Common health problems that

develop during infancy

Imperforate anus
Known as the stricture of the anus
Problems occur in 1:5000 live births
More common in males
Occur as an additional complication of Spinal
cord defects.

Assessment
May reveal no anal formation
Abdominal distention is evident
No stool will pass
Absent of wink reflex

Diagnostic
X- ray
Sonogram
Urinalysis


Therapeutic management
Surgical repair
Post-op care
- No rectal temp taking
- Stool softener is given
- Place a diaper under but do not put on
- Side-lying position
- May need rectal dilatation once or twice a day

- Instruct parents in care ofcolostomy

Nursing priority:
- Record the first passage of meconium stool. If
infant does not pass stool within 24 hours,
further assessment is required.

Cleft Lip
- A fissure of the upper lip to the side of the
midline, which may vary from a slight notch to
a complete separation extending into the
nostril; may be unilateral or bilateral

- Caused by failure of the maxillary process to
close in early fetal life; usually occurs during
the 6
th
week of gestation

- Increased incidence in males; occurs in about
1:800 live births

Assessment:
- Visible at birth an incompletely formed lip

Treatment:
- Surgical repair is done early (2-6 months)


Nursing intervention
Goal: To provide preoperative care
A. Maintain Nutrition
- Use a large-holed nipple or a modified nipple
- Feed slowly
- Burp frequently
- Rinse cleft with water every after feeding
- Elevate head of bed, put pillow under the
mattress
B. Prepare parents for newborns surgery
- Encourage parents to position infant flat on
back or side
- Encourage parents to place infant in arm
restraints periodically
- Encourage parents to feed infant with the
same method
Goal: To provide postoperative care
A. Prevent trauma to suture line and maintain
patent airway
- Observe for respiratory distress
- Provide suction equipment at bedside
- Position on side or back and elevate head of bed
- Used soft elbow restraints
- Cleanse suture line after each feeding: use
cotton-tipped applicator and roll along the
suture line
- Prevent any crust or scab formation on lip and
suture line

B. Provide for adequate nutrition
- Feed in an upright position
- Feed slowly ( burp at frequent intervals)
C. Provide discharge teaching to parents
- Encourage to cuddle and play infant to
decrease crying
- Provide referrals to speech therapist

Cleft Palate
- Failure of fusion of the secondary palate; may
involve the soft and hard palates along with
the alveolar (dental) ridge.

- Generally associated with low birth weight
infant, increased incidence of other
malformations especially GI tract defects

assessment
Opening in roof of mouth; usually associated
with cleft lip
Sucking difficulties
Breathing problems
Later problems:
- Speech and hearing difficulties
- Increased incidence of URTI and otitis media
Treatment
Surgical: may be done in stages
- Usually repaired around 18 months to allow
for bone growth; some are delayed until 4
years.

Nursing intervention
Goal: To provide preoperative care
A. Maintain nutrition
- Use a modified nipple for feeding( lambs
nipple, brecht feeder, cup)
- Feed child in semi-upright position
- Cleanse mouth after feeding with water
B. Prevent infections
C. Provide support and teaching to parents

Goal: To provide postoperative care
A. Maintain patent airway
- Observe for respiratory distress
- Position on side or abdomen to provide
drainage of mucus
B. Prevent injury and trauma to suture line
- Restraints: Elbow infant, jacket older child
- Avoid use of straw, suction catheter, tongue
depressor, pacifiers or spoons
- Decrease crying
C. Maintain nutrition
- Give fluids initially, then advance to diet based
on age
- Older child: not allowed to eat hard items
such as: crackers, potato chips
- Cleanse mouth after each feeding with water
D. Provide guidance to parents
- Provide emotional support
- Provide referrals to speech and orthodontist
as needed

