INFANT CARE

Aileen Filoteo-Quiogue, R.N. Lecturer

The newborn.
A sperm and an ovum meet in the velvety softness of a fallopian tube. They fused. A pregnancy begins. After 9 months of waiting, a product of love came out in this world and is called

NEONATES AND INFANTS

Neonates Babies from birth to the end of the first month Infants Babies from one month of age to 1 year

GROWTH AND DEVELOPMENT

Growth

Physical change and increase in size Can be measured quantitatively Indicators: height, weight, bone size, dentition Growth rate is rapid during neonatal, infancy and adolescent stages.

GROWTH AND DEVELOPMENT

Cephalocaudal direction (head-trunklegs-feet) Proximodistal direction (center of the body outward)

GROWTH AND DEVELOPMENT

Development

An increase in the complexity of function and skill progression Capacity and skill of a person to adapt to the environment Behavioral aspect of growth

DEVELOPMENTAL TASK

A task which arises at or about a certain period in the life of an individual, successful achievement of which leads to his happiness and success with later tasks, while failure leads to unhappiness in the individual, disapproval by society, and difficulty with later tasks. (Havighurst, 1972)

Developmental Tasks Infancy and Early Childhood (Havighurst)

Learning to walk Learning to take solid foods Learning to talk Learning to control the elimination of body wastes Learning sex differences and sexual modesty Achieving psychologic stability

Developmental Tasks Infancy and Early Childhood (Havighurst)

Forming simple concepts of social and physical reality Learning to relate emotionally to parents, siblings, and other people Learning to distinguish right from wrong and developing a conscience

INFANCY

Basic Task- Survival

Breathing Sleeping Sucking Eating Swallowing Digesting Eliminating

PHYSICAL DEVELOPMENT

Weight

Birth weight- 2.7 to n3.8 kg (6.0-8.5 lb) 5 months twice the birth weight 12 months thrice the birth weight At birth- approximately the same as head circumference 6 months gain of 13.75 cm (5.5 in) 12 months gain of another 7.5 cm (3 in)

Length (crown-to-rump)

PHYSICAL DEVELOPMENT

Head and Chest Circumference

Important to determine the growth of the brain and skull At birth average head circumference 35 cm (14 in). Chest Circumference usually less than head circumference by about 2.5 cm (1 in) As the infant grows, the chest is larger than head 9-10 months-head and chest about the same After 1 year chest larger

PHYSICAL DEVELOPMENT

Head Molding

Head of newborns are misshapen because of molding Made possible by fontanels and by overriding of sutures Within a week head regains its symmetry 6 months size gradually decreases

Posterior- closes at 2-3 months Anterior- closes at 9-18 months

PHYSICAL DEVELOPMENT

Vision

Newborn Follows large objects and blinks in response to bright lights and to sound 4 months Recognizes familiar objects and follows moving ones 6 months Perceives colors 9 months Recognizes facial characteristics and often smile in response to a familiar face 12 months- Depth perception has developed; able to recognize where a change in level occurs

PHYSICAL DEVELOPMENT

Hearing

React with a startle to a loud sound (Moro reflex) Within a few days, able to distinguish different sounds 5 months - Infant will pause while sucking to listen to the mothers voice 9 months - Able to locate source of sound and recognize familiar ones 1 year - Listens to sounds, begins to distinguish words, responds to simple commands

PHYSICAL DEVELOPMENT

Smell and Taste

Functional shortly after birth Prefers sweet tastes and decrease their sucking in response to liquids with a salty content Can recognize the smell of the mothers milk and responds to this smell by turning toward the mother

PHYSICAL DEVELOPMENT

Touch

Well developed at birth Responds positively to the warmth, love, and security it perceives when touched, held and cuddled. Sensitive to temperature extremes and pain Cannot isolate discomfort

PHYSICAL DEVELOPMENT

Reflexes

Unconscious Involuntary Neither learned nor consciously carried out Nervous system responses to a number of stimuli

MOTOR DEVELOPMENT

1 Month

Lies in flexed position Head lags when baby pulled from a supine to a sitting position Head sags forward when baby is held in sitting position Turns head to side when prone Holds hands in tight fists Can grasp an object placed in the hand but drops it immediately

1 month

Keeps knees tucked under abdomen

When pulled to a sitting position, has gross head lag and rounded swayed back

2 Months

Hold head in same plane as rest of the body

Can raise head and maintain position; looks downward

3 Months

Follows past midline

When raised to a sitting position, shows only slight head lag

MOTOR DEVELOPMENT

4 Months

6 Months

Sits with support Rolls over from front to back Plays with fingers Grasps object held near hand Objects are carried to mouth Turns completely over Hitches- moves backward when in a sitting position by using the arms and back Drops one object when another is offered Transfers object from one hand to another Begins to bang objects

