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Nursing Care of the Infant

The first yearThe first yearGrowth is Growth is VERYVERY rapid rapid

gains 5-7 ounces (150-210g) qd x 6mthsgains 5-7 ounces (150-210g) qd x 6mthsdoubles by 6 monthsdoubles by 6 monthstriples by 1 yeartriples by 1 year

Infants breast fed after 4 months grow slower than bottle fedInfants breast fed after 4 months grow slower than bottle fed

HeightHeightIncreases by 1 inch (2.5cm) every month for the first 6 months, slows down for the Increases by 1 inch (2.5cm) every month for the first 6 months, slows down for the rest of the year.rest of the year.50 increase in birth height by the end of the first year.50 increase in birth height by the end of the first year.

Head circumferenceHead circumferenceRapid growth in HC – 0.6inches (1/5cm) a month for 1Rapid growth in HC – 0.6inches (1/5cm) a month for 1stst 6 mths, then 0.2 inches 6 mths, then 0.2 inches (0.5cm) in second 6 months.(0.5cm) in second 6 months.By 1 year HC has increased 33%.By 1 year HC has increased 33%.

Fontanels:Fontanels:Posterior:Posterior: closes by 2 monthscloses by 2 monthsAnterior: Anterior: closes by 12-18 monthscloses by 12-18 months

* With every health care encounter HC & fontanels should be assessed.** With every health care encounter HC & fontanels should be assessed.*

Respiratory systemRespiratory system Short Eustachian tubes encourage easy passage of bacteria/viruses/fluid to Short Eustachian tubes encourage easy passage of bacteria/viruses/fluid to

middle ear = increase in otitis media.middle ear = increase in otitis media. Very prone to upper airway infections due to short distance between Very prone to upper airway infections due to short distance between

structure (trachea/bronchi/lungs)structure (trachea/bronchi/lungs) Cardiovascular SystemCardiovascular System

Fetal Hgb present during the 1Fetal Hgb present during the 1stst 6 months HgF, after 5 months changes to 6 months HgF, after 5 months changes to adult Hgb, anemia is common at 2-3 mths when high levels of fetal HgF adult Hgb, anemia is common at 2-3 mths when high levels of fetal HgF inhibit RBC production. Maternal Iron stores last for 5-6 months.inhibit RBC production. Maternal Iron stores last for 5-6 months.

Renal systemRenal system Immature till about 18months with decreased filtration, this decrease can Immature till about 18months with decreased filtration, this decrease can

lead to toxic accumulation of meds, toxins.lead to toxic accumulation of meds, toxins. TeethingTeething

First teeth are the lower central incisors. Teething is often accompanied by First teeth are the lower central incisors. Teething is often accompanied by drooling, gumming, low grade fever, diarrhea, difficulty sleeping/eating. drooling, gumming, low grade fever, diarrhea, difficulty sleeping/eating. Use teething rings, baby Oragel, Tylenol Use teething rings, baby Oragel, Tylenol

SleepSleep By 3-4 months nocturnal pattern 9-11 hrs per night, total sleep 15 hrs/qd.By 3-4 months nocturnal pattern 9-11 hrs per night, total sleep 15 hrs/qd. Most sleep problems are “Learned behavior” Most sleep problems are “Learned behavior”

BACK TO SLEEPBACK TO SLEEP Crib is ideal spot for sleeping but many families use “family bed”Crib is ideal spot for sleeping but many families use “family bed”

NutritionNutrition For the first 6 months the ideal food is breast milk if breast feeding is not possible - For the first 6 months the ideal food is breast milk if breast feeding is not possible -

commercial baby formula. Parents must be taught to strictly adhere to instructions commercial baby formula. Parents must be taught to strictly adhere to instructions for preparation of formula.for preparation of formula.

6mths-1 year breast milk/formula + iron fortified cereal +baby food fruits & 6mths-1 year breast milk/formula + iron fortified cereal +baby food fruits & vegetables.vegetables.