Spina bifida
- Congenital anomaly of the spinal cord characterized
by nonunion between the laminae of the vertebrae.
- A neural tube defects results in midline defects and
closure of the spinal cord
- Most common site is lumbosacral area
TYPES
1. Spina bifida occulta
a. Noncystic spina bifida
- Results on failure of the spinous processes to join
posteriorly in the lumbosacral area, usually around
L5 and S1
b. Neuromuscular disturbances may be
apparent with foot weakness, bowel and
bladder sphincter disturbance, and numbness
and tingling of the extremities.
c. Infant may have no apparent clinical
manifestations.
- Dimpling on the site
2. Spina bifida cystica
a. Meningocele: a sac-like cyst of meninges
filled with spinal fluid that protrudes through
a defect in the bony part of the spine.
b. Myelomeningocele: a sac-like cyst containing
meninges, spinal fluid, and a portion of the
spinal cord with its nerves that protrudes
through a defect in the vertebral column;
other defect most frequently associated with
hydrocephalus.
- Paralysis of lower extremities
- Musculoskeletal deformities
- Neurogenic bladder and bowel

Risk factors
- Maternal Folic-acid def.
- Previous pregnancy affected by neural tube
defect
Etiology
- Combination of unknown
genetic/environmental factors
- Advanced maternal age
- High levels of AFP (alpha-feto protein)

Diagnostics
Ultrasound
CT scan
Prenatal diagnosis: AFP elevated
- Normal AFP level (>30 mg/dl)


Treatment
A. Occulta: no treatment
B. Meningocele/meningomyocele:
- Surgical
- Closure of defect with 24-48 hours to
decrease risk of infection, relieve pressure,
repair sac, and possibly insert a shunt.


Nursing intervention
Observe for irritation, CSF leakage and signs of
infection
Maintain asepsis; cover lesion with moist
sterile dressings
Position patient on the abdomen or
semiprone with sandbags
Provide optimum skin care, especially to
perineal area

Detect early development of hydrocephalus
- Measure head and check circumference
frequently
- Check fontanels for bulging and separation of
suture line
Check for abnormal movement of extremities,
absent or abnormal flexes, incontinence, fecal
impaction, flaccid paralysis or lower
extremities
Observe for increased ICP
Observe for signs of meningeal irritation

Provide parental bonding and education
regarding proper positioning, feeding, skin
care and exercises.
Teach the parents credes maneuver to
prevent urinary retention


Hydrocephalus
A congenital or acquired condition
characterized by anincrease in the
accumulation of CSF within the ventricular
system.
Causes:
- Neoplasm
- Aqueductal stenosis
- Spina bifida
- Congenital cyst/ vascular malformations
Types
A. Communicating
- Due to increased production of CSF or
impaired absorption of CSF
B. Non-communicating
- Due to obstruction/blockage of CSF
circulation between ventricles and
subarachnoid space

assessment
Fronto-occipital circumference increases at
abnormally fast rate
Split sutures and widened distended, tense
fontanelles
Prominent forehead, dilated scalp
Sunset eyes, nystagmus
Irritability, vomiting
Unusual somnolence

Convulsion
High-pitched cry

Implementation
Operative management
a. Ventriculoperitoneal shunt
- Connection between ventricles and
peritoneal cavity
b. Ventricular atrial shunt
- Connection between ventricles and right
atrium
c. Ventricular drainage
- Provides external drainage of fluid


Observation of shunt functioning (not fnng well:
dilated cerebral veins)
Shunt needs to be modified as child grows
Continual testing for developmental
abnormalities/mental retardation
Discharge planning
- Measure the head circumference: tape measure
Monitor for increased ICP
- LOC earliest sign
- Restlessness
- Pupillary changes
- V/S changes: Inc BP dec Pulse


Intussusception
Telescoping of one portion of the bowel into
another portion
The condition results in an obstruction to the
passage of intestinal contents
INCIDENCE:
Males affected two times more than females
Usually occurs between 3-12 months of age

Assessment
Colicky abdominal pain
Vomiting
Bile-stained fecal emesis
One or two normal stool then currant jelly-like
stools containing blood and mucus
Hypoactive or hyperactive bowel sounds
Tender distended abdomen
Palpable sausage-shaped mass in the upper
quadrant
Therapeutic interventions
Medical reduction by hydrostatic pressure (
barium enema)