4 Months

Grasps rattle Actively lifts head up and looks around When pulled to a sitting position, no longer has head lag

5 Months

May play with toys Maintains straight back when in sitting position Able to push up from prone position and maintain weight with forearms

6 Months

May sit with legs apart and hands as prop between legs

MOTOR DEVELOPMENT

7 Months

Sits alone on hard surface Holds two toys at once Imitates simple acts of others Holds cup

7 Months

When held in a sitting position, bounces

8 Months

Beginning thumbfinger grasping

Sits securely without support

MOTOR DEVELOPMENT

9 Months

11 Months

Crawls Creeps Drinks from cup with some spilling Holds own bottle Bangs two objects together Stands erect with minimal support Cruises: walks holding on to furniture Removes toys from boxes

8 Months

Practices picking up small objecs

Can pull self into a standing position; unable to let self down again

9 Months

Begins creeping

Abdomen off floor

11 Months

Preparing to walk independently; wide base stance

MOTOR DEVELOPMENT

12 Months

Sits down from standing position alone Stands alone for variable length of time Walks in a few steps with help or alone Good pincer grasp Enjoys eating with fingers Drinks from a cup and eats from a spoon but still requires some help

12 Months

May hold cup and spoon and feed self fairly well with practice

Can offer toys and release them

PSYCHOSOCIAL DEVELOPMENT

Developmental Crisis: Trust vs. Mistrust Infants depend on the parents for all their physiologic and psychologic needs. Fulfillment of these needs is required for the infant to develop a basic sense of trust.

PSYCHOSOCIAL DEVELOPMENT

Developmental Crisis: Trust vs. Mistrust Mothering or Nurturing Behavior Consistent care, handling, stroking, and cuddling

PSYCHOSOCIAL DEVELOPMENT

Developmental Crisis: Trust vs. Mistrust Ways to Enhance Sense of Trust Responding consistently to an infants needs Providing a predictable environment in which routines are established Being sensitive to the infants needs and meeting these needs skillfully and promptly

PSYCHOSOCIAL DEVELOPMENT

Newborn: Displays displeasure by crying and satisfaction by soft vocalizations Attends to adult face and voice by eye contact and quieting

PSYCHOSOCIAL DEVELOPMENT

3 Months Recognizes and smiles in response to caregivers face (social smile) Stops crying when familiar person approaches

PSYCHOSOCIAL DEVELOPMENT

6 Months: Starts to imitate sound. Vocalizes one syllable sounds: mama, da-da.

PSYCHOSOCIAL DEVELOPMENT

9 Months: Complies with simple verbal commands Displays fear of being left alone (e.g. going to bed) Waves bye-bye

PSYCHOSOCIAL DEVELOPMENT

6 Months: Starts to imitate sound. Vocalizes one syllable sounds: mama, da-da.

PSYCHOSOCIAL DEVELOPMENT

Infants have no understanding of waiting and no time frame by which to measure waiting Learn gradually to tolerate stress Oral Stage: Reduce tension by sucking and mouthing objects

COGNITIVE DEVELOPMENT

Perceptual Recognition Respond to new stimuli Remember certain objects and look for them for a short time Concept of both time and space Experiment to reach a goal such as a toy on a chair

MORAL DEVELOPMENT

Associate right and wrong with pleasure and pain

What gives them pleasure is right, since they are too young to reason otherwise. When infants receive abundant positive responses from the parent such as smiles, caresses, and voice tones of approval, they learn that certain behaviors are wrong or good and that pain and pleasure is the consequence

HEALTH PROMOTION GUIDELINES FOR INFANTS

Sensory Stimulation

Touch: holding, cuddling, rocking Vision: colorful, moving toys Hearing: soothing voice tones, music, singing Play: toys appropriate for development

Care of the Cord

Keep the area clean. Keep the area dry.

Exposing the cord to air allows it to dry at its base so it will fall off faster. To prevent irritation from a wet or soiled diaper, make sure that you change your baby's diaper every two hours. Keep the front of the baby's diaper folded down, leaving the cord exposed.

Give sponge baths only. During the healing process, give the baby sponge baths instead of tub baths. Once the umbilical cord has fallen off, you can bathe your baby in a baby tub or sink.

Care of the Cord

Signs of Infection

Appears red and swollen around the cord Continues to bleed Oozes yellowish pus Produces a foul-smelling discharge

Bathing

First two weeks - Sponge Baths Once the umbilical area is healed - Baby can be placed directly in the water

First baths should be gentle and brief as possible

Use warm water Bathing Supplies should be at hand Room should be warm Never leave a baby alone in the bath, even for an instant.

Bathing

If baby enjoys his bath, give him some extra time to splash and explore the water. As baby gets older, the length of the bath will extend until most of it is taken up with play. Bathing should be a very relaxing and soothing experience, so don't rush unless she's unhappy.