First solid food at 5-6 months (when extrusion reflex disappears) First solid food at 5-6 months (when extrusion reflex disappears) 11stst food iron fortified baby cereal (rice/barley/oatmeal) mixed with BM or food iron fortified baby cereal (rice/barley/oatmeal) mixed with BM or

formulaformula Fruit juice should be diluted 50%-avoid large amounts, can cause diarrhea and Fruit juice should be diluted 50%-avoid large amounts, can cause diarrhea and

fills child up with empty caloriesfills child up with empty calories Strained fruits, vegetables, meatsStrained fruits, vegetables, meats YogurtYogurt

At 8-9 months junior foods,cherrios, zwieback toast, crackers, small pieces of fruit At 8-9 months junior foods,cherrios, zwieback toast, crackers, small pieces of fruit (banana, orange) NO Grapes, very well cooked vegetables(banana, orange) NO Grapes, very well cooked vegetables

By age of 1 year can have table foods with appropriate texture and appropriate By age of 1 year can have table foods with appropriate texture and appropriate size.size.

Never use skim, 1%, 2%, condensed or evaporated milk in child under the age of 1.Never use skim, 1%, 2%, condensed or evaporated milk in child under the age of 1. Feed baby food first, then formula or BMFeed baby food first, then formula or BM Never use honey in any food preparation – botulism sporeNever use honey in any food preparation – botulism spore Never allow baby to fall asleep with bottle of juice or milk (H20 if absolutely Never allow baby to fall asleep with bottle of juice or milk (H20 if absolutely

necessary), causes severe dental carries & predispose infant to OMnecessary), causes severe dental carries & predispose infant to OM Introduce 1 new food every 3-5 days to identify any potential allergies. Do not feed Introduce 1 new food every 3-5 days to identify any potential allergies. Do not feed

baby eggs or nuts (including peanut butter) for the first yearbaby eggs or nuts (including peanut butter) for the first year Home cooked baby foods should be made from fresh vegetables/fruits Home cooked baby foods should be made from fresh vegetables/fruits

(canned/frozen high in Na)(canned/frozen high in Na)

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GI SystemGI System Immature until 3 months. Decreased pancreatic and Immature until 3 months. Decreased pancreatic and

gastric enzymes. Solid foods passed almost unchanged gastric enzymes. Solid foods passed almost unchanged in stools (corn, raisins), high fiber can cause diarrhea. By in stools (corn, raisins), high fiber can cause diarrhea. By 1 year of age baby should be eating 3 meals /qd in 1 year of age baby should be eating 3 meals /qd in addition to formula. Liver function also remains addition to formula. Liver function also remains immature until 1 year.immature until 1 year.

Body composition is 75-80% water mostly extracellular, Body composition is 75-80% water mostly extracellular, child can have rapid dehydration from V & D.child can have rapid dehydration from V & D.

Prevention of InjuriesPrevention of Injuries

Aspiration of foreign bodies into respiratory tract is Aspiration of foreign bodies into respiratory tract is the leading cause of fatal injuries in children <1year. the leading cause of fatal injuries in children <1year. Infants aspirate toy parts, buttons, batteries, food.Infants aspirate toy parts, buttons, batteries, food.

Suffocation by covering airway or entrapmentSuffocation by covering airway or entrapment MVA. Proper use of car seats Infants must be rear MVA. Proper use of car seats Infants must be rear

facing until 1 year of agefacing until 1 year of age ANDAND 20lbs. (neck muscles)20lbs. (neck muscles) Poisoning: medications, household cleaners, alcoholPoisoning: medications, household cleaners, alcohol DrowningDrowning Burns (including sunburn) Burns (including sunburn)

Attachment , separation anxiety and Attachment , separation anxiety and stranger anxietystranger anxiety

AttachmentAttachment Attachment begins at birth and continues throughout the Attachment begins at birth and continues throughout the

first year. During the first few weeks infants respond first year. During the first few weeks infants respond indiscriminately or anyone. Between 8-12 weeks infants indiscriminately or anyone. Between 8-12 weeks infants cry, smile and vocalize more to the mother than to cry, smile and vocalize more to the mother than to anyone else but continue to respond to others .anyone else but continue to respond to others .

