Promoting Optimal H ealth during Infancy

1. Promoting Optimal Health during Infancy https://www.google.jo/search?biw=1366&bih=662&tbm=isch&sa=1&ei=VZL2WY68BoS4aYeqgNAK&q=group+of+infants&oq=grpup+of+infants+&gs_l=psy-ab.1.0.0i13i30k1.45953.57527.0.59735.19.19.0.0.0.0.375.4068.0j5j3j7.15.0....0...1.1.64.psy-ab..4.3.1066...0j0i13k1j0i7i30k1j0i8i7i30k1.0.ah7d3eEa76U#imgrc=GRXDvk03GXSP6M:

2. Objectives By the end of this discussion you will be able to: • Assess the nutritional status for infants • Discuss the introducing of solid food for infants • Discuss the sleep patterns among infants • Identify the most common sleep problems among infants

3. Objectives By the end of this discussion you will be able to: • Discuss the dental care for infants • List the immunization Schedule in Jordan as presented by Ministry of Health • Discuss Safety promotion and Injury Prevention during infancy

4. Nutrition • Mother should decide the method of optimum nutrition for infant in prenatal period • Mother should have an adequate balanced amounts of protein, vitamins and minerals which have an impact on the growth of fetus

5. Nutrition • Nurses should encourage and teach parents about an appropriate feeding method before delivery date • Human milk is the most desirable complete diet for the infant during the first 6 months • The normal infant receiving breast milk from a well-nourished mother usually requires no specific vitamin and mineral supplements • Daily supplements of vitamin D and vitamin B12 may be indicated if the mother's intake of these vitamins is inadequate

6. The First 6 Months • The American Academy of Pediatrics recommendations: • All infants (including those exclusively breastfed) receive a daily supplement of 400 IU of vitamin D beginning in the first 2 months of life to prevent rickets and vitamin D deficiency • Fluoride supplementation is not required for exclusively breast fed infant in the first 6 months unless mothers water supply does not contain required amount of fluoridation

7. The First 6 Months 3. Iron supplementation to exclusively breast-fed infants after 4 to 6 months: • To compensate the decrease in iron available in human milk at this time • To enhance erythropoiesis.

8. The First 6 Months • Infants who are breastfed or bottle-fed do not require additional fluids, especially water or juice, during the first 4 months of life. • Excessive intake of water in infants may result in water intoxication, failure to thrive, and hyponatremia.

9. The First 6 Months • Employed mothers can continue breast-feeding with guidance and encouragement . • Pumping milk away from home may be needed every 3 to 4 hours to maintain adequate supply.

10. The First 6 Months • Breast milk expressed by hand or pump (manual or electric) should be stored in an appropriate air-tight glass or plastic container.. • Expressed breast milk may be stored in the refrigerator (4 c) without danger of bacterial contamination for up to 5 days, and may be frozen (0 F{-18c}or lower) for up to 6 months

11. The First 6 Months • Mothers need child care by a trusted individual or agency and support and assistance from significant others. • Maternal fatigue is considered the biggest threat to successful breast-feeding in employed mothers • Employed women must have proper nutrition and rest for adequate lactation.

12. The First 6 Months • Human milk or formula continues to be the primary source of nutrition • Fluoride supplementation should begin, depending on the infant's intake of fluoride • If breast-feeding is discontinued, a commercial iron-fortified formula should be substituted.

13. The First 6 Months • Commercial iron-fortified formula is an acceptable alternative to breast-feeding It supplies all of the nutrients needed by the infant for the first 6 months.

14. The First 6 Months • low-fat cow's milk, skim milk, other animal milksare not acceptable as a major source of nutrition for infants because of: • Poor digestibility • An increased risk of contamination • Alack of components needed for appropriate growth such as essential fatty acids

15. The First 6 Months • Pasteurized whole cows milk should not be given before 12 month of age for the following reasons: • It lack of iron, zinc, and vitamin c • It has a high renal solute load (AAP, 2014)

16. The First 6 Months • The number of feedings per day vary • among infants. • Infants on demand feeding usually determine their own feeding schedule • Infants may need a more planned schedule based on average feeding patterns to ensure sufficient nutrients.

