Infants

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Topic Objectives

Upon successful completion of this topic, for the following age groups (infants, toddlers, pre-schoolers, school-age children and adolescents), you should be able to:

Development

Describe the physical, social and emotional developmental milestones and the social learning theories related to the development of an infant

Development Theories

Freud Theory of Psychosexual Development

Infants are in the oral stage of development . They obtain pleasure and comfort through the mouth

Erickson Theory Theory of Psychosocial Development Trust vs mistrust the baby establishes a sense of trust when basic needs are met

Physical Milestones

Newborn

*Turns head from side to side

*Grasps by reflex when object is placed in palm of hand

4 Months

* Rolls over sits with support, holds head steady when sitting

6 Months

*Lifts chest and shoulders when prone, bearing weight on hands

*Manipulates small objects

9 Months

*Creeps and crawls, uses pincer grasps with thumb and forefinger

12 Months

* Walks alone with help

*Uses spoon to feed self

Social Development

Newborn

*Displays displeasure by crying and satisfactions by soft noises

*Responds to adult face and voice by eye contact and settling

4 Months

*Babbles, laughs and increased response to verbal play

6 Months

*Starts to imitate sound. Says one syllable sounds 'ma ma' da da

9 Months

*Complies with verbal commands

*Displays fear of being left alone

*Waves bye-bye

12 Months

*Clings to mother in unfamiliar situation

*Demonstrates emotions such as anger and affection

Emotional

Based around the concept of pleasure and pain with right and wrong

Explain the importance of attachment and bonding to children’s growth and development

In health care attachment is described as interactive behaviors between caregivers and their infants and their larger environment. Bonding refers to the initial maternal emotional tie to the newborn immediately following delivery .

Demonstrate an understanding of the current health recommendations for infants around critical topics of health including sleep and nutrition.

Rest and Sleep

Establish Routine for sleep and rest

Ensure cot sides and raised to prevent accidental falls

How much sleep do babies need? Is your baby getting enough sleep at the right times? Just like grown-ups, babies all sleep for different amounts of time. As a guide:

an 8-9 month-old baby will sleep for about 14-15 hours every 24 hours

an 8-9 month-old baby will have two naps per day lasting at least one hour each

wakeful, grizzly babies probably need more sleep

wakeful, contented babies are probably getting enough sleep!

Nutrition

Exclusively breast feed for six months and should continue until 2 years of age, if breast feeding is not feasible the use of appropriate infant formulas made up as per instructions are needed

Introduction of solids at 4 months

Assessment

Demonstrate an understanding of a compete head to toe physical assessment of an infant

0-4wks

• General

appearance

• Skin

• Head /

Fontanelle

• Face, Eyes,

Neck

• Chest,

Abdomen

• Genitalia

• Extremities

• Hips

• Back

• Neurological

(posture, tone,

reflexes)

2 months

• General

appearance

• Skin

• Head /

Fontanelle

• Face, Eyes,

Neck

• Chest,

Abdomen

• Genitalia

• Extremities

• Hips

• Back

• Neurological

(posture, tone,

reflexes)

4 months

General

appearance

• Skin

• Head /

Fontanelle

• Face, Eyes,

Neck

• Chest,

Abdomen

• Hips

• Genitalia

• Neurological

(posture,

tone, reflexes)

6 months

General

appearance /

behaviour

• Head /

Fontanelle

• Face, Eyes

Neck

• CLR

• Hips

• Genitalia

• Neurological

(posture,

tone,

reflexes)

[8, 9, 17]

12 Months

General

appearance /

behaviour

• Head /

Fontanelle

• Face, Eyes,

Neck

• CLR

• Hips

[8, 9, 17]

Hospitalisation and pain management Average pulse and respirations for an infant

Pulse rate 100-170

Respiration 30-55

Average weight and length of an new born infant

The normal weight of a baby who reaches full term between 37 and 40 weeks is 2.7–4.1kg (6 – 9 lbs), with an average weight of 3.5kg (7.7 lbs). A baby who weighs less than 2.5kg (5.5 lbs) is considered to have a low birth weight.Mar 13, 2014

Demonstrate an understanding of the impact of hospitalisation on infants and their families

Effect of Hospitalisation

Strategies to aid child and family

Seperation anixity

Reassure family of normal behaviours, encourage the caregivers to

remain with the child as much as possible,

Stranger anxiety

keep normal routines, good communication with family’s, introduce yourself – enter and leave room

slowly

Painful and invasive procedures

Appropriate use of pain relief

Imobilization

Sleep deprivation, sensory overload

Determine bedtime routines and adhere, encourage the use of comfort

items. Ect quite environment , limited stimuli -

, increased work at home stress and worry about children, anxiety

fear

Keep family informed – help encouragement and support from nursing

staff. Good relationship with hospital staff. Chaplain, social worker ect

Adverse effects of siblings, fear, feelings of abandonment worry

confusion anxiety

Answer questions and give time to siblings, encourage siblings to

visit be truthful, assure, allow, encourage, warn, encourage expression of

feelinds

Describe the pharmacological and non-pharmacological approaches to pain management with special focus on medications, doses and administration.