About 6 months of age they begin to show distinct About 6 months of age they begin to show distinct preference for their mother, following her more, crying preference for their mother, following her more, crying when she leaves, playing with her more and feeling most when she leaves, playing with her more and feeling most secure in her arms.secure in her arms.

Approximately 1 month after attachment to the mom, the Approximately 1 month after attachment to the mom, the infant begins attachment to other family members (most infant begins attachment to other family members (most often dad)often dad)

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Between 4-8 months infant begins to have Between 4-8 months infant begins to have awareness of self and mother as separate awareness of self and mother as separate persons and object permanence begins. Infant persons and object permanence begins. Infant is aware that parent can be absent and is aware that parent can be absent and separation anxiety begins. Infant begins to separation anxiety begins. Infant begins to protest when put in crib, when mom leaves protest when put in crib, when mom leaves and can anticipate her leaving and begin to and can anticipate her leaving and begin to protest.protest.

About 6-8 months stranger anxiety and fear About 6-8 months stranger anxiety and fear begin (healthy sign of attachment to parents)begin (healthy sign of attachment to parents)

Language developmentLanguage development

Children are born with the ability to develop speech and language skills if they Children are born with the ability to develop speech and language skills if they have intact physiologic structure , intact CNS and hearing.have intact physiologic structure , intact CNS and hearing.

But even with all of the above they must have stimulation, they must hear But even with all of the above they must have stimulation, they must hear their language to begin to speak it.their language to begin to speak it.

First means of communication is crying usually for physiologic needs to be met First means of communication is crying usually for physiologic needs to be met (hunger, cold, etc.). (hunger, cold, etc.).

They begin to vocalize by 5-6 weeks with throaty type sounds.They begin to vocalize by 5-6 weeks with throaty type sounds. By the age of 2 months they make single vowel sounds like ah, eh, uh.By the age of 2 months they make single vowel sounds like ah, eh, uh. By 3-4 months they begin using consonants n/k/g/p/b, they begin to By 3-4 months they begin using consonants n/k/g/p/b, they begin to

gurgle, coo and laugh out loud.gurgle, coo and laugh out loud. By 8 months they begin to imitate sounds adding t/d/w and begin to By 8 months they begin to imitate sounds adding t/d/w and begin to

combine syllables, Dada is frequently the first “word” they make but do not combine syllables, Dada is frequently the first “word” they make but do not know the meaning know the meaning

By 9-10 months they comprehend the meaning of “NO”By 9-10 months they comprehend the meaning of “NO” By the age of 1 year they can say 3 or 4 word in proper context (dada , By the age of 1 year they can say 3 or 4 word in proper context (dada ,

mama, cat, dog, up, downmama, cat, dog, up, down

Growth & development during infancyGrowth & development during infancy 1 month1 month

Physical: wt gain =150-210g (5-7 oz) wkly for 1: wt gain =150-210g (5-7 oz) wkly for 1stst 6 mths, HC increases by 6 mths, HC increases by 1/5cm wkly for 11/5cm wkly for 1stst 6mths, flexed position. Breathes through nose 6mths, flexed position. Breathes through nose

Gross MotorGross Motor: primitive reflexes present and strong, can turn head from side : primitive reflexes present and strong, can turn head from side to side, can lift head momentarily from bed, marked head lag, esp. when to side, can lift head momentarily from bed, marked head lag, esp. when pulled from lying to sittingpulled from lying to sitting

Fine motor: hands closed, clenches when in contact with object: hands closed, clenches when in contact with object SensorySensory: able to fixate on moving object. Visual 20/100, follows light to : able to fixate on moving object. Visual 20/100, follows light to

midline, quiet when hears a voice.midline, quiet when hears a voice. Vocalization: cries when wet, cold, hungry, frightened, makes small throaty Vocalization: cries when wet, cold, hungry, frightened, makes small throaty

sounds, comfort sounds during feedingsounds, comfort sounds during feeding Socialization/cognitionSocialization/cognition: in Sensorimotor phase, trust vs. mistrust, watches : in Sensorimotor phase, trust vs. mistrust, watches

parents face as they talk to infantparents face as they talk to infant 2 months2 months

