WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024
Unang Yakap: Essential Newborn Care
vNewborn deaths are due to stressful events /
conditions during labor, delivery, and immediate
postpartum period
vSimple, cause effective
Ø Immediate and thorough drying (3o mins drying to
promote breathing; prevent hypothermia)
Ø Early skin-to-skin contact (est mother and child
bonding, minimizes the risk of sepsis and
hypoglycemia)
Ø Properly timed cord clamping and cutting (1st
clamp = 2cm from the umbilicus of fetus, 2nd
clamp = 5cm; prevent anemia and hemorrhage)
Ø Non-separation of the newborn and mother for
early initiation of breastfeeding
§ carry out eyecare and immunization process
(HepB and Vit K)
§ Rooming in
Principles of Immediate Newborn Care
Maintain Patent Airway
vPriority goal
vClear the neonates airways = extension of fetal head
even before the chest is born
vCrying w/ mucus in mouth can cause aspiration of
mucus and meconium (meconium aspiration)
vNever stimulate crying b4 suctioning
vSuctioning =immediately when the head extends;
mouth to nose (bulb syringe = shallow suctioning;
prevents stim of the vagus nerve)
vSuction briefly 5-10 secs in full term, >5 seconds if
preterm and high-risk newborns (prevents
breathlessness)
vSlight Trendelenberg position = after suctioning; 1015 degrees angle head down (for the drainage of
nasopharyngeal secretions; prevents abd contents
from compressing the diaphragm; contraindicated =
high risk of increased intracranial pressure)
vOxygenate between suctioning; may cause neonatal
blindness = O2 toxicity
vAsphyxia neonatorum = failure to initiate breathing
in the first 60s of life; clogged air passages; ensure
patent airway
vNewborn is OBLIGATE NASAL BREATHER = ensure
nostril patency
vGently stimulate cry and turn q2hrs =fully inflate
alveoli
vGently rub his back / slap soles = stimulate cry
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MOTHER AND
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Ø Use of bulb syringe
Ø Squeeze
Ø Place in 1 nostril ¼ - ½ inch / inside of the cheek
Ø Quickly release the bulb (pulls the mucus into
bulb)
Maintain Body Temperature
vNewborn temp is higher than mother’s but drops
continuously
vWrap the newborn
vCover head with insulated fabric or knitted bonnet
vNewborn temp = stabilizes @ 8- 10hrs
vHead loses a lot of heat
vGooseneck lamp = place the newborn for added heat
by radiation
v36.5-37.5 deg C per axilla
vHypothermia = a condition in which the newborns
temp falls below 36.5 degrees C
vCheck initial temp = per rectum; also to check for
patency
vTaking rectal temp
Ø apply lubricating KY jelly into the tip of digital
thermometer
Ø insert into the rectum about ½ - 1 inch
Mechanism of Heat Loss
vConvection
Ø loss of heat to the cool air
Ø wrap baby and promote flexion
Ø avoid unnecessary exposure when doing
procedures
vRadiation
Ø heat loss due to cool surfaces not in contact with
the body (walls, floors, ceiling, etc.)
Ø Indirect contact
Ø Most of newborn heat is loss this way
Ø Wrap the infant
Ø Gooseneck lamp
vConduction
Ø loss of heat to cool surfaces in direct contact
Ø do not put the newborn in cold unlined surfaces
(eg weighing scale)
Ø line the weighing scale w/ linen or weigh infant’s
clothes and weigh him with the clothes (subtract
weight of the cloth from the newborns weight)
Ø rest the infant on maternal abdomen / give him to
the mother or father to hold
Ø maternal abd temp = same as temp in incubator
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WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
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vEvaporation
Ø loss of heat as water evaporates from the infant’s
body
Ø dry infant right away @ birth
§ Newborns don’t shiver = the burn heat through
BROWN FAT
vBrown Fat
Ø located around the scapula, sternum, kidneys,
and adrenals this is easily burned and produces a
lot of heat in the process
Ø major source of heat prod.
Ø excess causes metabolic acidosis
Ø requires more O2 and glucose = respiratory
distress / hypoglycemia
Ø nurse should keep the newborn warm and prevent
heat loss
Ø cold stress = metabolic acidosis, hypoglycemia,
and respi distress
Nursing Management in Thermoregulation
vDry baby at once after delivery
vPlace under radiant warmer (prewarm baby’s
clothes)
vWrap the baby accordingly
vProvide gooseneck lamp
vMonitor VS accordingly
Carry out APGAR Scoring
vdetermines wellbeing
vnumerical expression of the newborn’s adaptation to
extrauterine life performed @ 1min and 5 min after
birth
v10 min scoring = when 5min score is under 7
v1 min scoring = cardiorespiratory function of the
newborn, general condition and the need for
resuscitation
(resuscitation
must
be
done
immediately and not delayed for the 1min score)
vneed for resuscitation can be more accurately
assessed by = eval of NBs HR, respi activity, and
color than by the APGAR score
v5 min scoring = detects the NBs adjustment to the
new environment, detects prognosis’
vin Nursing care planning we use 2nd APGAR score
(5 min)
v0-3 = poor; need resuscitation
v4-6 = fair; may need suctioning and oxygenation;
newborn is condition guarded
v8-10 = good; no signs of distress; admission care
only; no special care
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MOTHER AND
CHILD CARE
vHR / pulse = most important APGAR score; w/o this
the other conditions will not be observed
vColor = least important
vAcrocyanosis
Ø score of 9
Ø body pink, extremities blue
Ø sluggish peripheral circulation of the NB in the
first 24hrs
Ø gently stimulate cry to improve peripheral circ.
