The Infant: Basic Assessment and Health Promotion - PowerPoint Presentation

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The Infant: Basic Assessment and Health Promotion

Chapter 9

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Basic Terms

NeonateFirst 30 days of life

Infant

First 12 months of life

Mother or parent

Person caring for the infant

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Family 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

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Infant-Parent Attachment

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Attachment

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

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Infant

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

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Binding 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

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Maternal

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

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Stress 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

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Warm 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

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Child 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

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Examples 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

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Nursing 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

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Family 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

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Neonate and Infant

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Physical 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

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Physical 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

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Nutritional 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

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Benefits 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

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Formula

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

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Water

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

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Feeding

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

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Sleep

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

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Importance 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

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Play 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

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Health Promotion

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At Birth

Neonate should have antibiotic ointment instilled in eyes

Prevents

gonoccal

or Chlamydia

ophthalmic

neonatorum

Injecting 1mg of Vitamin K helps prevent hemorrhagic

disease

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Immunizations

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

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Dental

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

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Fall 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

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Baby 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

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Psychosocial

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Concepts

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

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Sensorimotor 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

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Sequence 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

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Language 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

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Emotional Development

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Developmental 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

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Trust 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

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Self-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

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Tasks 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

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Tasks 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

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Hospitalized 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

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