Chapter 9 Basic Terms Neonate First 30 days of life Infant First 12 months of life Mother or parent Person caring for the infant Family Development Birth of child is the first crisis Must change patterns of living and values ID: 931489
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Slide1
The Infant: Basic Assessment and Health Promotion
Chapter 9
Slide2Basic Terms
NeonateFirst 30 days of life
Infant
First 12 months of life
Mother or parent
Person caring for the infant
Slide3Family Development
Birth of child is the first “crisis”
Must change patterns of living and values
Involves a sense of loss
Even when the change is welcomed and anticipated
Need to work on effective communication
Mutually satisfying sexual relationship
Family planning
Slide4Infant-Parent Attachment
Slide5Attachment
AttachmentEmotional tie between two persons
Bonding
Initial maternal emotional tie to the newborn immediately following birth
Engrossment
Father’s initial paternal response to the baby
Slide6Infant
Looking at motherVocalizing
Stretches out arms
Sucking reflex
embracing
Parents
Mother
Put baby face to face
Touching baby
Calling by name
Recognize odor of baby
Father
Interest in baby face
Touch/pick up baby
Feelings of elation
Attachment Behaviors
Slide7Binding In
Critical first hour after birth
Stimulate feelings of attachment
Identification of the infant
Part of, and belongs to mother
Claiming child
Claims child as own emotionally and physically
Polarization
Separating the infant from the mother-fetus unity
Slide8Maternal
Her rearing and culture
Relationship with partner and family
Previous pregnancy experience
Stress/financial worries
Gender/appearance of the child
Depersonalized care
Age of mother
Paternal
Education level
Participate in prenatal class
Role concept
Attendance at delivery
Type of delivery
Early contact
Feeding method
Factors affecting attachment
Slide9Stress indicators for post-partum difficulties
First babyNo support system to help
Complications during pregnancy
Mother’s mother is deceased
In conflict with own mother
Father is away a lot
No previous experience with babies
Slide10Warm Feelings
Calls baby by name
Expresses enjoyment of the baby
Looks at baby enface
Talks in loving voice
Safety precautions
Responds to cues for attention/care
Difficulty
Little or no eye contact with baby
Does not touch or pick up to meet needs
Does not support head
Held at arms length
Calling baby “it” rather than name
Full list pg. 254
Attachment Behaviors
Slide11Child Maltreatment
Demonstrable harm and child endangerment
Includes physical, sexual, emotional, and neglect
Abusive parents may express anger, stress, poor self-esteem, apathy, irresponsibility, or emotional withdraw
Abuse a result of microsystem and
macrosystem
Rejecting
Does not return smiles
Isolating
Leaves child alone for extended periods
Terrorizing
Teases, scares child
Ignoring
Fails to respond to attachment cues from baby
Corrupting
Reinforces bizarre behavior, creates
addictions
Slide12Examples of maltreatment
Shaken baby syndromeHead trauma or death
Seizures
Listlessness/lethargy
Fears loss of support, loud noises, unexpected motion
Munchausen syndrome by proxy
Induces or fabricates illness
Usually done to gain attention for the adult
Slide13Nursing Interventions for attachment
Ask the mother how she is doing
Show nurturance to the father
Make favorable comments about the infant’s progress
Complement the mother on intentions or ability to provide for the baby
Avoid judgmental attitudes
or guilt
statements
Call the child, mother, and father by their names while caring for them
Talk about the pleasure the baby shows in response to the parent’s caring
Reassure parents that positive changes in baby are a result of their care
Slide14Family attachment
Encourage family members such as grandmothers not to take over
Respect role of family members as some cultures have grandmothers in important role
Encourage couple’s autonomy
Assist parents in working with family members, including
grandparents
Slide15Neonate and Infant
Slide16Physical Attributes of Neonate
May have
misshappen
head
Called molding
Fontanels
Anterior- diamond shape at top of head
Posterior- triangle at back of head
Short neck
Large, round abdomen
Head larger than body
Bluish color to hands/feet
Unstable vital signs
Underdeveloped heat regulation mechanism
Respirations50-80Pulse100-160
Sensitive to touch/pain
Vision least developed at birth
Hear normal voice
Cannot hear whispers
Reflexes
Table 9-3 pg. 266
Slide17Physical Attributes of Infant
Head2/3 adult size at 1
yr
Rapid growth
Weight
Doubles 6 months
Triples 12 months
Need tactile stimulation
Vision improves
Respiratory
20-30
Pulse
100-115 – gradual decrease
Muscle strength increases
GI improvesChew, hold/spit out foodVoluntary swallowing
Slide18Nutritional Needs
Feeding is a crucial time to strengthen attachment, baby to feel love, and develop a sense of trust
Types of feedings
Breastfeeding
Formula
Solid foods
American Academy of Pediatrics: exclusive breastfeeding for the first 6 months; breast milk for at least 12 months
Teach about both breast and bottle feeding
Reasons not to breastfeed include
substance-abuse problem,
inability to produce enough milk,
desire to include family in feeding
Slide19Benefits of Breastfeeding
Natural and easily digestible food
Sterile and available
Many nutrients and reduced risk of food allergies
Colostrum helpful to neonates
Denser bone growth and jaw and tooth development
Better neurological and cognitive development
Slide20Formula
Can adequately nourish infantSoy and rice milk should not be used
Cow’s milk unsuitable for infant less than 6 months
Special formulas available
Teach parents how to prepare formula and hold baby and
bottle
Slide21Water
Infants vulnerable to body fluid lossParents should be aware of signs of dehydration
Water should not be substitute for milk
Too much water can cause water intoxication
Slide22Feeding
First week: every 2-3 hours
After first week: every 4 hours
Many physicians recommend later introduction of solid foods (6 months)
Teach parents to avoid overfeeding
Emphasize food and meal time are learning experiences
Teach about nutritional value and potential pollutants
Slide23Sleep
Baby should be placed on back
Longer periods of sleep and wakefulness that gradually become regular
Teach that babies have different levels of arousal and importance of sleep for growth
Teach parents about consistent bedtime routine
Baby needs consistent place for sleep.