PhysicaPhysical: posterior fontanel closesl: posterior fontanel closes Gross motorGross motor: less head lag when pulled to sitting, when prone can hold head : less head lag when pulled to sitting, when prone can hold head

also 45 degrees off tablealso 45 degrees off table Fine Motor: hands openFine Motor: hands open Sensory: Binocular fixation, visually searches to locate sounds.Sensory: Binocular fixation, visually searches to locate sounds. Vocalization: vocalizes (different from crying), different types of cries noted, Vocalization: vocalizes (different from crying), different types of cries noted,

coo’s, vocalizes to familiar voicecoo’s, vocalizes to familiar voice Socialization/cognition: social smile begins Socialization/cognition: social smile begins

.. 3 Months3 Months Physical: Physical: primitive reflexes fadingprimitive reflexes fading Gross Motor: Gross Motor: able to hold head more erect (but still not steady), Slight able to hold head more erect (but still not steady), Slight

head lag when pulled to sitting, regards own hand.head lag when pulled to sitting, regards own hand. Fine Motor: holds rattle but will not reach for it, hands kept open : holds rattle but will not reach for it, hands kept open

(loosely), clutches hand, will pull at blankets and clothes.(loosely), clutches hand, will pull at blankets and clothes. Sensory: Follows objects 180 degrees, locates sound by turning head to : Follows objects 180 degrees, locates sound by turning head to

side looking in same direction.side looking in same direction. Vocalization: squeals with pleasure, coo’s, babbles, chuckles, vocalizes Vocalization: squeals with pleasure, coo’s, babbles, chuckles, vocalizes

when smiling, “Talks”, less crying.when smiling, “Talks”, less crying. Socialization/cognitionSocialization/cognition: very interested in surroundings, stops crying : very interested in surroundings, stops crying

when parent enters room, can recognize familiar objects and faces, when parent enters room, can recognize familiar objects and faces, shows awareness of strange situations.shows awareness of strange situations.

4 months4 months Physical: DroolingPhysical: Drooling begins, Moro, tonic neck and rooting disappear begins, Moro, tonic neck and rooting disappear Gross motor: almost no head lag when pulled to sitting, balances head : almost no head lag when pulled to sitting, balances head

well when" sitting”, back less rounded, begins rolling front to backwell when" sitting”, back less rounded, begins rolling front to back Fine motor: inspects and plays with hands, pulls blanket and clothes over Fine motor: inspects and plays with hands, pulls blanket and clothes over

face in play, tries to reach objects (but cannot), grasps objects with both face in play, tries to reach objects (but cannot), grasps objects with both handshands

Sensory: binocular vision well established, beginning to have eye-hand : binocular vision well established, beginning to have eye-hand coordinationcoordination

Vocalization: : Vocalization: : Makes constant sounds n/k/g/p/b, laughs aloud, Makes constant sounds n/k/g/p/b, laughs aloud, vocalization based on mood.vocalization based on mood.

.. 5 months5 months

Physical: Tooth eruption, BW Doubles Gross Motor: able to sit erect if propped, raises head in prone position to 90 degrees, Rolls

from front to back, back to side Fine motor: grasps objects voluntarily, palmer grasp-using both hands, plays with toes,

objects into mouth, can hold a cube while looking at a second one. Sensory: visually pursues a dropped object. Vocalization: squeals, makes cooing vowel sounds with consonant sound ah/eh/oh/goo. Sensory/cognition: smiles at self in mirror, can tell family from strangers, discovering parts of

body, very playful 6 months

Physical: growth rate begins to slow down- wt gain= 90-150g (3-5 oz) per week, HC 1.25 cm mth . Teething and to tooth eruption may begin, chewing and biting begin

Gross motor: when prone can lift head off surface bearing weight on both hands, when pulled to sitting position- lifts head, sits in high chair with back straight, rolls from back to abdomen, when held instancing position can bear wt.