TEETHING

Increased drooling Desire to chew on things. For most babies, teething is painless Others may experience brief periods of irritability, crying episodes and disrupted sleeping and eating patterns. As a rule, teething does not cause high fever or diarrhea

Tips to Keep in Mind when Baby is Teething

Wipe your baby's face often with a cloth to remove the drool and prevent rashes from developing. Place a clean, flat cloth under the baby's head during sleep to catch the drool.

Tips to Keep in Mind when Baby is Teething

Give baby something to chew on. Big enough to be swallowed Can't be broken into small pieces. A wet washcloth placed in the freezer for 30 minutes A cool spoon Rubber teething rings but avoid the ones with liquid inside because they may break.

Tips to Keep in Mind when Baby is Teething

Rub baby's gums with a clean finger. Never tie a teething ring around a baby's neck, as it could get caught on something and strangle the baby. If baby seems irritable, paracetamol may help but the pediatrician must be consulted first

DENTAL HYGIENE

Daily dental care should begin even before baby's first tooth emerges. Wipe your baby's gums daily with a clean, damp washcloth or gauze, or brush them gently with a soft, infant-sized toothbrush and water (no toothpaste!). As soon as the first tooth appears, brush them with water. Early dental care helps prevent tooth decay and the child the importance of regular dental care.

Health Examinations

At 2 weeks and at 2, 4, 6, and 12 months Goals: Promote growth and development to their optimum potential Through the promotion of wellness, assist to have fuller and more productive lives

Health Examinations

These goals can be achieved by:

Early disease detection Immunizations Health Education Anticipatory Guidance Counseling Continuity of care

Health Examinations

At 2 weeks and at 2, 4, 6, and 12 months Goals: Promote growth and development to their optimum potential Through the promotion of wellness, assist to have fuller and more productive lives

Protective Measures

Immunizations Fluoride Supplements Screening for tuberculosis Prompt attention form illnesses Appropriate skin hygiene and clothing

Immunizations

BCG - at birth DPT,OPV- started at 6 wks and one thereafter (3 doses) Hep B - started at 6 wks and one thereafter (3 doses) Anti-measles - 9 months

Infant Safety

Importance of supervision Car seat, crib, playpen,, bath, and home environment safety measures Feeding measures (e.g. avoid propping bottles) Providing toys with no small parts or sharp edges

Nutrition

Breastfeeding and bottle-feeding techniques Formula preparation Feeding schedule Introduction of solid foods Need for iron supplements at 4-6 months

Signs of Underfeeding

Baby's skin remains wrinkled well into the first month of life, and the baby's face does not seem to fill out (this may signal inadequate weight gain) The baby does not appear to be satisfied, even after a complete feeding

Warning Signs of Overfeeding

Vomiting after a complete feeding Frequent loose, watery stools

Urine Elimination

As often as every one to three hours, or as infrequently as four to six times a day. Urination should never be painful. In a healthy child, urine is light- to darkyellow in color (the darker the color, the more concentrated the urine; the urine will be more concentrated when your child is not drinking a lot of liquid).

Fecal Elimination

Breastfeeding Babies

Stools should resemble light mustard with seedlike particles. Until he starts to eat solid foods, the consistency of the stools should be soft. Stools usually will be tan or yellow in color. They will be firmer than in a baby who is breastfed but no firmer than peanut butter.

Formula-Fed

Fecal Elimination

Hard or very dry stools

May be a sign that he is not getting enough fluid, or that he is losing too much fluid due to illness, fever or heat. Once he has started solids, hard stools might indicate that he's eating too many constipating foods, such as cereal or cow's milk, before his system can handle them.

Occasional variations in color and consistency of the stools are normal.

Layette

3 or 4 pajama sets (with feet) 6 to 8 T-shirts 2 sweaters 1 sleeping bag 2 bonnets 4 pairs of socks or booties 4 to 6 receiving blankets 1 set of baby washcloths and towels (look for towels with hoods) 3 to 4 dozen newborn-size diapers (plus diaper pins and 4 plastic pants if you use cloth diapers)

Rest and Sleep

20% of the whole 24 hours spent on sleeping Establish sleep and rest patterns

PLAY

Importance of Play

The child grows, develops, learns, and ultimately matures Children develop their physical and intellectual abilities They develop moral values through playing with others Play can develop creativity Play can provide a therapeutic release from stresses and tensions produced by environmental influences

SELECTION OF TOYS

No sharp edges that can cut No sharp points that can puncture No propelled objects that can injure eyes No small parts that can be swallowed or inhaled

SELECTION OF TOYS

No excessive noise, which could damage hearing No elements that can cause blindness No toxic paints or other toxic materials

