their reflexes. Newborn’s responses to touch suggest this sensory system is well prepared to receive and process tactile messages. Birth trauma or stress and depressant drugs taken by the mother decrease the infant’s sensitivity to touch or painful stimuli.
A tasteless solution – no response Sweet solution-eager sucking Sour solution –puckering of lips
We didn’t included the immunization schedule because if you are interested it is on Janis’ W drive The infant is also given a Vitamin K shot soon after birth. Vitamin K is produced my intestinal bacteria and since that it not developed in the newborn for the first few days, a shot is needed to prevent hemorrhages.
As a nurse, when doing a family assessment of a newborn and their family its important to assess how much eye contact baby and parents are having and if the parents voice bring a smile to the newborns face. It is also important to ask the parents how much the infant cries and what their reaction is to the crying. -Ask the parents about their own health and its influence on caring for the infant. -Ellicit what family support systems are present.
It is also important to educate the new mother on feeding, bathing, changing and physical and developmental changes that the infant will undergo.
EDUCATION: The parents education on normal developmental tasks for the baby are important. The parents should both be educated on the different physical changed that the baby undergoes. The mother should also be educated on her nutrition how it can influence the baby. FINANCIAL SUPPORT: Money is important in order to provide the necessities for the baby and the family. Such things as diapers formula etc are expensive. SUPPORT NETWORKS: It is important for the mom and baby to receive support from the partner and family members as well as friends.
Health promotion and the newborn
Growth andDevelopment During Infancy Dr.(Mrs.) S.Valliammal Lecturer College of Nursing NIMHANS Bangalore
Skin of newborn is pink and look healthy. Newborn will have fine textured hair. 80% of newborn may have physiological jaundice (yellow skin)
APGAR Score Permits rapid assessment of the newborn’s transition to extrauterine existence based on five signs that indicate the physiologic state of the newborn: (1) Heart Rate (2) Respiratory Rate A- Activity (3) Muscle Tone P- Pulse (4) Reflex irritability G- Grimace (5) Color A- Appearance R- Respiration
APGAR ScoreSign Score 0 1 2Heart Rate Absent Slow (<100) > 100Respiratory Rate Absent Slow, irregular Good cry hypoventilationMuscle Tone Flaccid Some flexion of Active motion, well extremities flexedReflex Activity No Response Crying ,Some Vigorous cry body motionColour Blue Pale Body pink, pink extremities blue
One Month-Follows and fixes on bright objects with eyes when itmoves within field of vision.-Turns head when prone, but unable to support.-Holds hands in fists.-Grows 1 inch monthly for 6 months.-Cries when hungry or uncomfortable.-Makes small, throaty sounds.
Two Months-Has closed posterior fontanel.-Listens actively to sounds.-Lifts head almost 45 degrees off table when prone.-Follows moving objects with eyes.-Recognizes family faces.
Piaget’s Five Stages ofInfant Development Stage 1: Birth to 1 month -Modification of reflexes Infant practices and perfects reflexes present at birth. Sucking reflex becomes more refined and voluntary.
Eriksons stage ofDevelopment Trust vs Mistrust Birth to one year Develop a healthy personality
Feeding 36-48 Hr to Discharge: A breast feeding and formula feeding mom should be feeding successfully 8-10 times/day.
Advantages of BreastFeeding The correct balance of all essential nutrients for infants. Full of immunological agents to protect against disease. Easier to digest than formula. Contains anti-inflammatory properties. Promotes growth of Lactobacillus bifidus.
Skin to Skin Contact It is helpful to place the infant on the mothers abdomen soon after birth. It helps with spontaneous breastfeeding and allows for bonding.
Kangaroo Care The infant is placed on the mothers bare chest and is only wearing a diaper. It is used for both full term and preterm infants. Benefits……
Normal Sleep Patterns 2-3 Months Low: 10 hours of sleep in 24-Hour period Average: 16 ½ hours of sleep in 24-Hour period High: 23 hours of sleep in 24-Hour period (2 to 4 naps)
Bathing a Newborn Benefits of bathing - complete cleaning of infant. - observer infants condition. - promote comfort and bonding time
Bathing a newborn... Temperatures Gather supplies needed Bathing Cleansing hands and feet Cleansing genitals
Umbilical Cord Care The umbilical cord stump is an excellent medium for bacterial growth and can easily become infected. Common methods of care include use of an antimicrobial agent such as bacitracin or triple dye. Also, use of soap and water or sterile water alone are used. Current recommendations for cord care include cleaning the cord with sterile water or a neutral pH cleanser. The stump and base should be assessed for edema, erythema, and drainage with each diaper change. The stump deteriorates and average seperation time is 10 to 14 days.
Normal development ofhearing After the amniotic fluid drains from the middle ear several days after birth, the infant’s hearing becomes acute. Hearing is one of the better-developed senses in the infant; the fetus can hear in utero and responds to loud sounds. The ability to listen and discriminate among sounds is an important task during infancy. The closer the infant is to the sound, the easier the sound can be discriminated.
Touch The newborn is responsive to touch on all parts of the body. The face (especially the mouth), hands, and soles of the feet seem to be most sensitive.
Taste The newborn can distinguish between tastes, and various types of solution elicit different facial expressions.
Smell Newborns react to strong odors such as alcohol or vinegar by turning their heads away. Breastfed infants are able to smell breast milk and can differentiate their mother from other lactating women by the smell.
Immunizations If the infant is born to an infected mother or to a mother who is a chronic carrier, hepatitis vaccine and hepatitis B immune globulin (HBIG) should be given within 12 hours of birth. For infants born to a hepatitis B-negative woman, the first dose of the vaccine may be given at birth or at 1 or 2 months of age (depending on province of residence).
Family Assessment Process Do the parents and infant have eye to eye contact frequently? How much body contact is present? Does vocalization by the parents evoke a smile from the infant? How much does the infant cry? What is the mother’s reaction? What is the father’s reaction? How does the mother describe the infant’s feeding and sleeping patterns? Does the mother describe the infant’s tasks positively or negatively?
Nursing Interventions Improve family interactions and relationships. Improve family’s ability to cope with stress from the new addition to their family. Praise positive parenting behaviors. Provide adequate nutrition to malnourished infant. Allow parents to vent their feelings about the infant. Refer to appropriate agency for financial, social, or other family needs.
Determinants of Health EDUCATION FINANCIAL SUPPORT SUPPORT NETWORKS
SUMMARY Appearance of Newborn Sleeping, eating, and elimination patterns Reflexes SIDS Car seats Bathing Process
References Edelman, C. L. and Mandle C. L. (2002). Health promotion throughout the lifespan. St. Louis: Mosby Wong, D. L., Perry, S. E., Hockenbery, M.J., Lowdermilk, D. L., & Wilson D. (2006). Maternal Child Nursing Care (3rd ed.). St. Louis: Mosby.