vReflex irritability
Ø should not be limited to the ability to illicit cry or
sneezing upon stimulation
Ø the demo of reflexes in the NB like the moro reflex
(reflex to lack of support; spreading of arms and
crying) means irritability and deserves perfect 2
score
Ø Good cry = breathing well; score of 2
Prevention of Hemorrhage
vVit K or phytomenadione
Ø IM; to prevent hemorrhage
Ø Vit K = 0.5 mg
Ø phytomenadione = 1.5 mg
Ø to prevent bleeding due to deficiency in the clotting
factor vitamin K
Ø 0.5mg (preterm)
Ø 1.5mg (term)
Ø the NBs GI tract is initially sterile = no bacteria
such as E. coli to stimulate the prod of vit K
Ø neonatal hemorrhage = lack of cofactor to blood
clotting Vit K
§ Central nervous system hemorrhage = occurs
in infants not given vit K
§ given in the anterolateral aspect of the thigh or
the vastus lateralis
§ alternate sites: medial thigh / rectus femoris
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WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
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Ø ideal dose = 1mg
Ø stock dose for phytomenadione: 10mg/ml: 0.1 ml
per IM
Prevention of Infection
vCrede’s prophylaxis
Ø eyecare by prophylaxis against ophthalmia
neonatorum / gonorrheal conjunctivitis =
neonatal blindness
Ø legal responsibility given to NBs whether or not the
mother has gonorrhea
vDrugs:
Ø Silver nitrate = can cause black staining
Ø Tetracycline
Ø Erythromycin = most common
Ø all medications can cause chemical conjunctivitis
in the eyes within the first 24hrs after application
Ø rinse eyes before application, no rinsing after
application
Ø eyecare may be delayed in 1-2 hrs after birth in
order not to interfere w/ the bonding process
vCord dressing and daily cord care
Ø strict asepsis to prevent
Ø tetanus neonatorum (Clostridium tetani)
Ø Omphalitis (nonspecific bacterial infection of the
cord)
Ø Check the # cord’s blood vessels: one big vein and
2 small arteries = single cord artery requires
evaluation for genitourinary / kidney anomaly
Ø drying up = 70% alc application 1-2x a day or PRN
Ø cord stump drops off by 7-10 days (on its own)
Ø silver nitrate cauterization = If the cord did not
drop
Infant Identification
vID Band bracelets or Foot Tags
Ø mother’s name, mother’s hospital number, date of
delivery, time of delivery, and sex of the baby
Ø identify NB properly in the delivery room and not
in the nursery
Ø the identification of the NB is done before the NB
is separated from the mother:
§ Prevent switching
§ Misidentification
§ Abduction
Ø the nurse must be familiar with the infant security
system used in the area of practice
Ø home birth = identified properly before being
transported to a health facility
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MOTHER AND
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Maternal-Infant Bonding
vUnang Yakap (ENC)
Ø promoting bonding, encourage breastfeeding right
on the DR table
Ø delay prophylaxis / Crede’s prophylaxis for 1- 2hrs
(in order not to interfere with the bonding process
due to blurred vision which does not promote eye
contact)
Ø eye contact = most important prerequisite to early
bonding
vEarly Rooming in
Ø an infant delivered by normal spontaneous
delivery (NSD) may be roomed in = 30mins after
birth
Ø an infant delivered through c section = 4 hrs after
birth varying any infant complications /
contraindications
Continue Further Assessment
vcommonly used technique of gestational age
assessment
vassigns a score to various criteria and the sum of all
is extrapolated to the gestational age of the fetus
vPhysical Maturity
Ø allows for the estimation of age from 26wks44wks
Ø the scoring relies on the intrauterine changes that
the fetus undergoes during its maturation
Ø how well the fetus has matured
Ø depends on anatomical changes
vNeurological Criteria
Ø depend on muscle tones
Ø response of the newborn
Ø Physiological Hypotonia = the neonate is in a
state of physiological hypotonia
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WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
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Ø this tone increases throughout the fetal growth: a
more premature baby would have a lesser muscle
tone
Ø each of the criteria in physical and neurological
maturity is scored 0-5 in the original Ballard’s
score
Ø scores then range from 5-50 with corresponding
gestational ages in weeks
Ø ^in score by 5 = ^in age by 2 weeks
Cont. Immediate Newborn Care
vThe newborn is a child from the time of compete
delivery until 28 days old
vNeonatal stage = neonate
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MOTHER AND
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Taking of anthropometric measurement of the
newborn
vWeight
Ø avg: 300-400g ranging 2500g – 4000g (max)
Ø most raw data by weighing the infant naked /
subtracting the weight of the clothes from the total
length of the clothes of the baby
vBody Length
Ø full term NB varies from = 18-22 inches; avg of
50cm from heel to crown
Ø Straighten the legs of the newborn
Ø Measure till the highest point of the head
vHead Circumference
Ø The frontal-occipital measurement (FOC) is
measured in cm with a measuring tape placed
around the largest part of the occipital area and
gathered over the forehead on top of the eyebrows
Ø Tape measure should be clean
Ø 33-38cm / 34-35cm = normal head circumference
range for term measurement
Ø 3 measurements should be done, LARGEST of the
3 is recorded by the nurse
Ø Hydrocephalus = 0.5-1inch / month or greater
than 1 inch per month of increase in
circumference; water in the brain
Ø Head is the biggest part of the body; ¼ of the
body’s length
vChest circumference
Ø Range: 32-33cm
Ø Equal to abd circumference
Ø Nipple line = landmark for chest circumference
vAbdominal Circumference
Ø Range: 31-33cm
Breastfeeding
vMost important infant feeding
vMaintain rooming in to promote breastfeeding
vDemand feeding = best feeding sched; feeding the
infant according to his biologic need for food
whenever he is hungry and not whenever he cries
vCrying is the only means of communication
vOral / feeding needs = essential for the foundation
of the development of personality (Freud’s
psychosexual dev’t theory); sense of trust
vFirst 6 months
vColostrum
Ø Thin, light yellow fluid present in the breast from
pregnancy into early post-partum
Ø First breast milk
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WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
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Ø Rich in antibodies and proteins compared to
mature breast milk
Ø Binds bilirubin and acts as laxative to promote the
excretion of meconium
vTransitional Milk
Ø Produced after colostrum and immediately before
mature milk
vForemilk
Ø Thin, watery milk secreted at the beginning of a
feeding
Ø Low in calories but high in water soluble vitamins:
§ Vit B
§ Vit C
vHindmilk
Ø Thick, high fat breast milk secreted at the end of a
feeding
Ø Highest concentration of calories
vMature Milk
Ø Breast milk that contains 10% solids for energy
and growth
Ø Compared to cow’s milk, breast milk is higher in
carbs, fat, and water content but lower in proteins,
vitamins, and minerals.
vLactalbumin
Ø protein in human milk
Ø better protein
Ø easy to digest
Ø hypoallergenic
vAntibodies
Ø most important part of breast milk
Ø protect the infant from common diseases of
childhood which his mother has immunity
vIdeal feeding sched: q2-3hrs regardless the time
of the day and even when the newborn is asleep
vPrerequisite of Breastfeeding
Ø Physiologic readiness
Ø Absence of emotional stress
Ø Sucking (stimulates first let down reflex)
Ø Rest, exercise & diet
Ø Absence of contraindications
Maternal Contraindication to Breastfeeding
vSevere Cardiac Diseases – life-threatening diseases
vCancer – breastfeeding is incompatible with
chemotherapeutic agents
vSevere debilitating disease and conditions (surgery)
vAcute contagious diseases – Hep C virus but not Hep
B virus
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MOTHER AND
CHILD CARE
Ø Children born to mothers with active Hep B or
carriers will be given Hep B Hepatitis
immunoglobulin (HBIG) after birth + dosage of
human Hep B vaccine + 2nd dose a week later
vDrug Abuse / Narcotic Amdection
vMothers that are positive w/ HIV antibody to avoid
postnatal transmission
vHIV infection – to avoid pre-natal transmission
Infant Contraindications to Breastfeeding
vNewborn conditions that will not allow normal
sucking, swallowing, grasping of the nipple
vDiagnosed inborn errors of metabolism may
necessitate cessation of breastfeeding
Pharmacologic Indications to Breastfeeding Would
Include:
vDrugs that pass into breast milk
Ø Cocaine
Ø Most medications appear only in small amounts in
breast milk
vDrugs contraindicated in lactating women
Ø May suppress lactation
Ø Toxic effects have been reported or predicted on
theoretical grounds
Ø Analgesics,
anti-inflammatory,
antibiotics
(chloramphenicol, isoniazine, tetracycline)
Ø Hormones: estrogen
Ø Iodine salts
Ø Anticoagulants: reserpine
Ø Anti-neoplastics
Ø Atropins
Ø Drugs acting on the CNS
Ø Lithium
Ø Mephrodomate (?)