17. The First 6 Months • The number of feedings decreases from six at 1 month of age to four to five at 6 months. • Regardless of the number of feedings, the total amount of formula ingested will usually about (960 mL/day)

18. The First 6 Months • Developmentally, infants are not ready for solid food before 4 to 6 months of age for the following reasons: • The extrusion (protrusion) reflex is strong and causes food to be pushed out of the mouth. • Solid foods are not compatible with the ability of the gastrointestinal tract and nutritional needs of the infant. • It increases the risk of developing food protein allergy. • Their limited motor ability make infants to be unable to deliberately avoid food which may lead to excessive weigh gain

19. The First 6 MonthsEBP • Food known to be allergenic such as eggs, fish, peanuts, and seafood should not be introduced before 9 month of age according to the child risk of atopy (hypersensitivity) (Heinrich, Koletzko,& Koletzko, 2014)

20. The First 6 Months • Non nutritive drinks such as fruit-flavored drinks or carbonated beverages (eg., soda) should be avoided because: • They do not provide sufficient intake of calories for infant younger than 12 months old • They may replace the nutrients in breast milk or formula milk and lead to growth and health problems

21. The Second 6 Months

22. The Second 6 Months • By 6 months of age, human milk or formula continues to be the primary source of nutrition • The major change in feeding habits is the addition of solid foods to the infant's diet • the infant 4 to 6 months of age is in a transition period

23. The Second 6 Months • By this time, physiological and developmental readiness includes: • The gastrointestinal tract has matured sufficiently to handle more complex nutrients and is less sensitive to potentially allergenic foods. Tooth eruption is beginning and facilitates biting and chewing • Swallowing is more coordinated to allow the infant to accept solids easily.

24. The Second 6 Months 3. Head control is well developed, which permits infants to sit with support and purposely turn the head away to communicate disinterest in food. 4. Voluntary grasping and improved eye-hand coordination gradually allow infants to pick up finger foods and feed themselves 5. Their increasing sense of independence is evident in their desire to try to "help" during feeding or to hold the bottle. • https://www.google.jo/search?q=baby%27s+first+food&dcr=0&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjEiuqc_ZXXAhUHuBoKHZJhB0oQ_AUICigB&biw=1600&bih=745#imgrc=c10MUEHDmjyl8M:

25. Selection and Preparation of Solid Foods • Iron-fortified infant cereal is generally introduced first because of its high iron content • Rice is usually suggested as an initial food because of its easy digestibility and low allergenic potential

26. Selection and Preparation of Solid Foods • Commercial cereals are combined with fruit (not used) for the following reasons: • Lack of nutritional benefit from these preparations • They are more expensive. • Risk of developing allergy

27. Selection and Preparation of Solid Foods • New foods should be added one at a time • Infant cereal (iron fortified) is mixed with formula until whole milk is given. • If the infant is breast-fed, the cereal is mixed with expressed breast milk or water.

28. Selection and Preparation of Solid Foods • After 6 months of age: • Fruit juices can be mixed with the dry cereal the vitamin C content of the juice enhances the absorption of iron in the cereal. Infant cereals should be continued until the child is 18 months of age, because of their benefit as a source of iron

29. Selection and Preparation of Solid Foods • Fruit juice can be offered from a cup for its rich source of vitamin C and as a substitute for milk for one feeding a day • Large quantities of certain juices (e.g., apple, pear, sweet cherry, peach, grape) are avoided because they may cause abdominal pain, bloating, or diarrhea in some children • White grape juice is reported to be well absorbed and safe for infants t without causing gastrointestinal distress

30. Selection and Preparation of Solid Foods • AAP (2014) recommended that: • Juices not be given to infants less than 4 to 6 months old • juices is not warmed, because vitamin C is naturally destroyed by heat • Juice containers are always kept covered and refrigerated to prevent vitamin loss.

31. Selection and Preparation of Solid Foods • A common sequence is to introduce fruits followed by vegetables and, finally, meats Some clinicians prefer to add vegetables before fruit. • Citrus fruits, meats, and eggs are delayed until after 6 months of age because of potential allergy.

32. At 6 months: • Foods such as a cracker can be offered as a type of finger and teething food. • By 8 to 9 months • A cooked vegetable, raw pieces of fruit (except grapes), or cheese can be given. • By 1 year • Well-cooked table foods are served.

33. Selection and Preparation of Solid Foods • Commercially prepared baby foods can be relatively expensive. • An alternative is to prepare baby foods at home • Fruits and vegetables can be steamed in a small amount of water ,then, blended • Some food such as banana can be mashed fine with a fork.

34. Selection and Preparation of Solid Foods • Fruits such as apples or pears require little or no water in the cooking process. • Vegetables such as carrots, potatoes, or beans require additional water in the cooking and blending

35. Introduction of Solid Foods • See Family Centered Care Table Page 321 • Introduce solid when infant is hungry. • Begin spoon feeding by pushing food to back of tongue because of infant's natural tendency to thrust tongue forward.