Crib – not with adult
No pillows, stuffed animals, bulky blankets
Slats 2.5 inches apart
Babies should be placed on their back or side to sleep to reduce the chance for SIDS with firm mattress
Slide24Importance of Play
Play stimulates development and helps the infant explore and learn about their world.
Hands, feet
Roll
Getting into various positions
Making sounds
Promotes health and holistic development
Clean environment important
Toys should be colorful, safe, sturdy, without dangerous edges, and big enough to avoid ingestion or aspiration
Play stations should be used no more than 20 minutes
Teach parents importance of play and avoiding overstimulation
Slide25Play Activities
1 month
Mobiles, music
2 months
Rattles, cradle gym, soft small toys you squeeze, large wooden toys
7 months
Peek-a-boo, pat-a-cake, noise makers, mirror, reading, walks, water
10 months
Small blocks, objects of color and texture, rides in stroller, parallel play, climbing boxes, kitchen utensils, fill cups with sand, water
12
moths
Open and close things, empty and fill toys, push-pull toys, rag books, balls, nursery rhymes, music
Slide26Health Promotion
Slide27At Birth
Neonate should have antibiotic ointment instilled in eyes
Prevents
gonoccal
or Chlamydia
ophthalmic
neonatorum
Injecting 1mg of Vitamin K helps prevent hemorrhagic
disease
Slide28Immunizations
Essential for disease prevention and health promotion
Immunization schedule changes frequently
Instruct parents about importance of immunizations
Help them get immunizations
Encourage them to keep record
Send mail reminders or call parents
Slide29Dental
Begins with maternal dental care and parental counseling
Avoid giving milk to infant lying in bed
Avoid fruit juice in bottle before 6 months
Oral health examination recommended before 6 months
Use water and soft-bristled brush to clean teeth beginning at 1
year
Slide30Fall Prevention
Keep crib rails up
Maintain firm grasp when carrying the baby
Sturdy infant and car seats
Lock windows so infants cannot crawl out
Baby gates
Keep wires, loose rugs
etc
away from the baby
Remove all breakable objects
Clean spills from the floor
Slide31Baby Proof Home
Poisons,
cleaners out of reach
Keep in original containers
Medications out of reach – especially at GM
Cover all plugs
Don’t leave alone in bathtub
Gate around pool – water in buckets
Keep floor clean of small objects that could be inhaled
Latex balloons
Keep away from stove, heaters
Keep plastic bags and cords away from the baby
Slide32Psychosocial
Slide33Concepts
Babies adapt and react to the environment with which they are confronted
Premature and low weight babies experience developmental delays
Cognitive development
includes thinking, perceiving, remembering, forming concepts, making judgments, generalizing, and abstracting
Slide34Sensorimotor Period
Separation
Infant learns to separate himself from objects in their environment
Object permanence
Realization that objects that leave the visual field still exist
Use of symbols
Infant can think of an object or situation without actually experiencing it
Slide35Sequence of Intellectual Development
Reflex stage
Behavior is entirely reflexive
Primary circular reactions
Stimulus creates a response and gratifying behavior is repeated
Secondary circular
4-8 months
Initiates and recognizes new experiences and repeats pleasurable ones
Intentional behavior is seen
Behavior becomes intentional
Coordination of Secondary Schemata
8-12 months
Uses certain activities to attain basic goals
Sees self as separate from environment,
Parents stimulating the baby will enhance intellectual development
Slide36Language Development
Fetus hears in utero
Pre-speech
sounds
Cooing
Babbling
Squealing, grunting
Lalling
Sucking sounds
Initial vocalizations are reflexive
By 9 months a baby will have made every sound basic to any human language
Infants comprehend more than they say
Infants associate meanings with sounds
Slide37Emotional Development
Slide38Developmental Crisis
Trust
versus mistrust
Development of confidence, optimism, acceptance, and reliance on self and
others
Foster trust by
Prompt, loving, and consistent response to infant’s distress and needs
Positive response to happy, contented behavior
Slide39Trust vs
Mistrust
Newborn & Infant demonstrates trust by
Ease of feeding
Depth of sleep
Relaxation of the bowels – dirty diapers are sign of trust
Overall appearance of contentment
Misturst
Sense of not feeling satisfied emotionally or physically, an inability to believe in or rely on others or self
Slide40Self-concept
Primitive awareness begins at 3 months
End of first year, a sense of separateness of self develops
Body image important and incorporated into self-concept
Initial experiences with body are basis for developing body image and how infant will grow to handle the body and react to others
Slide41Tasks of Infant
Achieve equilibrium of organ systems after birth
Establish self as dependent but separate person from others
Become aware of animate vs. inanimate objects, familiar vs. unfamiliar, and develop rudimentary social interaction
Develop a feeling of and desire for affection and response from others
Adjust somewhat to expectations of others
Slide42Tasks of Infant
Begin to manage changing body and learn new motor skills, develop equilibrium, begin eye-hand coordination, establish rest-activity rhythm
Understand and master the immediate environment through exploration
Develop a beginning symbol or language system, conceptual abilities, and preverbal communication
Direct emotional expression to indicate needs and wishes
Slide43Hospitalized Infant
Need to meet infants needs to foster development of trust
Be aware of both obvious and subtle signs of discomfort such as crying or body tension
Assume en face position when working with the infant
Comfort infant after uncomfortable experiences
Slide44