Surgical procedure; sometimes with intestinal
resection
Nursing interventions
Monitor for signs of perforation
Insertion of NGT
Administer antibiotics
Start and IV line
Monitor passage of normal brown stool

Colic
Paroxysmal abdominal pain or cramping
Baby cries for longer than 3 hours everyday
for more than 3 days a week
Extreme end of normal crying behavior
The condition is harmless though is can be
distressing to the parents or carers.
Is uncontrollable, extended crying in baby
Incidence
About 20% of babies get colic
Boys and girls equally affected
Often occurs in 1
st
born child and those born
later
Appears around 2-4 weeks of age and can last
for 3 months or longer in some cases.

Cause:
- Unknown
ASSESSMENT
- Characteristics of the cry
- Diet of breastfeeding mother
- When the attack occur in relation to feeding
- Activity of caregiver around time of attack
- Mothers habit such as smoking

Treatment
No single medicine or proven cure for colic
Different babies are comforted by different
measures
Parents who bottle-feed their babies may try a
new formula
Continue breatsfeeding
Carry the baby in front sling or back pack
Warp snugly in a blanket (swaddling)
Take the baby for a car ride or a walk outside
Give a tummy or back rubs
Take a shower together warm water may be
comforting

Hirschsprungs disease
Characterized by a congenital absence of
ganglion cells in the myenteric plexus of the
colon
Congenital aganglionic megacolon
Most common site is the rectosigmoid colon

Risk factors/ Etiology
- Congenital, may be associated with Down
syndrome
ASSESSMENT
- Inadequate or absent peristalsis (Newborn)
- Failure to pass meconium within 24-48 hours
after birth
- Vomiting
- Abdominal distention
- Reluctance to take fluids
Older infant
- Passage of watery stools or diarrhea (ribbon-
like stools)
- Failure to thrive
- Lack of appetite
- Persistent constipation, impactions
DIAGNOSTICS
- Rectal biopsy
- Barium enema

Treatment
Surgical correction involves creation of a
temporary colostomy, then a pull-through of
the colon to a point near the rectum. After the
reanastomosis has healed, the temporary
colostomy is closed.

Nursing intervention
Allow parents to ventilate feeling regarding
congenital defect of infant
Foster parent-infant attachment
Maintain a low residue diet: low fiber, high
calorie, high protein diet
Measure abdominal girth
Administer stool softener as ordered
Careful explanation of colostomy to parents

Care of colostomy
Colostomy: opening of the colon through the
abdominal wall, stool is generally semisoft and
bowel control may be achieved.
- Maintain regular irrigations
- Irrigate colostomy same time each day to
assist in establishing a normal pattern of
elimination

Failure to thrive
Failure to thrive is a delay in physical growth
and weight gain that can lead to delays in
development and maturation.
Failure to thrive is a diagnosis given to children
who are consistently underweight or who do
not gain weight for unclear reasons.
The diagnosis is based on a growth chart
comparison, thorough examination, and
parents' answers to specific questions about the
child's health and environment.
Normal growth:
- Normal child usually 2x their weight by 4mos and
3x by 12mos
CAUSE:
1. Environmental and social factors
- Parental neglect or abuse
- Chaotic family
2. Medical disorder
- Cleft lip and palate - infections
- HIV - intolerance to milk
- GERD


Diagnoses are made in infants and toddlers in
the first few years of life.
Use standard growth chart to plot weight,
length and head circumference
Failure to gain weight for 3 consecutive
months during the first year of life.