Fine motor: rescues a dropped object, drops one cube when given another, can grasp and manipulate small objects, holds bottle, grabs feet – puts in mouth.

Sensory: adjusts posture to see something. Vocalization: begins to imitate sounds, babbling sounds like one syllable words (ma/da/hi),

vocalizes to toys, mirror, loves hearing own voice. Socialization/Cognition: Recognizes parents, stranger anxiety beginning, holds arms out to be

picked up, has like & dislikes, plays peek-a-boo, object permanence beginning, mood swings .

7 months7 months PhysicalPhysical: Eruption of “two front teeth”.: Eruption of “two front teeth”. Gross motorGross motor: leaning forward on both hands, sits erect (for a second) : leaning forward on both hands, sits erect (for a second)

bears full wt on feetbears full wt on feet Fine motorFine motor: transfers objects form one hand to the other, rakes at small : transfers objects form one hand to the other, rakes at small

objects, can use both hands to grasp, bangs cube on table.objects, can use both hands to grasp, bangs cube on table. SensorySensory: can fixate on small objects, responds to own name, has taste : can fixate on small objects, responds to own name, has taste

preferencespreferences VocalizationVocalization: vowel sounds and chained syllables: dada/baba/kaka, : vowel sounds and chained syllables: dada/baba/kaka,

“talks” while others are talking to them.“talks” while others are talking to them. Socialization/cognition: fear of strangers, imitates simple acts and Socialization/cognition: fear of strangers, imitates simple acts and

sounds, attracts attention by coughing/snorting, plays peek a boosounds, attracts attention by coughing/snorting, plays peek a boo 8 months8 months

PhysicaPhysical: beginning of regular bowel & bladder pattern.l: beginning of regular bowel & bladder pattern. Gross motorGross motor: sits unsupported, bears wt on legs when supported may : sits unsupported, bears wt on legs when supported may

be standing holding on to furniture (or person), has pincer grasp using be standing holding on to furniture (or person), has pincer grasp using index finger, 4index finger, 4thth & 5 & 5thth finger , release objects, retains 2 cubes while finger , release objects, retains 2 cubes while observing third, pulls on strings, reaches for toys out of reach.observing third, pulls on strings, reaches for toys out of reach.

VocalizationVocalization: consonant sounds t/d/w,combines syllables (dada) but : consonant sounds t/d/w,combines syllables (dada) but does not know meaning.does not know meaning.

Socialization/cognitionSocialization/cognition: increased separation anxiety, stranger anxiety, : increased separation anxiety, stranger anxiety, responds to word “NO”, does not like getting undressed, diaper responds to word “NO”, does not like getting undressed, diaper changingchanging

.. 9 months9 months

PhysicalPhysical: eruption of upper lateral incisor may begin: eruption of upper lateral incisor may begin Gross Motor Gross Motor : creeping begins, sits steadily on floor, can recover : creeping begins, sits steadily on floor, can recover

balance when sitting, pulls self to standing position when holding on to balance when sitting, pulls self to standing position when holding on to furniture/person recovers balance when leaning forwards (but not furniture/person recovers balance when leaning forwards (but not sideways)sideways)

Fine motor: Use thumb and index finger in crude pincher grasp, : Use thumb and index finger in crude pincher grasp, dominant hand not obvious, grabs third cube, compares to comes by dominant hand not obvious, grabs third cube, compares to comes by bringing them togetherbringing them together

Sensory: localizes sound by turning head: localizes sound by turning head Vocalization Vocalization :responds to simple verbal commands, comprehends “NO”:responds to simple verbal commands, comprehends “NO” Socialization/cognitionSocialization/cognition: mother extremely important, trying to please : mother extremely important, trying to please

parents, beginning to show fears of going to bed/being left alone. parents, beginning to show fears of going to bed/being left alone. covers face to avoid having it washedcovers face to avoid having it washed

10 months10 months Physical: when prone or supine can lift headl: when prone or supine can lift head Gross motorGross motor: can easily change from prone to supine position, stands : can easily change from prone to supine position, stands

holding on to furniture, sits by falling down on butt, recovers balance holding on to furniture, sits by falling down on butt, recovers balance easily while sitting, when standing lifts one foot to take a step.easily while sitting, when standing lifts one foot to take a step.

Fine motorFine motor: releasing of objects beginning (crude): releasing of objects beginning (crude) Sensory: can followed rapidly moving objectsy: can followed rapidly moving objects Socialization/cognition: stops behavior on “NO”, waves bye-bye, stops behavior on “NO”, waves bye-bye,

imitates facial expressions, develops object permanence, repeats imitates facial expressions, develops object permanence, repeats actions that attract attention/laughter, pulls others clothing, cries when actions that attract attention/laughter, pulls others clothing, cries when scolded, Demonstrates independence is dressing, feeding, locomotion, scolded, Demonstrates independence is dressing, feeding, locomotion, looks at and follows pictures in a book. looks at and follows pictures in a book.

.. 11 months11 months

PhysicalPhysical: eruption of lower central incisors begins: eruption of lower central incisors begins Gross motorGross motor: cruises or walks holding on to furniture or with both hands held: cruises or walks holding on to furniture or with both hands held Fine motorFine motor: explores objects, has Neat pincher grasp, puts one object into : explores objects, has Neat pincher grasp, puts one object into

another, can manipulates small objectsanother, can manipulates small objects VocalizationVocalization: imitates speech sounds: imitates speech sounds Socialization/cognitionSocialization/cognition: experiences joy and satisfaction when a task is : experiences joy and satisfaction when a task is

mastered, anticipates body gestures when a familiar song/nursery rhymes is mastered, anticipates body gestures when a familiar song/nursery rhymes is told, plays games up-down, so-big, shakes head for “NO”told, plays games up-down, so-big, shakes head for “NO”

12 months12 months PhysicaPhysical: BW tripled, HT increased by 50%, HC=chest circm , 6-8 teeth, l: BW tripled, HT increased by 50%, HC=chest circm , 6-8 teeth,

anterior fontanel almost closedanterior fontanel almost closed Gross motorGross motor: walks with 1 hand held, cruises well, may attempt to stand : walks with 1 hand held, cruises well, may attempt to stand

alone for a moment, can sit from standing position without help.alone for a moment, can sit from standing position without help. Fine motorFine motor: releases cube in cup, tries to build 2 cube tower, can turn pages : releases cube in cup, tries to build 2 cube tower, can turn pages

of a book (a few at a time)of a book (a few at a time) SensorySensory: Can follow rapidly moving objects: Can follow rapidly moving objects VocalizationVocalization: recognizes object by name, comprehends the meaning of : recognizes object by name, comprehends the meaning of

several words, imitates animal sounds, understands simple verbal several words, imitates animal sounds, understands simple verbal commandscommands

Socialization/cognitionSocialization/cognition: shows emotion (jealousy, affection, anger, fear), may : shows emotion (jealousy, affection, anger, fear), may kiss on request, imitates facial expression, explores familiar surroundings kiss on request, imitates facial expression, explores familiar surroundings (away from mom), fearful in nes situations may cling to mom, security (away from mom), fearful in nes situations may cling to mom, security blanket time, determined to perfect locomotion blanket time, determined to perfect locomotion

ImagesImages

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Head lagHead lag

fontanelsfontanels

Plantar or grasp reflexPlantar or grasp reflex

SafetySafety

Head control (prone)Head control (prone)

G & DG & D

Development of sittingDevelopment of sitting

Development of locomotionDevelopment of locomotion

Crude pincer grasp 8-10 monthsCrude pincer grasp 8-10 months

Fine motor development,Fine motor development,Neat pincher grasp (10-11mths)Neat pincher grasp (10-11mths)

Developing Body ImageDeveloping Body Image

Dental cariesDental caries

Inner earInner ear

Measuring head Measuring head circumferencecircumference

Head control when pulled to sittingHead control when pulled to sitting

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HealthHealth

Problems Problems

of the infantof the infant

Failure to thriveFailure to thrive

Inadequate weight gain based on standardized Inadequate weight gain based on standardized growth charts. If growth ht/wt/hc falls below 5growth charts. If growth ht/wt/hc falls below 5thth percentile (or falls off child’s curve)percentile (or falls off child’s curve)

Is divided into 2 categories:Is divided into 2 categories: organic failure to thrive- OFTTorganic failure to thrive- OFTT Non- organic failure to thrive NFTTNon- organic failure to thrive NFTT

Organic FTTOrganic FTT

Identifiable cause for inadequate weight Identifiable cause for inadequate weight gaingain

Medical cause for inability to metabolize kcalMedical cause for inability to metabolize kcal 2 most common causes:2 most common causes:

Congenital Heart DiseaseCongenital Heart Disease Cystic FibrosisCystic Fibrosis

Other medical causes include: inherited metabolic Other medical causes include: inherited metabolic disorder, endocrine disorder, neurological disorder, endocrine disorder, neurological condition/lesion. HIV, GERD, Malabsorption syndrome.condition/lesion. HIV, GERD, Malabsorption syndrome.

Non-organic FTTNon-organic FTT

No identifiable medical cause of inadequate growth, No identifiable medical cause of inadequate growth, psychological cause.psychological cause.

3 types of NOFTT3 types of NOFTT Accidental: inadequate nutrition as a result of a mistake Accidental: inadequate nutrition as a result of a mistake

(improper preparation of formula, not enough breast milk (improper preparation of formula, not enough breast milk production, feeding an infant condensed milk) Watering production, feeding an infant condensed milk) Watering down formula to make it last longer is very commondown formula to make it last longer is very common

Neglectful: inadequate nutrition resulting from parent being Neglectful: inadequate nutrition resulting from parent being overwhelmed (post-partum depression, other kids, financial overwhelmed (post-partum depression, other kids, financial reasons) not knowing how often a infant needs to eat etc…reasons) not knowing how often a infant needs to eat etc…

Deliberate: deliberate withholding of food – child abuseDeliberate: deliberate withholding of food – child abuse

Physical assessment in FTTPhysical assessment in FTT

Wt below 5Wt below 5thth % % Sudden rapid decline in growth curveSudden rapid decline in growth curve Delay in developmental milestoneDelay in developmental milestone Decreased muscle massDecreased muscle mass Abdominal distensionAbdominal distension HypotonicHypotonic WeaknessWeakness

Behavioral findings in FTTBehavioral findings in FTT

Avoidance of eye contactAvoidance of eye contact Sleep disturbancesSleep disturbances ApathyApathy Extreme irritabilityExtreme irritability

Diagnostic testing in FTTDiagnostic testing in FTT

Developmental screeningDevelopmental screening Nutritional screeningNutritional screening Evaluation of growth curveEvaluation of growth curve Urine Analysis (bladder infection/sepsis)Urine Analysis (bladder infection/sepsis) Sweat Chloride test (CF)Sweat Chloride test (CF) Stool CultureStool Culture T4T4

Nursing IssuesNursing Issues

Nursing Diagnosis:Nursing Diagnosis: Altered nutritionAltered nutrition Altered G & DAltered G & D Altered family processAltered family process Alteration in parental bondingAlteration in parental bonding

Nursing interventionsNursing interventions Carefully document feeding patterns (quality, quantity, Carefully document feeding patterns (quality, quantity,

suck, effort, interest)suck, effort, interest) Observe and carefully document parent/child interactionObserve and carefully document parent/child interaction Feed on demand & increase feeding s as toleratedFeed on demand & increase feeding s as tolerated Strict I & OStrict I & O Weight dailyWeight daily Consistent primary RNConsistent primary RN

SIDSSIDSSudden infant death syndromeSudden infant death syndrome

Sudden unexplained death of infant. Sudden unexplained death of infant. Death unexplained after autopsy, Death unexplained after autopsy, review of history.review of history.

