ELECTIVE - 1Parent – Child Nursing

PARENTING INFANTSDEVELOPMENTAL EVENTS IN INFANCYA. Learning Self-regulated Behaviors

Feeding• Sucking reflex is one of the earliest to appear during prenatal development; this reflex is elicited by almost any stimulation to the lips, cheeks, or mouth areas.• One of the initial decisions in providing care at this time must be whether to breast or bottle-feed the infant.• Most normal infants required feeding once every 3 or 4 hours the first few months after birth.• Babies generally feed themselves when they are able to hold a cup and drink from it as well as coordinate their hands to bring food to their mouths.

Weaning• The shift from liquid to solid foods• Most infants are weaned when several signs indicate readiness to begin taking solid foods. These signs include drinking from a cup, grasping a spoon easily, drinking more than a quart of formula daily, and enjoying playing with food.• A major concern in the weaning process is providing an adequate amount of protein and iron in the infant’s diet to meet growth requirements. Lack of adequate sources of these nutrients in infancy can lead to malnutrition and eventually result in permanent damage.• The first solid food normally given is strained cereal mixed with stained fruit; it may be introduced slowly to the baby once a day for a week or so and gradually increased to twice a day.• Strained foods such as vegetables and meat are gradually introduced between 3-6 months of age• Finger foods and foods that can be easily manipulated by spoon are introduced at 9 months of age. These include pudding, creamed food, and others

Sleeping• Sleep during the first several months after birth is interrupted only long enough for the baby to be fed. This pattern of alternating periods of sleeping with feedings changes to longer intervals of wakefulness during the third month.• During the remainder of the time until the baby approaches its second year, sleep needs decrease to 10-14 hours daily.

Basic Motor and Locomotor Skills• Control over the muscles of the body appears first in the head region and proceeds to the feet (cephalocaudal) and from the trunk region out to the extremities (proximodistal). • During the first month, the baby’s movements are random.• Reflex activity in the neonatal and early infancy period assists the individual in becoming ready to walk.

• Accompanied by the maturation of muscle groups and nerve fibers, the development of upright locomotion occurs by sequences of events following the cephalocaudal pattern.• Typically, girls ca be observed to walk at an earlier average age than boys. The usual range among girl infants is between 10-14 months whereas for boys it occurs between 12-16 months.

B. Establishing a Sense of Basic Trust Basic trust emerges through different interactional activities between the mother and baby. The feeding situation provides ample opportunity for the infant to explore the caregiver through vision touch. A consistent caregiver who holds the infant in a consistent manner, and who has a consistent pattern of behavior during feeding enables the infant to learn to trust.

This early discovery of a consistent pattern of life helps the infant predict that certain events or sensations will occur if he/she behaves in particular ways. example: a baby learns that a lust cry will make the caregiver attend to his needs. Interactions with the physical environment also contribute to the infant’s learning that there is predictability or consistency within the environment. example: a baby discovers that movements in the crib make his mobile move in response

C. Learning Self-differentiation Self-differentiation begins when the infant learns that objects can be manipulated or that he/she is a separate entity from significant others

Separation anxiety, or the distress experienced by the baby upon the absence of the caregiver appears during the sixth or seventh month of life. The return of the caregiver or object reinforces the baby’s learning that the parent or object has not gone away forever and assists the child in developing trust; this is called object permanence.

THE NURSE ROLE IN HEALTH PROMOTION OF THE INFANTA.Promoting Infant’s Safety

Aspiration• Be certain any object that an infant can grasp or bring to the mouth is either safe to eat or too big to fit in the mouth.• Inspect toys and pacifier for small parts that could be aspirated or broken off.

• Do not feed infants food such as popcorn or peats because these can easily be aspirated.

Falls• Never leave the infant on an unprotected surface• Place a gate at the top and bottom of stairways, do not allow the infant to walk with a sharp object in the hands or mouth.• Raise crib rails and make sure they are locked before walking away from the crib.• Do not leave the child unattended in a high chair.

Motor Vehicle Accident• Do not be distracted by an infant while driving.• Do not leave an infant unattended in a parked car.• Do not place an infant seat in the passenger side.

Suffocation• Do not place plastic bags within infants reach.• Do not use pillows inside the crib.• Store unused appliances such as refrigerators or stoves with the doors removed. • Remove constricting clothing such as a bib from neck at bedtime.

Poisoning• Never present medication as candy.• Buy medications in containers with safety caps and put away immediately after use.• Place all medications and poisons in locked cabinets or shelves.• Hang plants or set on high surfaces.