Treatment
High calorie diet to catch up growth
Treat the specific cause
Sometimes child may be hospitalized

Trisomy 21
Down syndrome
Characterized by chromosomal abnormality
related to an extra chromosome 21.
CAUSE:
- Unknown
- Associated with maternal age greater than 35
y. o

assessment
Mental retardation
Marked hypotonia
Altered physical development
Large tongue
Simian crease
Slanting eyes
Low set ears
Usually associated with CHD

Diagnostic test
- AFP usually decreased
TREATMENT
- Establish adequate nutrition
- Provide parental education
- Refer parents for genetic counselling

Meningitis
Viral or bacterial infection affecting the
meninges
CAUSE:
- Virus
- Bacteria
- Fungal

Assessment
Headache
Fever
Photophobia
Signs of meningeal irritation
- Nuchal rigidity
- Kernigs sign
- Brudzinskis sign
- Opisthotonic position
Changes of LOC
Seizures
Special symptoms in infants
- Refuse feedings, vomiting, diarrhea
- Bulging fontanelles
- Vacant stare
- High-pitched cry


Implementation
Medications
- Antibiotic penicillin (DOC)
- Antifungal amphotericin
- Mycobacterium INH, streptomycin
NURSING INTERVENTION
- Implement strict isolation until first 24 hours
of antibiotic treatment
- Refer to audiologist



Wilms Tumor
Nephroblastoma
Most common intraabdominal tumor in
children associated with congenital anomalies
especially in the genito-urinary tract
Associated with genitourinary anomalies
Majority of children (80%) are younger than 5
years, peak incidence at 3 years


Assessment
Swelling or mass on the abdomen
Painless abdominal tumor (first sign)
Abdominal pain as tumor enlarges
Fever
Nausea and vomiting
Blood in the urine
Hypertension


Diagnostics
Biopsy
Ct scan
MRI
X-ray

Treatment
A. Surgery
- Is frequently scheduled within 24-48 hours
after the diagnosis.
- Nephrectomy: Kidney is removed but the
adrenal gland may be spared, depending on
the invasiveness of the tumor.
If both kidneys are involved the less affected
kidney is retained, bilateral nephrectomy is
the last resort.

Nursing intervention
Nsg. Priority: POST A SIGN ABOVE THE BED
THAT READS: DO NOT PALPATE ABDOMEN
Handle the child carefully to prevent trauma
to the tumor site.
Prepare the child for the surgery, including
anticipation of a large incision and dressing.
Assess V/S especially BP
Refer parents to a geneticist

Poisoning
Aspirin Poisoning
Lead poisoning
Tylenol poisoning

Assessment:
1. ABC rule
- Treat the patient first then the poison
2. Identify poison
- Amount and time of ingestion


3. Diagnostics
- Urine and serum analysis
- Long-bone x-rays if lead deposits is suspected
- CT scan and EEG

Implementation
1. Prevention
a. Child proofing
- Store all potentially poisonous substances in
locked-out-of-reach area
b. Increased awareness of precipitating factors
- Growth and development characteristics
under/overstimating the childs capabilities
- Changes in household routine
- Condtions that increase family tension of
family members
2. Instructions for caretakers in case of
suspected poison ingestion
a. Recognize signs and symptoms of accidental
poisoning
- Change in childs appearance/behavior;
presence of unusual substances in childs
mouth, hands, play area, burns, blisters or
suspicious odor.
b. Initiate step to stop exposure
c. Save any substance, vomitus, stool and urine

d. Induce vomiting if indicated
3. Ipecac direct stimulation of vomiting center
and gastric irritant;
a. dose:
9-12months -10ml do not repeat
1-2 years old 15ml
12 years and older 30 ml
b. Follow each dose with a clear fluids (4-8oz)
c. Position childs head lower than the chest to
prevent aspiration

d. Repeat once every 30 minutes for child over
than 12 months
e. If no vomiting after 2 doses, transfer to ER
f. Contraindications to inducing vomiting
- When child is danger or aspiration
- When substance is petroleum distillate or
strong corrosive substance
g. General considerations
- Water may be used to dilute the toxin: avoid
giving large amounts of fluid when medication
has been ingested

- Milk may delay vomiting
4. Emergency care
a. Basic life support
- Respiratory
- Circulation
b. Gastric lavage
c. Activated charcoal : 5-10gms for each g of toxin
- Give within 1 hour of ingestion and after emetic
- Mix with water to make a syrup