HEALTH PROBLEMS

Infant Colic

An acute abdominal pain caused by periodic contractions of the intestines. Occurs in infants under 3 months of age and for most infants disappears at 3 months of age Factors associated with colic

Swallowing air Feeding too rapidly Allergies Taking excessive amounts of carbohydrates Infant emotional distress Anxiety of the caregiver

HEALTH PROBLEMS

Infant Colic

Management

Position infant on the abdomen Provide a quiet atmosphere Smaller and more frequent feedings Burping infants well during and after feedings Holding the infant upright over the shoulder Placing infant in an upright seat after a meal Turning the infant frequently when in the crib

Prevention

HEALTH PROBLEMS

Regurgitation

Vomiting

Maybe considered normal during the first 6 months of life Head should not be lower than the body when the infant is returned to the crib after a feeding because the gastroesophageal reflux is common during the first six months Bringing up an appreciable amount of the feeding some time after it was taken May lead to dehydration and electrolyte imbalance

HEALTH PROBLEMS

Regurgitation and Vomiting

Management and Prevention

Place infant in a side lying position when returned to the crib after feeding Protect skin around the infants mouth and on the chin and neck if regurgitation is persistent

Change bibs frequently

How to Prevent Regurgitation

Make each feeding calm, quiet and leisurely. Avoid interruptions, sudden noises, bright lights and other distractions during feedings. Burp the bottle-fed baby at least every three to five minutes during feedings. Avoid feeding while your infant is lying down. Place the baby in an upright position in an infant seat or stroller immediately after feeding. Do not jostle or play vigorously with the baby immediately after feeding.

How to Prevent Regurgitation

Try to feed her before she gets frantically hungry. If bottle-feeding, make sure the hole in the nipple is neither too big (which lets the formula flow too fast) nor too small (which frustrates your baby and causes her to gulp air). If the hole is the proper size, a few drops should come out when you invert the bottle and then stop. Keep the head higher than the stomach when feeding to prevent the baby from aspirating in case she spits up

HICCUPS

Change babys position Try to get baby to burp or relax. Wait until the hiccups are gone to resume feeding. If they don't disappear on their own in five to ten minutes, a few sucks of some water should stop them. If baby gets hiccups often, try to feed her when she's calm and before she's extremely hungry to reduce the likelihood of hiccups during the feeding

BURPING

Hold the baby upright with her head on your shoulder, supporting her head and back while you gently pat her back with your other hand.. Sit the baby on your lap, supporting her chest and head with one hand while patting her back with your other hand. Lay the baby on your lap with her back up. Support her head so it is higher than her chest, and gently pat or rotate your hand on her back.

HEALTH PROBLEMS

Diarrhea or Loose Stools

Prevent dehydration

Increase fluid intake

Continue breastfeeding Give other fluids such as boiled water, fruit juices, am, oral rehydration salts

If diarrhea is caused by overfeeding, withhold feedings and solid food temporarily

Observe for blood or mucus in the stool Bring the child to the pediatrician if diarrhea persists

Fever

Perform tepid sponge bath Light clothing. Do not wrap baby. Increase fluid intake Environmental temperature If baby has intermittent/continuous fever, consult a pediatrician

Cradle Cap

Scaling and Redness of the Scalp Management

Shampoo more frequently than before Soft brushing Mineral/ Baby oil may be used but only a little should be rubbed into the scales, and then shampoo and brush out Frequent hair washing with a mild baby shampoo.

Prevention

Sudden Infant Death Syndrome (SIDS)

Crib Death Sudden and unexpected death of an infant Research has shown that sleeping on the side or back, not prone, greatly decreases the risk of SIDS

Sudden Infant Death Syndrome

Place your baby to sleep on his or her back. Babies who sleep on their backs have a much lower risk of dying from SIDS and suffocation. Remove all soft bedding from the crib. A baby can suffocate from soft bedding in a crib. Be sure to remove all pillows, quilts, comforters, and sheepskins from your crib. Put your baby to sleep in a safe crib.
A safe crib is the best place for your baby to sleep. Make sure your crib has:
no missing or broken hardware no corner posts over 1/16" high no cutout designs in the headboard or footboard a firm, tight-fitting mattress a safety certification seal (on new cribs)

5 As in Providing Care to a Child

Affection Acceptance Attention Approval Appreciation

Points to Remember in Caregiving

Every child is unique. His growth is orderly and continuous. The rate of growth is not constant. The child develops as a whole person. Heredity, maturity, and environment. influence the level of development attained.

Duties and Responsibilities of a Child Caregiver

Give the child affection, companionship, and understanding. Teach the child the importance of good moral values, self discipline, and religious instruction. Inculcate in their minds to learn the value of industry, thrift, and self reliance Be the childs model, thus always set good examples