Burns• Test warmth of formula or food before feeding• Do not smoke or drink hot liquids while holding an infant.

• Turn handles of pans toward back of the stove.• Place lit candles away from infants.• Do not leave infants unsupervised near hot water faucets.• Keep electric wires and cords out of reach.

B. Promoting Infant Development in Daily Activities Bathing and dressing• An infant does not necessarily need to bathed everyday; the infant’s face, hands and diaper area needs to be washed.• To prevent seborrhea or scaly scalp, the infant’s head and scalp must be washed at least every other day.• If seborrhea lesions to develop, they adhere to scalp in yellow, crusty patches and the underlying skin may become slightly erythematous.• Patches can be softened by applying oil or petroleum jelly on the infant’s scalp; crusts can be removed by shampooing the hair the next morning using a soft or fine toothed brush.

• Bath time helps an infant learn different textures and sensations and provides opportunity for parents to touch and communicate with the child.• Infants needs soft-soled shoes, socks or booties to keep them warm.• Binding clothes should be avoided so as not to restrict their movement.

Oral Care• The most important time for children to receive fluoride is from 6 months to 1 years.• Breastfed infants do not receive a great deal of fluoride from breast milk, so it may be recommended that they receive fluoride drops once a day• Parents should be taught to begin brushing their child’s teeth even before teeth erupt; use a washcloth over the gum pads.• Once the teeth begin erupting, all surfaces should be brushed with a soft brush or washcloth once or twice a day

• Toothpaste is not necessary for the infant because it is the scrubbing that facilitates removal of plaque.• Initial dental check-up should be made once the child is 2 years old and continue at 6-month intervals throughout adulthood.

Skin Care• Do not allow infant to wear soiled diaper for a lengthy period of time; change diapers at least every 2 to 4 hours.• During each diaper change, parents should wash the skin with clear water or alcohol-free wipes and allowed to air dry.• Use petroleum jelly to keep urine and feces away from the infant’s skin.• Baby powder can be used; however. Caution parents not to shake the powder directly on infant’s skin, instead, sprinkle powder on their hands before applying on the infant.

Exercise• Protect infant from sunburn; expose him/her to the sun for only short periods, beginning to 3-5 minutes the first day, and gradually increasing exposure on the succeeding days.• Sunscreen is not recommended for infants less than 6 months.• Arrange an enclosed outdoor space for the child to crawl and walk.• Encourage the use of walkers to exercise their leg muscles.

C. Promoting Nutritional Health The first year of life requires a high-protein, high-calorie intake. A normal full-term infant can thrive a commercial iron-fortified formula or breast milk without the addition of any solid until age 6 months. Introduce solid foods when the extrusion reflex disappears; this life- saving reflex prevents an infant from swallowing or aspirating foreign objects that touch the mouth

Introduce one food at a time, waiting 5 – 7 days between new items.• The first food generally given to infants is cereal which is fortified with B vitamins and iron. Cereal should be mixed in a small bowl with enough fluid to make the mixture fairly liquid.• Vegetables and fruits are the second ad third food to be introduced. Vegetables have higher iron content than fruits. Caution parents not to add butter or salt to the preparation.• Meat is introduced at 9 months and egg yolk at 10 months. The egg yolk contains the bulk of the iron content of an egg while the white portion contains the protein.• With the introduction of solid food, parent should arrange for the child, to be feed three meals a day, if that is the family’s pattern, and to join the family at the table.

Introduce the food before formula or breastfeeding when the infant is hungry.

Use a minimum amount of salt and sugar on solid foods to keep the number of additives to a minimum. To prevent aspiration, do not place food in bottles with formula.

PARENTAL CONCERNSA.Teething

During this period, the infant might be resistant to chewing for a day or two and be slightly irritable. Also, a breastfed baby might refuse to feed because of pain. High fever, convulsions, vomiting, diarrhea, and otic pain are not normal signs of teething. Use of over the counter medicines are not encouraged because these may contain benzocaine, a topical anesthetic. If this is applied too far back in the throat, it could interfere with the gag reflex. Acetaminophen may be given every four hours, up to four times a day.

Instruct parents to check with the health care provider before giving any medication to the infant.

B. Thumb Sucking Assure parents that thumb sucking is a normal behavior as long as it does not deform the jaw line and it stops when the child enters school. Sucking reflex peaks at 6-8 months, whereas thumb sucking peaks about 18 months.