Sucrose

Panadol oral 15mls per kg

Skim read the above chapter and make some notes on the following topics

according to infants

1. Developmental

aspects of pain (focus only on infant)

Less than 6 months have no

understanding of pain; is responsive to parental anxiety. May be charterised by

generalised body movements, chin quivery, facial grimacing poor feeding and

verbal crying.

6-12 months has a pain memory; is

responsive to parental anxiety. Reflex withdrawal to stimuli, facial grimacing,

disturbed sleep, irritability, restlessness, verbal crys

2. Cultural influences

of pain

3. Pain Assessment

(Focus on FLACC Chart only)

FLACC Behaviotal Pain Assessment

Each catergory is socored on a 0-2

scale wit results between 0-10

0 – relaxed and comfortable

1-3 Mild discomfort

4-6 Moderate pain

7-10 severe discomfort of pain or

both

4. Acute Pain

Physiologic Indicators

Tachycardia,

tachypnoea, hypertension, pupil dilation, pallor, increased perspiration and

increased secretion of catecholamine’s and adrenocorticoid hormones

Behavioural Indications

Short attention span, facial

grimacing, Posturing, Drawing up knees, flexing limbs, massaging affected

areas, lethargy, remaining quite or withdrawal , sleep disturbances

Immunisation

Analyse why immunisation is a public health initiative and the RN role in national and state initiative to maximise immunisation rates of Australian Children

·

Vaccination

Vaccination is the

administration of antigenic material (a vaccine) to stimulate an individual's

immune system to develop adaptive immunity to a pathogen

·

Immunisation

'Immunisation'is

the term used for the process of both getting the vaccine and becoming

immune to the disease as a result of the vaccine.

·

control

·

elimination

·

eradication

the

complete destruction of something

·

extinction

·

herd immunity

Herd immunity is a form of immunity that occurs when the

vaccination of a significant portion of a population (or herd)

provides a measure of protection for individuals who have not developedimmunity.Jun 15, 2012

Summarise the current NHMRC immunisation schedules for 0-6 years.

Child programs

Age

Vaccine

Birth

Hepatitis B (hepB)

2 months

Hepatitis B, diphtheria, tetanus, acellular pertussis (whooping

cough), Haemophilus influenzae type b, inactivated poliomyelitis (polio)

(hepB-DTPa-Hib-IPV)

Pneumococcal conjugate (13vPCV)

Rotavirus

4 months

·

Hepatitis B, diphtheria, tetanus,

acellular pertussis (whooping cough), Haemophilus influenzae type b,

inactivated poliomyelitis (polio) (hepB-DTPa-Hib-IPV)

·

Pneumococcal conjugate (13vPCV)

·

Rotavirus

6 months

·

Hepatitis B, diphtheria, tetanus,

acellular pertussis (whooping cough), Haemophilus influenzae type b,

inactivated poliomyelitis (polio) (hepB-DTPa-Hib-IPV)

·

Pneumococcal conjugate (13vPCV)

·

Rotavirus b

12 months

Haemophilus influenzae

type b and meningococcal C (Hib-MenC)

Measles, mumps and rubella

(MMR)

·

18 months

Measles, mumps, rubella

and varicella (chickenpox) (MMRV)

4 years

Diphtheria, tetanus,

acellular pertussis (whooping cough) and inactivated poliomyelitis

(polio) (DTPa-IPV)

Measles, mumps and rubella

(MMR) (to be given only if MMRV vaccine was not given at 18 months)

Identify common issues of risk and injury for infants

z Sleep babies on their back from birth – never on their

tummy or side.

z

Sleep babies with their head and face uncovered, with

their feet at the foot of the cot. Don’t use quilts, doonas,

duvets, pillows, cot bumpers, and sheep skins, or place

soft toys in the cot.

z

Tuck bedding in securely so it is not loose, or sleep the baby

in a sleeping bag that is the right weight for the season and

fits the neck firmly.

z

Avoid exposing babies to tobacco smoke during pregnancy

and after birth. Avoid smoke in the air around babies, and

on your clothes.

z

Sleep babies in their own cot or bassinette in the same room

as you for the first 6–12 months, not in the bed with you.

Common Causes of Injury

z

Rolling off the change table, bench or bed.

z

Falling out of high chairs, prams, strollers, beds, couches,

change tables or bouncers.

z

Choking on small items as everything goes into their mouths.

z

Burns from hot drinks spilt over a child while being held by or

close to a carer.

z

Poisoning from medicines or swallowing dangerous substances

such as detergents, chemicals, and alcohol.

z

Baby walkers - falling, crashing, pulling things down on

themselves.