Leading cause of death in infants, 90% Leading cause of death in infants, 90% of cases occur before 6 mths of age. of cases occur before 6 mths of age. Most common in 2-4 months olds, Most common in 2-4 months olds, more frequent in males, in winter more frequent in males, in winter and spring.and spring.

SIDS, cont.SIDS, cont.

Referred to as a syndrome because of many varied clincal Referred to as a syndrome because of many varied clincal findings on autopsy, autopsy does not identify one single findings on autopsy, autopsy does not identify one single cause of death. Child discovered after sleep dead, appears cause of death. Child discovered after sleep dead, appears to be a struggles (in crib) upon examination (messy to be a struggles (in crib) upon examination (messy bedding) position may be changed from the position bedding) position may be changed from the position parents put child to sleep in, there may be frothy, blood parents put child to sleep in, there may be frothy, blood tinged secretions around mouth& nares.tinged secretions around mouth& nares.

Parents report no crying or disturbances during child’s sleep.Parents report no crying or disturbances during child’s sleep.

Current thinking is that the etiology of SIDS is an abnormality Current thinking is that the etiology of SIDS is an abnormality in the brainstem that causes a delayed development of in the brainstem that causes a delayed development of arousal with cardiac-resp or cardiovascular control. Other arousal with cardiac-resp or cardiovascular control. Other proposed causes include: H.pylori infection, prolonged QT proposed causes include: H.pylori infection, prolonged QT syndromesyndrome

SIDS, cont.SIDS, cont.

It is believed that a very small % of SIDS It is believed that a very small % of SIDS are actually homicides (1-3%) but as no are actually homicides (1-3%) but as no cause of death is found this makes this cause of death is found this makes this suspicion very hared to prove.suspicion very hared to prove.

Despite much media attention there has Despite much media attention there has been no link between DTaP & SIDS found.been no link between DTaP & SIDS found.

Risk FactorsRisk Factors

h/o ALTE or cyanosis, resp distress in neonatal periodh/o ALTE or cyanosis, resp distress in neonatal period Apnea of infancyApnea of infancy PreemiePreemie Multiple birthMultiple birth Exposure to passive smokeExposure to passive smoke Poor prenatal carePoor prenatal care Poor wt gain of mom while pregnantPoor wt gain of mom while pregnant Brain stem defectBrain stem defect Prone sleepingProne sleeping Mom smoking during pregnancyMom smoking during pregnancy Sibling with SIDSSibling with SIDS Multiple pregnancies with short intervals between themMultiple pregnancies with short intervals between them Soft bedding, use of pillowsSoft bedding, use of pillows

Nursing interventions to prevent & Nursing interventions to prevent & educate about SIDSeducate about SIDS

““BACK TO SLEEP”BACK TO SLEEP”Educate, educate, Educate, educate,

educateeducateNo pillows, quilts under babyNo pillows, quilts under baby, firmfirm approved approved

beddingbedding

Nursing interventions after Nursing interventions after death of childdeath of child

Help them contact family members.Help them contact family members. Referral to SIDS support groups.Referral to SIDS support groups. Compassionate, empathetic care.Compassionate, empathetic care. Family advocacy in ER when police are involved.Family advocacy in ER when police are involved. Reassure parents that they are not responsible Reassure parents that they are not responsible

for child’s death.for child’s death. Immediate referral to compassionate friends.Immediate referral to compassionate friends. If there are siblings, reassure them that this will If there are siblings, reassure them that this will

not happen to them & it is not their bad thoughts not happen to them & it is not their bad thoughts about sibling that caused this.about sibling that caused this.

Allow parents to hold child, take hand/foot prints, Allow parents to hold child, take hand/foot prints, lock of hair, photos.lock of hair, photos.