36. Introduction of Solid Foods • One food item is introduced at intervals of 4 to 7 days to allow for identification of food allergies • New foods are fed in small amounts, from 1 teaspoon to a few tablespoons. • As the amount of solid food increases, the quantity of milk is decreased to less than 1 L daily to prevent overfeeding

37. Weaning • Weaning is the process of giving up one method of feeding for another • Weaning usually refers to relinquishing the breast or bottle for a cup • There is no one time for weaning that is best for every child, but generally most infants show signs of readiness during the second half of the first year

38. Weaning • Infant have learned that good things come from a spoon. • Imitation becomes a powerful motivator by age 8 or 9 months, and they enjoy using a cup or glass like others do. https://www.google.jo/search?biw=1366&bih=662&tbm=isch&sa=1&ei=4pT2Wcq3O8b3aIfArsgK&q=infant+breast+feeding+&oq=infant+breast+feeding+&gs_l=psy-ab.12..0i13k1l3j0i13i30k1l2j0i8i13i30k1l2j0i10i24k1l2.13964.25919.0.28326.25.22.0.0.0.0.1054.3956.4-1j0j3j1.5.0....0...1.1.64.psy-ab..21.2.1920...0j0i67k1.0.Nkxeu_vPht8#imgrc=E8-bJ3fuzWozbM:

39. Weaning • Weaning should be gradual by replacing one bottle- or breast-feeding at a time. • The nighttime feeding is usually the last feeding to be discontinued. • It is advisable never to begin allowing a child to take a bottle of milk to bed—this is a major cause of nursing caries in deciduous teeth.

40. Weaning • If breast-feeding is terminated before 5 or 6 months of age, weaning should be to a bottle to provide for the infant's continued sucking needs. • If discontinued later, weaning can be directly to a cup, especially by age 12 to 14 months. • Any sweet liquid, such as fruit juice, should be given in a cup.

41. Sleep and Activity By 2 months: The total daily sleep is approximately 15 hours. By 6-12 months • The total daily sleep is approximately 13 hours By 12 months • Most infants have developed a nocturnal (night-time) pattern of sleep that lasts at least 8 hours • One or two naps by

42. Sleep and Activity • Breast-fed infants usually sleep for less prolonged periods, with more frequent waking, especially during the night, than do formula-fed infants.

43. Sleep and Activity • Most infants are naturally active and need no encouragement to be mobile • Problems of using devices such as playpens, s and mobile walkers are: • Restrict movement and prevent infants from exploring and developing gross motor skills • dangerous if tipped over or placed near stairs.

44. Sleep problems 1. Nighttime feeding: need prolonged time. Management: • Increase time day feeding, • Late last feeding, • Put to bed awake. • When he is crying; reassure but do not hold . https://www.google.jo/search?biw=1366&bih=662&tbm=isch&sa=1&ei=ZJf2Wc2AHNHUaZi_ntgK&q=infant+sleep+problems&oq=infant+sleep+problems&gs_l=psy-ab.12..0i24k1l6.61101.66529.0.68374.9.9.0.0.0.0.840.2393.6-3.3.0....0...1.1.64.psy-ab..6.3.2388....0.7hKjsQR9oTc#imgrc=ms264zsaJ-g93M:

45. Sleep problems 2. Developmental night crying: 6-12 months, nightmares. Management: • Reassure parents that phase is temporary • Avoid feeding • Avoid taking to parent's bed

46. Sleep problems 3.Refusal to go to bed. Management: - Evaluate if hours of sleep is too early - If child persists in leaving bedroom, close door for progressively longer periods - Use reward system with child to provide motivation

47. Sleep problems 3.Refusal to go to bed. Management: - Evaluate if hours of sleep is too early - If child persists in leaving bedroom, close door for progressively longer periods - Use reward system with child to provide motivation

48. Sleep problems 4. Trained night crying: rocking, crying Management: Put child in own bed when awake. Check at progressively longer intervals each night. Reassure child but do not resume usual routine. Arrange sleeping area separate from other family.

49. Sleep problems 5. Nighttime fears: Management: Evaluate if hours of sleep is too early which let him think in dark room Calmly reassure the frightened child Keeping a night-light on Use reward system with child to provide motivation to deal with fear Avoid sleeping with child or taking child to parent's room

50. https://www.google.jo/search?q=teeth+growth+in+infants&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjs7pf5nJjXAhXK6xoKHQHUA7QQ_AUICigB&biw=1600&bih=794#imgrc=p0NzEvJLAH8nZM:https://www.google.jo/search?q=teeth+growth+in+infants&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjs7pf5nJjXAhXK6xoKHQHUA7QQ_AUICigB&biw=1600&bih=794#imgrc=p0NzEvJLAH8nZM: