Highlights of Chapter 16; Health issues during infancy

1. Highlights of Chapter 16; Health issues during infancy • Piaget, Erikson and Freud • Colic • Immunizations • Nutrition • Developmental Milestones • Safety • SIDS

2. Piaget, Erikson and Freud • Sensorimotor Stage of development • Children think/learn with eyes, ears, hands, body • Object permenance develops • Trust vs Mistrust • Oral • Focus of pleasure is oral

3. Sensorimotor Stage implications • Age appropriate toys to develop the infant • Learning starts with their reflexes and is built upon as they neurologically mature • Child’s knowledge is limited to the actions they perform. • Problems are solved without mental representation • In this stage, children are unable to distinguish themselves from the world around them.

4. Trust vs. Mistrust implications • From ages birth to one year • children begin to learn the ability to trust others based upon the consistency of their caregiver(s). • trust develops = confidence and security. • inability to trust= anxiety, heightened insecurities, and an over feeling of mistrust in the world around them.

5. Oral Stage implications. • Infants need to suck! • Judicious use of a pacifier when infant is unable to nurse or feed. • Pacifiers can be considered an appropriate self comforting measure. • Teething brings on another dimension to the oral need. • As infants develop the use of their hands they are now able to develop pleasure from other sources.

6. Colic • Normal development • Diagnosis • Etiology • Management

7. Colic; Normal Development • Crying is part of part of normal development • Crying peaks in the second month (4-6 weeks) • ~20% normal, healthy infants cry >3 hours a day

8. Colic; Diagnosis • Wessel "Rule of 3" (in one form or another) is probably the most accepted pediatric criteria for colic • Crying for at least 3 hrs/day for at least 3 days/week for 3 consecutive weeks • Based on parent report (e.g. diary, interview) • Additional features: • Sudden onset high pitched/loud cry; • Physical signs (hypertonia, flushed face, drawing up legs) • Inconsolability

9. Etiology of Colic • Organic: • cow’s milk protein intolerance, • excessive gas, • bowel distention and spasm, • abnormal intestinal motility, • gastroesophageal reflux (GER). • Immature Central Nervous System • Psychosocial: Parenting, feeding, handling, soothing • Normal: Extreme normal crying, temperament

10. Colic is associated with • Sleep disturbances • Feeding problems • Difficult temperament • Temper tantrums • Behavior problems • Anger and depression in parents • Disrupted family relationships • Altered parent perception of infant

11. Treatment of Colic • Pharmaceutical (Simethicone) • Dietary (hypoallergenic diet/formula, soy formula) • Anticipatory guidance • Counseling (education, psychotherapy, support) • Behavioral (carrying, massage, decreased stimulation) • Naturopathic (herbal tea)

12. Credit A Colic Primer Barry Lester PhD Brown Medical SchoolInfant Development CenterWomen and Infants’ Hospital, Providence, RI http://www.colic-baby.com/powerpoint4.htm

13. Tips for reducing colic • Provide Rhythmic movement • Alternative positioning • Reducing environmental stimuli • Providing tactile stimuli Activity: Using your textbook and own ingenuity give one activity to reduce colic in each of the four above

14. Tips for reducing colic; the five S’s • Swaddling • Side/stomach • Shhhhhh • Swinging • Sucking

15. Additional Credits to: • Tammy C. Tempfer, MSN, RN-C, PNP http://www.medscape.com/viewarticle/506306 • Harvey Karp, MD: The Happiest Baby on the Block

16. Immunizations • Immunizations are artificially acquired active immunity • The vaccine or toxoid administered stimulates the immune system to produce antibodies against a specific antigen or disease

17. Types of immunizations • Live attentuated • a live organism grown under conditions which greatly reduce it’s virulence (strength) • Inactivated • killed organism • Toxoid • some bacteria produce toxins which cause disease. These toxins are specially treated to weaken its toxic affect but stimulate the production of antibodies

18. Immunization Schedule 2007

19. Rotavirus Vaccine is Here! • Rotavirus infects nearly every child throughout the world by age 5 years. • Symptomatic disease includes diarrhea, vomiting and/or dehydration. • Rotavirus often causes death in children who lack adequate nutrition and medical attention. • RotaShield vaccine was licensed in 1998 but was withdrawn due to an increased risk of intussusception.

20. Rotavirus Vaccine is Here! • Two new rotavirus vaccines, RotaTeq and Rotarix, are currently in late-stage development. • Once licensed in the US this will be recommended for infants at ages 2,4 and 6 months

21. Nutrition in Infancy • Extrusion reflex • Stomach capacity at birth 10 to 20 mls • By 12 months stomach capacity 200 mls. • Review of nursing tips 394 and 398

22. Iron deficiency prevention • Maternal iron stores decrease by age 4 months therefore, iron fortified formula is recommended • Whole milk is not recommended for infants under 12 months; • it is difficult for the immature GI system to digest and may contribute to iron deficiency anemia due to intestinal blood loss • By 12 months limit whole milk to 24 ounces/day so that infant is not filling up on an iron deficient nutritional resource.

23. Progression of solid foods • Breast or formula only for the first six months. • Iron fortified rice cereal is recommended as the first solid food • Do not mix cereal in bottle with formula • NO HONEY for the first 24 months • Low fat diet in infants under age 2 years compromises growth and development

24. Denver Developmental Screening Test • Purpose: • To screen children from 1 month to 6 years of age for possible developmental problems, • to gather objective data about suspected developmental problems, • to monitor children at risk for developmental problems. • Four areas of functioning: • fine motor-adaptive, • gross motor, • personal-social, • language skills. • Ages of Administration • 1 month to 6 years.

25. One Month Old • Holds head up in prone • Hands remain tightly fisted

26. Four Months • Up on hands in prone • Rolls front to back • No head lag • Holds a rattle • Reaches out for object if in supine

27. Six Months Old • Rolls from back to front • Lifts head when pulled • Sits propped on hands • Palmer grasp

28. Eight Months • Sits without support • Supports weight and bounces while standing • Commando crawls • Feet to mouth • Radial-palmar grasp of cube • Pulls round peg out • Inferior scissors grasp of pellet • rakes object into palm • Hand to hand transfer

29. Another Eight Month Old

30. Nine Months Old • Pulls to stand • Creeps on hands and • knees • Radial-digital grasp of cube held with thumb and finger tips • Inferior pincer grasp of pellet held between ventral surfaces of thumb and index finger

31. More Nine Month Old

32. Ten to eleven months • Cruises around furniture • Walks with 2 hands held then one hand held • Stands alone • Isolates index finger and pokes

33. Twelve Months Old • Independent steps • Fine pincer grasp of pellet between finger tips • Marks with crayon • Attempts tower of 2 cubes • Precise release of cube • Attempts release of pellet into bottle

34. Infant Safety • Car Safety: rear facing infant seat until one year AND at least 22 pounds • Falls: never leave unattended on any raised surface, crib rails, secured in high chairs, stairway protection • Safe crawling environment re: poison control, pools, plugs, wires, pets, blind cords, batteries,magnets, and other choking hazards • Burns: scalding from bath, reaching for hot liquids, spilling hot liquids on infant while holding

35. Infant Safety • Car Safety • Falls: • Safe crawling environment • Burns • Water

36. Prevention of Drowning

37. Prevention of Burns

38. Smoke detectors save lives

39. Blind Cord Strangulation • Children die from the cords on blinds.

40. Infant Walkers • Have a well established record of being dangerous for infants • Puts them at risk for falls and burns and being able to reach things they shouldn’t!

41. Prevention of SIDS • Back is best • Crib free of toys, extra blankets • Firm fitting mattress to crib • Do not overheat room • Smoke free environment • Close but separate sleeping