C. Use of Pacifiers An infant who completes a feeding but seems to appear restless and actively searches for something to put inside his/her mouth may need a pacifier. A baby who has colic also enjoys pacifier because he/she interprets pain as hunger.

If the infant is formula fed, parents should check the nipple of the feeding bottle that the holes are small enough and the rubber is sturdy. Caution parents not to make pacifiers from a nipple stuffed with cotton because it can lead to aspiration. Parents should not attempt to wean the child from a pacifier from 3 months of age and during the time that the sucking reflex is fading (usually at 6-9 months).

D. Head Banging Head banging is used by infants to relax and fall asleep; this behavior is considered normal. Parents should pad the crib rails so infants cannot hurt themselves and reassure them that head banging is a normal mechanism for relief of tension.

Head banging past pre school age suggests a pathologic basis and needs further evaluation.

E. Sleep Problems Breastfed babies tend to wake up more often than those who are formula fed because breastmilk is more easily digested. Interventions for coping with this situation include delaying bedtime by an hour, shortening afternoon sleep period, not responding immediately to the child at night due to the possibility that he/she might fall back to sleep, and providing soft toys or music and allowing the infant to play during waking time.

F. Constipation Constipation usually occurs with formula-fed infants if their diet is deficient in fluid. As long as stools are not hard and contain no evidence of fresh blood, this is normal infant behavior.

If constipation persists beyond 5 or 6 months of age, encourage parents to check with the infant’s health care provider. Temporary measures to relieve constipation include adding foods with bulk, such as fruits or vegetables, and increasing fluid intake. All infants with a history of constipation for more than a week should be examined for anal fissure or tight anal sphincter. If tight anal sphincter exists, parents are instructed to manually dilate the sphincter two to three times daily until it dilates sufficiently. Hirschprung’s disease may be manifested by constipated as early as infancy. Symptoms of this disorder include ribbonlike stool, diarrhea and abdominal distension.

F. Loose Stools Stools of breast-fed infants are generally softer than those of formula-fed infants. If a mother is taking laxative while breastfeeding, its effect is demonstrated as very loose stools in the infant

Malabsorption syndrome or Celiac disease may manifest itself first by loose stools and distended abdomen and deficiency of fat-soluble vitamins. Infants with associated symptoms such as abdominal cramping, loss of appetite, decrease in voiding and weight loss should be examined by a health care provider.

G. Colic Paroxysmal abdominal pain which occurs in infants under 3 months of age; its cause is unclear It may occur in susceptible infants from overfeeding, swallowing too much air while feeding, or from a formula high in carbohydrates. Infant cries loudly and assumes a fetal position; his/her face becomes flushed, fists clench and abdomen is tense. Take a complete health history if infants with colic symptoms because intestinal obstruction or infection may mimic an attack of colic and be misinterpreted by the casual interviewer. Ask the following:

• Duration of the problem and its frequency; colic symptoms usually last up to3 hours a day and occurs at least 3 days every week.• What happens prior to the attack, associated symptoms of the attack.• Number and type of bowel movement.• Family medical history because allergy to milk may stimulate colic• Baby’s feeding pattern, breast-fed or formula-fed, and type of formula used.• How parents/guardian feed the baby and whether they are burping their infant.

A basic rule for any abdominal discomfort is to avoid application of heat in case the child is a suspect of appendicitis. Caution parents to seek advice from their health care provider before administering antiflatulents. In most infants, colic disappears at the age of 3 months, because it becomes easier to digest food and the infant maintains a more upright position when feeding.

G. Miliaria Miliaria or Prickly heat rash, occurs most in warm weather or when the babies are overdressed or sleep in overheated rooms. Symptoms include pinpoint, reddened papules with occasional vesicles and pustules surrounded by erythema; usually appear on the neck and spread upward to around the earlobes and onto the face or down to the trunk. Bathe the infant twice a day during hot weather using water and with a small amount of baking soda to remove the rash.To prevent further rash eruption, dress the infant with clothes that have less-irritating fabric.

H. Baby-Bottle Syndrome Occurs when an infant is put to bed while drinking from a bottle; this results in decay of the upper teeth and lower posterior teeth.

Liquid from the propped bottle continuously soaks the upper front teeth and lower back teeth; the problem becomes more serious when the bottle is filled with milk and fruit juice because it has more amount of sugar. To prevent this problem, advise the parents not to put their infants to sleep while drinking from a bottle. If it is really necessary, advise parents to fill the bottle with water and use a nipple with a smaller hole. They might want to dilute milk with water if the baby insists on drinking milk.

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