§ Not contraindicated if the mother has inverted
nipples = use nipple guard
§ Cytomegalovirus
(CMV)
–
is
not
a
contraindication
because
milk has
the
appropriate antibodies to protect the infant from
this infection
§ The negative effects of smoking on an infant may
be offset by breastfeeding due to the effects of
hormones in breast milk. A study suggest that
children w/ smoking mothers who were
breastfeeding scored better in tests of mental
dev’t that those whose mother’s smoked and did
not breastfeed. If the mother cannot and would
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WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
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not stop smoking, she should be encouraged to
breastfeed as long as she does not smoke while
MOTHER AND
CHILD CARE
Different positions to assume while brea
vMake her comfortable
vSafety of the newborn
Latch-on Position
vCradle position / cradle hold
Ø Traditional and most common hold when cradling
or cuddling the infant
Ø The mother cradles the newborn’s head in the
bend of the elbow of the non-dominant hand with
her forearm reaching around the outside of the
infant’s body to grasp outer leg Ø The mother’s dominant hand help support the
infant’s back and bottom
vCross- cradle position
Ø Similar or same to the cradle position however the
mother is using the dominant hand and the nondom hand supports the head and the breast
vFootball hold
Ø Safe and secure hold for shampooing NBs and
young infants and during breastfeeding as well
Ø Recommended if the mother is feeding twins
simultaneously
Ø Half the length of the NB’s body is supported by
the forearm while his head and neck rests on her
palm
Ø The buttocks and legs are firmly wedged between
the mother’s elbow and hip
Ø Leaves the mother with a free hand to shampoo
the hair, or grasps something, or other essentials
while carrying the NB
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WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
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vLaid back positions
Ø Not ideal because mother might fall asleep in this
position
Ø Mother must not fall asleep while breastfeeding
the baby = the baby might fall or the baby may not
be attended to
vSide lying position
Ø The baby is placed on the bed while the mother is
feeding and is positioned in the lateral side facing
the baby
Ø Important to indicate = infant head has to be
elevated to prevent aspiration during feeding
vShoulder Hold
Ø After feeding burp the baby = shoulder hold.
Ø Burping or bubbling an infant
Ø Using two hands the mother holds up the infant
against one side of her chest and a shoulder
Ø One hand supports the infants buttocks while the
other hand supports the infants head and upper
back
Ø In burping:
§ The hand supporting the head and upper back
may be momentarily withdrawn to pat the back
gently from the waist upward to the shoulders
§ Repeat until the infant burps
Bathing
vWHO suggests delaying the baby’s first bath until
24hrs after birth or waiting at least 6hrs if whole day
is not possible
vTHINGS TO CONSIDER:
vBody Temp and blood sugar of the NB
Ø Babies who takes bath right away may become
cold and develop hypothermia
Ø The minor stress in the first bath = drop in blood
sugar / hypoglycemia
vBonding and breastfeeding
Ø Taking the baby for a bath too soon can interrupt
skin to skin mother child bonding, and early
breastfeeding success
vDry skin
Ø Vernix = white waxy substance that coats a baby’s
skin b4 birth acts as a natural moisturizer and
anti-bacterial properties
Ø Best to leave vernix on the newborn skin for a
while to help prevent their delicate skin from
drying out
Ø Important for preterms (skin is highly prone to
injuries)
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MOTHER AND
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vCheck water temp
Ø Fill basin w/ two inches of water that feels warm
not hot to the inside of the wrist / elbow
Ø If filling the basin from tap = turn cold on then off
last to avoid scalding the child
Ø Keep the baby warm
Ø After undressing the NB place him in the water
immediately so that he doesn’t get chilled
Ø One of the hands to support the head, the other to
guide in = feet first’
Ø Use soap sparingly = soap can dry baby’s skin
Ø If a cleanser is needed for heavily soiled areas =
use mild, neutral ph soaps w/o additives
Ø Clean gently
Ø Soft cloth can be used carefully so as not to scrub
or tug the skin
Ø Massage the scalp gently even the areas over the
fontanels or the soft spots
Ø After bathing:
§ Towel around the head and body to help him
stay warm while he is still wet
Ø Ensure safety from trips or falls
vSleep
Ø The avg NB sleeps much of the day and night
waking up only q few hours
Ø May be hard for the new parents since there is no
set sched for the newborn at first
Ø Many NB have their days and nights confused they
think that they are supposed to be awake at night
and asleep during the day
Ø Generally a newborn sleeps a total of: 8-9hrs in the
day time, 8hrs at night
Ø Small stomachs = awaken q 2-3hrs for feeding
Ø Most babies don’t start sleeping through the night
until 3monthsof age (can vary, some can be up to
one year)
Ø Most cases: Baby will wake up ready to eat q 3hrs
Ø How often to feed depends on what the baby is
being fed and his age
Ø Watch the sleep pattern
Ø Sleeping consistently waking up more often = may
be a problem
Ø Growth spurt and needs to eat more often = sleep
disturbances are caused by changes in dev’t or
overstimulation
Ø SIDS =Sudden Infant Death Syndrome
§ Unexplained death usually during sleep
§ Seemingly healthy baby less than a year old
§ Aka “crib death” – infants die in their death
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MOTHER AND
CHILD CARE
§ Unknown but linked to a defect in a portion of
the infant’s brain that controls breathing an
arousal from sleep
Ø NCM OF SIDS
§ put baby to sleep on their backs, not prone
position or side position
§ keep stuffed toys and fluffy blankets out of the
crib (not overheating the baby)
§ no smoking during pregnancy
§ no smoking around the baby
§ 10
§ increase in response to dietary intake and
bacterial colonization of the intestine
vAnticoagulant coumadin or warfarin - not given to
pregnant women as it crosses the placental barrier
and accentuates existing vitamin K dependent
factors deficiencies
vHEPARIN - If there is a need for vit. K therapy in
pregnancy; safe drug to use is as it does not cross
the placental barrier
Cardiovascular System
vdecreased pulmonary artery pressure
vBV = 300ml
vAcrocyanosis
Ø Pink body, bluish limbs
Ø Normal in first 24hrs of life
vHigh RBC, HCT, & WBC (increased destruction)
Ø Hemolysis
Ø Umbilical vein, arteries, and ductus venosus close
with clamping of cord
Ø Foramen ovale and ductus arteriosis close
functionally with establishment of respirations
caused by increased pressure in the left side of the
heart as a result of increased pulmonary blood
flow
Ø Only becomes permanently anatomically closed
after 3-4 months and explains why murmurs can
be observed at the first month of life
vApical pulse - detected at the level of the third or
fourth interspace to the left midclavicular line, and
normal rate would be 110-160bpm
Ø Pulses reflect systemic circulation and easily
palpable pulse can be found in the femoral and
brachial pulse sites
Ø Difficult to palpate temporal and radial pulse for
newborn infants
Ø Initial sterility of infant’s GIT is absent which
results to low levels of vit K = possibility of bleeding
Ø Cow’s milk - for bleeding; restores prothrombin
time faster than breastmilk because breastmilk
contains only a quarter of the amount of vit K per
deciliter of cow’s milk
Ø Coagulation factors - synthesized in the liver and
activated under the influence of vit. K
Ø Vitamin k dependent factors such as factors:
§ 2
§ 7
§ 9
Respiratory System
vObligatory nose bleeders, meaning infants breathe
through their nostrils
vInitiation of respiration is caused by different
factors:
Ø Increased CO2
Ø Decrease of oxygen, thus having low pH
Ø Decreased pulmonary vascular resistance
Ø Increased pulmonary blood flow
Ø Decreased alveolar surface tension from adequate
surfactant
Ø Recoil of chest causing replacement of fluids
Ø Change from weightlessness to gravity-controlled
environment
vRespirations may be irregular with short periods of
apnea
vAt times shallow, abdominal, nasal, quiet, and rapid
at 30-60 cycles per min
vMonitor rr = look into abdomen
vSURFACTANT - a requisite for mature long
functioning
vRespiratory secretions may be abundant
vRETRACTIONS - Look into for indications for highrisk newborns; intercostal retractions and sternal
retractions
vBluish or cyanotic mucous membrane / central
cyanosis- most reliable indication that inborn is
having low O2 saturation which demands urgent
attention due to hypoxia or congenital defects
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Gastrointestinal System
vNewborn often spits off mucus in the first 24 hours
regurgitation and is common in the first 3 months
vCalatia = immature or relaxed sphincter of the
stomach would cause self-limiting or vomiting;
Common in the first 3 months
Ø Nurses need to emphasize the importance of small
frequent feedings with infant in a semi-upright
position
Ø Avoid overfeeding to avoid regurgitation and
vomiting
vGastric capacitation of the stomach = 45-60mL
Ø Compute gastric capacitation through age of
newborn in months + 2 ounces
Ø Only simple carbohydrates and proteins can be
digested
Ø Cannot digest fat due to insufficient lipase
vLiver
Ø Immature
vPHYSIOLOGIC JAUNDICE
Ø decreased liver enzyme glucorenal transferase
resulting to poor bilirubin conjugation, resulting
to
Ø Normal blood sugar: 30-50mg/dl
Ø Caloric requirement: 400cal/day
Ø Benefit from IgA, enzymes and lactobacilli from
breastmilk
§ 17.5 ounces of fluid per day
Ø Stomach empties around every 3hrs
Ø Secrete meconium, more solid consistency with
solid foods
§ MECONIUM: black or dark green, passed during
the first 24hrs – 48hrs or second period of
reactivity which is 4-6hrs
§ TRANSITIONAL STOOL: lose, greenish or yellow
or brown, passed within 2-4 days. Resembles
diarrhea but is normal
§ MILK STOOL: from breastfed or bottle feeding,
passed within 4-6 days, breastfeed stool is
golden, yellow, mushy and sweet smelling and is
Page 89
MOTHER AND
CHILD CARE
usually after feeding while bottle fed stool is
more formed, light yellow, and foul-smelling
§ PHOTOTHERAPY STOOL: greenish due to the
evacuation of bilirubin
§ BILE-DUCT STOOL: grey due to decrease in
bile
§ LACTOSE-INTOLERANT STOOL: watery and
lose
Urinary System
vMust void within 24hrs
Ø Immature kidneys - Pale yellow due to lesser
concentration
Ø Cloudy - to high albumin content
v15mL/void on the first day
v300mL/day first week
v6-10 times a day initially and 20/day on the second
week
vIncreased uric acid in urine and red spots on diaper
are normal and occasional signs
Immune System
vImmature
vLacks competency of localizing infection
Ø Omphalitis (local infection of the cord) may readily
become systemic neonatal sepsis
vCapable of some body responses to immunizing
agents
vFever
Ø may have infection not infection but dehydration
vNeonatal sepsis
Ø may have hyperthermia or hypothermia as
manifestation
vIgG
Ø offers passive natural immunity for major and
communicable diseases provided mother is
immune; transferred through placenta
vIgM
Ø produced at 12 weeks
vIgA - secretory produced from breastmilk, protects
from some infection especially GI infections that
cannot be destroyed by GI enzymes
vEven if baby is breastfed, immunization is still
needed because available antibodies from placenta
and breastmilk is temporary
vBCG and hepatitis B vaccine
Ø immediately after birth
vthe rest are completed as scheduled before first
birthday
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WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
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MOTHER AND
CHILD CARE
Ø Neonatal sepsis - undue lethargy, poor feeding,
unstable body temp, vomiting
Ø Breastfed infants have increased jaundice due to
pregnanediol = render glucorenal transferase as
ineffective
Ø Breastfeeding may be stopped for 12- 24hrs due to
severe breastfeeding jaundice, phototherapy may
be used
Ø Look into sclera, it would also turn yellow
vPallor
Ø Unlikely for newborn to be pale due to fetal
polycythemia
Ø May be due to anemia
§ identify by blanch the forehead or chest region
to detect presence of jaundice Ø Anemia
and
hyperbilirubinemia
are
characteristic signs of erythroblastosis fetalis
Ø Hypothermia,
hypoglycemia,
and
newborn
bleeding Reddish plethora or ruddy
Ø Plethora- hematocrit greater than 70%
Ø Polycythemia -or elevated RBC give rice to ruddy
or reddish color
Ø Red and wrinkled is common among pre-term
Ø Red and smooth is common among term babies
vGreenish skin
Ø Stained by meconium due to chronic fetal hypoxia
Ø Green, dry, parchment-like: postmature and
chronically hypoxic due to aged placenta
Physical Assessment
vVital Signs
Ø Respiratory Rate
§ Observing the rise and fall of the abd counting to
a whole minute
§ 30-60 cycles/min
vPulse Rate
Ø Apical pulse = ideal way to take pulse; 3rd -4th
intercostal space, left of the clavicular line
Ø 120-160bpm
Ø Observe abdomen and count for 1 full minute
vBlood Pressure
Ø Rarely done, only if newborn has cardiac
problems
vTemperature
Ø Axillary
Ø 36.5-37.5 C
maybe darker if with more
vSkin Assessment
pigmentation, and depends on
Ø Skin is usually pinkish the race of the newborn
Ø Cyanosis
§ look into mucous membranes, most reliable
indicator of central color in all babies
§ central cyanosis = occurs in tongue and mucous vPhototherapy
membrane, demands urgent attention; low O2
Ø Blue light and bili blanket
sat levels; hypoxia / congenital defects
Ø transfers bilirubin from skin to blood then to the
Ø Jaundice
bile then passed through stool
§ may be pathologic or psychological
Ø 3-6 fluorescent light tubes with a total strength of
§ First action is to determine newborn’s age
200-500 candles
§ Pathologic: first 12-24 hours due to hemolytic
Ø Photo discomposition = is an alternative route for
disease or erythroblastosis fetalis
conversion - is a normal alternate route of bilirubin conversion
§ Physiologic: more than 24hrs or 2-7 days, due
Ø Exposure to light increases rate of conversion
to immature liver. Prevent cold stress, provide
Ø Place newborn 16 inches away except when we use the bili
blanket
early feeding to increase excretion
Ø Preparation:
• Head chest first, it manifests in the head then progresses to
§ Undress newborn and cover eyes to prevent
the chest
• Blanche chest or and head region
retinal damage
Page 90
Physiologic jaundice occurs after 24 hours
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WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024
MOTHER AND
CHILD CARE
§ Cover genitalia for possible painful penile
Nevus Flammeus: Stork Bites
erection and sterility (PRIAPISM)
§ Eyes must be closed before putting cotton balls
and additional dressing to prevent corneal
damage
Ø Regular care during treatment
Ø Follow regular feeding (q2-3hrs)to prevent
metabolic acidosis
Ø Cuddle and remove eye dressing during feeding to vNape and behind the ears of the newborn
give ample sensory stimulation
vLesions around nape and ears may fade
Ø Turn q 2hrs for max exposure to skin surfaces Increase sterile fluid intake in between feedings
Strawberry Hemangiomas
Ø Monitor temp. every 2 hours
Ø Heat must be turned down when temp reading
Ø Hyperthermia - added heat from radiation of
phototherapy
Ø Assess for side effects and manage as necessary
Ø Explain to parents that having bronze skin is
temporary
Ø Dark colored urine is expected, thus, increase
fluids
Ø Bright green, loose stools - due to excess bilirubin
excretion
Ø Turn of lights when blood is extracted for serum vFormed by immature capillaries and immature
bilirubin determination and obtain darkened
endothelial cells present at birth
container for blood specimen for accurate vMay be present up to 2 weeks after
determination. (Bilirubin is destroyed by light)
vMay continue to enlarge up to 1 year
is when the newborn is placed on the side; the lower
vHarlequin sign this
dependent portion of the body is darker in shade than the upper vShrinks or absorbs
Ø Lower body is darker than the upper due to vAt 5 years old, 50-75% would have disappeared
sluggish peripheral circulation
vComplete absorption at 10 years old
vBirthmarks or hemangioma
Ø Vascular tumors of the skin
MONGOLIAN SPOTS
Nevus Flammeus: Port-Wine Stain
vMacular purple or dark-red lesion
vPresent in birth and generally over the face /thigh
region
vFades over the nose some does not fade overtime
Page 91
vBenign and self-limiting skin mark
vGreyish or blue patch in the buttock or sacrum
vResults from the collection of pigments
melanocytes
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WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024
vDisappears within 1st-2nd year or as late as school
age
Lanugo
MOTHER AND
CHILD CARE
Forceps Mark
vMinor injury from forceps delivery due to pressure of
forces
vTemporary weakness or facial palsy in one side
vMinor marks are normal and temporary
vRare complications
-> facial paralysis
on one side
vFine hair on the shoulders, back, forehead, upper
body, cheeks
vMore in the pre-term and gradually disappears close
to term
Desquamation
vDry peeling of the skin on the
vpalms and soles of the feet
vMore on post mature newborn
vRequires no treatment
Erythema Toxicum
vNewborn rash
vWhite or pink popular ras 24-48 hours after birth
vBenign and disappears within a few days
vHarmless but must be differentiated from rashes in
infection
vTo confirm diagnosis, a smear of aspirate will show
numerous eosinophils which indicates an infection
Page 92
Milia
vWhite/ yellow papules on the nose, cheek chin and
forehead
vDue to the obstruction, immature, and blocked
sebaceous glands
vNeeds no treatment and disappears on its own
Head Assessment
vRound and symmetrical with molding
vMolding: reduction of 0.5-1cm in the fetal head size
or the biparietal diameter is normal
vHead will return to normal in 2-3 days
vNewborn may have head injuries and sutures and
fontanels must be patent
vHead moves from right to left, up to down
vWith silky hair
vCaput succedaneum and cephalhematoma = are
common variations
vMacrocephaly: frontal occipital circumference
greater than 90% vMicrocephaly: less than 31.7cm, head is smaller
than chest, small brain
vHydrocephaly: head is excessively large due to
increased amount of CSF
vAnencephaly: absence of cranial bones usually
incomplete
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WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024
MOTHER AND
CHILD CARE
FONTANELLES
vVision is focused on human face
vCan see clearest at 8-10 inches distance
vGross vision may be examined by holding examiner’s
face 8-10 inches from the newborn’s face and
determine infant’s ability to direct his gaze to the
nurse’s face
vNewborn can fixate and track for short distance to
midline with some degree of color and pattern
discrimination
v Posterior fontanel closes at 2-3 months of life
vAnterior fontanel closes at 12-18 months
vFontanels give an idea of hydration status of
newborn
vSunken: dehydration
vBulging: high ICP (intracranial pressure)
Craniotabes
vDemineralized skull or softening of skull
vindented with gentle pressure like a table tennis
ball
vmild degree near the suture line: normal
vover most of the skull: calcification deficiency such
as osteogenesis imperfecta or syphilis
Subconjunctional Hemorrhage
vRed spot on the sclera due to the rupture of small
capillaries during delivery and is absorbed in about
2 weeks
Strabismus
vPoor neuromuscular control or coordination
vCondition where there is an occasional crossing of
eyes due to the normal immaturity of eyes muscles
vControl is obtained in about 3-4 months
Eye Assessment
vEyes evenly placed on the face with outer canthus in
line with the upper border of the ears
Doll’s eyes
vBest way to inspect eyes is to hold the infant up and
vMoving of the eyes to the opposite direction as the
tip the head gently forward and backward better
position of the head is changed to the left and then
than forcing the eyelids open
to the right
vBright and clear blue or greyish true color appears
vPresent for about 10 days after birth Mouth
in 2-3 months
assessment
vPupils should be equal in size
vSclera should be white
Ø blue may mean osteogenesis imperfecta which
affects bone structure integrity and cause rupture
there is increased bilirubin, and prompt
Ø yellow may mean jaundice intervention would be to perform phototherapy
vCrying is tearless because of immature lacrimal
structures; fully functional at 2 months
vVision of newborn (pupillary and blink reflexes –
response to bright light) are present after 28 weeks
gestation
Page 93
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WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024
Mouth Assessment
vShould be closed and opens only when crying
vLips should be equal, complete with symmetrical
movement
vTongue should be midline and free moving and not
tongue tied
vLingual frenulum protrudes forward
vTaste is present at birth but prefers sweet over bitter
taste
vPalates should be intact; variation would be cleft
palate
vSaliva is scanty and increases with the development
of salivary glands at about 3 months wherein
drooling starts
vEpstein pearls - Small epithelial cyst pearls
disappear at 1-2 weeks
vdown syndrome - Open mouth with a tongue
protruding in states may mean
vesophageal atresia - Frequent or excessive drooling
despite of frequent feeding.
voral thrush - White, cheese-like substance on the
tongue.
Epstein Pearls
vSmall epithelial cells on the hard palate that
disappears after 1-2 weeks
Natal Teeth
vRarely are supernumerary teeth
vAlmost always genuine primary lower incisors
vMinimal length of root development, greyish and
hypermobile
vMay irritate the baby’s tongue during sucking or
irritate the mother’s nipple during breastfeeding
vRisk for aspiration - Usually extracted
Oral Thrush
vType of yeast infection that typically appears as
white or yellow irregular patches or sores that coat
the baby’s gums and tongue along with the sides and
root of the mouth
vCaused by yeast or fungi called candida albicans
Page 94
MOTHER AND
CHILD CARE
vMild but uncomfortable or painful
vProbably started in the birth infection as a yeast
in the birth canal
infection
Chest to genitalia assessment
vChest should be symmetrical and should have
uniform movements
vBreath sounds are clear and equal at both sides
vHR should be 120-160 bpm
vMay have functional low-pitched musical murmurs
heard just to the right of the apex of the heart,
common in the first month of life
vForamen ovale and ductus arteriosis take 2-3mos to
permanently and anatomically close
vACYANOTIC HEART DEFECT = Increased
murmurs and fatigue manifested by brow sweat
when sucking / feeding should be referred for
further investigation
vCough reflex is not present at birth and appears 2-3
days
vWITCH’S MILK = Breasts enlarge with milky
secretions, resulting from maternal hormones;
common in both sexes, part of self-limiting genital
crisis in newborn; occurs on the 3rd day and may
last up to 7 days after delivery
vLabia majora of female infants should be
symmetrical, slight edema to cover the labia minora
and may have vernix caseosa between folds; must be
cleansed to avoid bacterial growth
vPSEUDOMENSTRUATION = normal, occasional,
blood-tinged blood vaginal discharge due to
maternal hormones part of female genitalia crisis;
clitoris may be enlarged
Cremasteric Reflex
vCremaster muscles = contract and draw the testes
out of the scrotum temporarily = retractile testicle
vCommon for young boys or newborns, especially
during physical examinations which triggers reflex
vCREMASTERIC REFLEX = Elicited by gently
stroking a finger on the inner thigh and the muscles
will pull the testicles upward
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WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024
MOTHER AND
CHILD CARE
vBARLOW TEST = identifies loose hip that can be
pushed out of the socket with gentle pressure
vApprox. 80% of barlow positive test will resolve
spontaneously in the first few weeks of life
vMinor degrees of instability can be treated my
multiple diapers followed by an UTZ study at 6
weeks of age
Assessment of extremities
vGood muscle tone, flexed and should resist having
extremities extended
vArms and legs should be equal in length
vLegs should be shorter than arms
vDigits should be complete, 5 on each hand and foot
with nails
vPOLYDACTYLY - Excess fingers or toes
vSYNDACTYLY - Webbed fingers or toes
v TALIPES EQINOVARUS/“CLUBFOOT”
vPositional =can easily be returned to midline, no
treatment needed
vTrue
Barlow and Ortolani Test
vDetects presents of hip displacement
vORTOLANI TEST = identifies dislocated hips that
can be reduced in the socket or acetabulum,
describes feeling of reduction as a hip click and
translation is interpreted as sound instead of
sensation of the hip moving to the socket when it
relocated, rarely detectable sensation after 6 weeks
and should not confused with snapping
vPositive ortolani test (hip is dislocated) should be
treated to keep hip in socket until stability is
established
Page 95
Neuromuscular Assessment
vReflexes = are involuntary movements or actions
vSome are spontaneous, others are responses to
certain actions
vSome reflexes occur only during specific
developmental stages vTo check if the brain and NS is working well
vAbsence of newborn reflex at birth or persistence of
a reflex past a certain age may indicate a problem
with the CNS function
Classification of Newborn
vAGA
Ø Appropriate for Gestational Age
Ø Weighs 10th-90th percentile
vSGA
Ø Small for Gestational Age
Ø Weighs below 10th percentile
Ø Dysmaturity,
fetal
growth
restriction,
or
intrauterine restriction (infants who @ measure
less than the 10th percentile)
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WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024
Ø Risk for stilled birth, perinatal morbidity, adverse
effects in adulthood, disruption of parent infant
bonding
vLGA
Ø Large for Gestational Age
Ø above 90th percentile
vLBW
Ø Low birth weight
Ø Birth weight less than 2,500 grams
Ø Independent of gestational age assessment
Newborn Screening
vEssential for early detection and management of
congenital disorders which may lead to mental
retardation or death if untreated
vEarly diagnosis and long-term care is essential for
normal growth
vAvailable in PH for 1996:
Ø Phenylketonuria (PKU)
Ø Methylmalonic acidemia
Ø Maple syrup urine disease (MSUD)
Ø Tyrosinemia
Ø Citrullinema
Ø Medium chain acyl CoA dehydrogenase (MCAD)
deficiency
vExpanded screening includes 22 more disorders
such as hemoglobinopathies, and additional
metabolic disorders namely organic acids, fatty
acids oxidation, and amino acid disorders
vNewborn screening = should be done after 24 hours
of life but not later than 3 days from complete
delivery
vIdeally done on the 48th hour
v If done earlier than 24th hour, baby must be
screened again after 2 weeks for more accurate
results
vHigh-risk babies in the NICU may be exempted from
3 day requirement but must be tested within 7 days
vHow it is done:
Ø Explain procedure to parents and collect the blood
specimen
Ø Done by a physician, medtech, or after training—
nurse or midwife.
Ø Heel prick method: to obtain few products of
capillary blood from baby’s heel and blot on a
special absorbant filter paper
Ø Drying time of blood is 4 hours
Ø NBS fee is P550 for regular NBS, maximum fee for
specimen collection is P50
Page 96
MOTHER AND
CHILD CARE
Ø Send specimen to newborn screening laboratory
Ø For home deliveries baby may be brought to
nearest NBS
Ø Follow up results are available within 7-14 weeks
7-14 working days
after submission of specimen
(not weeks)
Ø Negative screen: extremely low risk of having any
disorders being screened screen
Ø Positive screen: high risk for having one of the
disorders screened and must be brought to
hospital for confirmatory test
Hearing Screening
vRepublic Act no. 9288 otherwise known as
Newborn Screening Act of 2004
Ø to ensure that all infants born are screened before
discharge
vInfants who do not pass the initial screening test will
be referred to proper treatment
vSupport is provided for families
vHeel prick method and hearing screening using
otoacoustic emissions (OAEs)
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WEEK 11 – POSTPARTUM CARE
Mrs. Emma Dotillos || BSN || BATCH 2024
Care of a PostPartum Mother
vPUERPERIUM - Latin word puer “child”, parere “to
bring forth”
Ø Refers to 6 week period after birth
Ø 2 types of changes:
§ Retrogressive = involves the returning of the
uterus and vagina to its non pregnant state
§ Progressive = production of milk, restoration of
normal mens cycle, beginning of parenting role
known as the
vPOSTPARTUM = 4th stage of labor also
FOURTH TRIMESTER
Ø 3 stages:
§ Immediate postpartum = 1st 24 hours after
delivery
§ Early postpartum = 1st week after delivery
§ Late postpartum = 2-6 weeks after delivery
Psychological Changes during the Post-Partum
vChanges are crucial within the first 24 hours of
These changes might affect the woman permanently
postpartum if not given appropriate attention and care.
vMay become permanent if not give appropriate
attention and care
v3 Phases:
Ø Taking in Phase This is the time for reflection of the woman
§ 2-3 days after delivery
§ The woman is passive
§ Dependent on the caregiver w/ daily task and
decision
making
(after
pains,
extreme
exhaustion and fatigue of childbirth)
§ Self-centered
§ Reliving birth experiences
§ Regaining physical strength and organize
thoughts on roles
§ Encouraging women to talk about labor and
birth will help them adjust and incorporate it in her new
life
Ø Taking - hold Phase
§ 3-10 days after delivery
§ Regaining autonomy (take action on their own
and make decisions) -> without relying on others
§ Open to health teachings
§ Women on anesthesia gets to this phase only
hours after birth
§ Actively learn newborn care
§ Demonstrate to the mother, and watch her do a
return demo
§ Needs positive reinforcement = may feel insecure
about the care for her child
§ Let the women settle in gradually on her own
Ø Letting-go Phase
§ Recognition and adjustment to new role
Page 97
finally, accepts her new role and gives
up her old roles
MOTHER AND
CHILD CARE
§ Post-partum depression may set in
§ Readjustment of relationship =
transition
for
easy
Rooming In
vThe more time a woman has to spend with her baby
= the sooner she will feel competent in childcare
vSound mother-child relationship
vInfant stays in the room with her mother rather than
in a central nursery
vMother can become better acquainted w/ her child
vCan give confidence when taking care of her child
vAllows the father and siblings can hold and feed the
infant when they visit this is for both complete and partial rooming-in
vHelp a couple retain instructions and anticipatory
guidance in the care of the newborn = nurses
demonstrate bathing, feeding, and changing
v2 Types:
Ø Complete rooming - in
§ Mother and child is together 24hrs a day
Ø Partial rooming-in
§ Infant remains in the room of the mother most
of the time (daytime)
§ She will then be taken to a nursery near the
mother’s room/central nursery at night.
Sibling Visitation
vPreparation is as painful to the mother as it is for
her children SEPARATION, not preparation
vWaiting at home for their mother and telephone
reports of what their new brother / sister looks like
= very difficult for older children
vAllowing visits reduces the feeling that their mother
cares more about the new baby than about them
vRelieves the impact of separation
vHelp make the baby part of the family
vMake sure of the ff:
Ø URT illnesses
Ø Contagious diseases
Ø Recent exposure to chickenpox
vMake them wash their hands if they want to hold
and touch the newborn w/ parental assistance
is worn by
vSome hospitals may require covered gown this
the older siblings
vCaution women that opinions of a new brother or
sister expressed by her children may not be
complementary
vappearance of the baby is not what the older child
expected = establishing strong relationships, should
be encouraged
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WEEK 11 – POSTPARTUM CARE
Mrs. Emma Dotillos || BSN || BATCH 2024
Postpartum: Maternal Concerns
vAbandonment
Ø many mothers feel abandoned and less important
after giving birth
Ø an hour before they were the center of attention;
during the birth of the baby the baby becomes
chief interest
Ø make a woman confused; sensation close to
jealousy
Ø help by verbalizing the problem: “how does it make
you feel?”
Ø the sensation is normal although, uncomfortable
Ø For the father: may also feel what the mother feels
Ø when a NB comes home, father may become
resentful of the time the mother spends with the
infant (e.g. sitting at the table to talk about their
day mother is hurrying to feed the baby)
Ø Nursing Care Management
§ help them accept and understand that
parenthood is compromise in favor of the interest
of the baby
§ teachings start during the pregnancy or in the
early post-partum period
§ making infant care and shared responsibility can
help alleviate these feelings and makes both
partners feel equally involved
vDisappointment
Ø disappointment in their baby
Ø couple imagined a cute, chubby-cheek, curly
haired, smiling baby girl/boy instead they have a
skinny baby, no hair, cries constantly
Ø diff. for parents to feel positive immediately about
the baby who does not meet their expectations.
Ø Nursing Care Management
§ accept that they can never change the sex, the
size or the look of their child
§ change the feeling of the parents by handling the
child warmly = you find the infant satisfactory /
special
§ comment good points on the child: long fingers,
lovely eyes, good appetite
§ have a key person offer support and help them
towards acceptance / take a clearer look into
their situation and begin to cope
many as 50% of women
vPostpartal Blues as
experience overwhelming sadness
Ø overwhelming feeling of sadness = may burst into
tears easily or feel let down, irritable
Ø temporary feeling
Page 98
MOTHER AND
CHILD CARE
Ø cause of hormonal changes = decrease in estrogen
and progesterone that occurs in the delivery of the
placenta
Ø it may be a response to dependence and low selfesteem:
Ø exhaustion
Ø being away from home
Ø physical discomfort and tension due to assumed
new role
Ø no support from partner
Ø tearfulness, feeling of inadequacy, mood liability,
anorexia, and sleep disturbance
Ø sudden crying episodes = normal
Ø 30% of women experience a more serious sadness
at birth; requires formal counseling or psychiatric
care= POSTPARTAL DEPRESSION
Ø Nursing Care Management
§ support from health care professionals help the
parents understand that this response is
normal
§ verbalize feelings
§ make as many decisions as possible = sense of
confidence
§ not all postpartal women cry because of baby
blues = may have other reasons:
• overwhelming problem at home
• financial problem
§ keep lines of communication open = differentiate
problems that can be handles well with
discussion, concerned understanding, and those
that should be referred to the social service dept.
Postpartum: Psychological Changes
vUterus
Ø involution completes in 6wks = reproductive
organs return to nonpregnant state
Ø 1 finger breadth per day; non-palpable on 10th day
Ø AFTERPAINS contraction of the uterus - the areas
where the placenta implanted is sealed off to avoid
bleeding.
Ø The areas where the placenta implanted is sealed
off to avoid bleeding
Ø Contractions = allow the uterus to go to its normal
size quickly; prevent hemorrhage
Ø Nursing Consideration
§ Monitor for Postpartum hemorrhage
§ Involution occurs more quickly in women who
are more nourished and ambulate early after
birth.
Compiled by TEAM SHAWTIES
WEEK 11 – POSTPARTUM CARE
Mrs. Emma Dotillos || BSN || BATCH 2024
vLochia
Ø Vaginal discharge after giving birth:
§ Blood
§ Mucus
§ WBC
§ Fragments
§ Bacteria
Ø Vaginal discharge after giving birth:
Ø Typically continues from 4-6weeks after birth
Ø Lochia Rubra =3-4days postpartum; red; blood
discharge Ø Lochia serosa = brownish, pinkish discharge; 4th
day; amount of blood and tissues decreases
Ø Lochia Alba = 10th day; discharge decreases; looks
colorless, whitish, or yellowish; may last until the
3rd week after birth
Ø Nursing Considerations:
§ Lochial Flow:
• Scant – less than 2 inches stain on the pad
• Light – 4 inches stain on the pad
• Moderate – more than 6 inches stain on the
pad
• Heavy –large; appear more than 6 inches and
saturated in an hour
• If with offensive odor = retained placental
fragments
• PUERPERAL SEPSIS = scanty with putrid odor
accompanied w/ fever and pyrexia
• Normal blood loss for Spontaneous Vag
Delivery = 300-500 ml
• C section = 800-1000 ml
§ Cervix
• Internal and external os
• Soft and malleable immediately after birth
• Contraction of the cervix = return to
nonpregnant state
• At the end of the 7 days = external os is
narrowed to the size of a pencil opening; slitlike or star-shaped
vEstrogen and progesterone drops (when placenta is
no longer present) = ^FSH
vFSH remains low for 12 days then starts to increase
to signal the start of new mens cycle
vEstrogen and progesterone levels return to prepregnancy = a week after birth
vHPL an d HCG are insignificant in 24hrs
vDiuresis (ridding the body of excess fluid)=
3000ml/day to get rid of the accumulated excess fluid
during pregnancy
Page 99
MOTHER AND
CHILD CARE
vAbd must be assessed to prevent damage of the
bladder = over distension
-> back to
vDecrease blood vol = 1st – 2nd week of birth normal level
vHematocrit levels go to pre-pregnancy = 6 weeks
after birth
v^Leukocytes and plasma fibrinogen = 1st
postpartum week; defense mechanism against
infection and hemorrhage
vPain upon bowel evacuation: passage of stool may still be slow
Ø relaxin present in the bowels;
difficulty in sleeping-> for several
Ø Pain in episiotomy
months of pregnancy due to
vStriae gravidarum lightens
unable to find a comfortable
position in bed because of fetal
vExhaustion
activity and presence of back
Ø As soon as birth is completed ache or leg pain
Ø Difficulty in sleeping while pregnant
Ø During labor she has worked very hard
Ø SLEEP HUNGER = makes it difficult for the mother
to cope w/ the new experiences and stressful
situations
vWeight loss – losing 19lbs
Ø At birth = 12lbs weight loss Ø 2nd – 5th day after birth = diuresis and
diaphoresis = 5lbs weight loss
Ø Lochial flow = 2-3lbs weight loss
Ø TOTAL: about 19lbs
vital signs changes in the postpartum
period reflects internal adjustments that
v^clotting factors
occur as the woman's body returns to its
vTemperature
pre-pregnancy state
Ø Never get rectal temp during puerperium = risk for
vaginal infections and rectal intrusion
Ø Dehydration – slight increase in temp after birth;
fluids for 24hrs = elevated temp will return to
normal
Ø Breast engorgement – breast fill with milk on 3rd
or 4th postpartum day = temp rises for a period of
hours due to increased vascularity in the breast If
high temp lasts for more than a few hours =
infection
Ø Puerperial infection – fibril episode after the 1st
temp = infection -> postpartum infection
vPulse
Ø Slightly slower than normal
Ø Increased BV returning to the heart = stroke vol
increases = reduce pulse rate
Ø 60-70bpm
Ø Diuresis diminishes = BV falls = pulse rate rises
Ø By the end of the 1st week the pulse rate will have
returned to normal
Ø NOTE: monitor the pulse closely
§ Rapid, 3D pulse = hemorrhage
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WEEK 11 – POSTPARTUM CARE
Mrs. Emma Dotillos || BSN || BATCH 2024
MOTHER AND
CHILD CARE
vBP precaution on medications
§ III – day 10 to weaning PP; mature milk supply
Ø Decrease in BP = bleeding
is driven by oxytocin and progesterone
Ø Elevation above 140 mmHg systolic, 90 mmHg
§ IV – after complete weaning PP until breasts
diastolic = development post-partal pregnancy
involute
induced hypertension
vEndorphins and oxytocin - help mitigate and reduce
Ø Unusual but serious complication of the
the risk oof developing PP depression
puerperium
vMaternal Reflex in Breastfeeding
-> drug frequently administered during postpartum period
vOxytocin to attribute uterine contraction
Ø Prolactin reflex (milk secretion reflex)
Ø Can cause contraction in all smooth muscle
§ ^prolactin stimulates the alveoli, specifically the
including blood vessels
acinae cells and milk is produced in the milk
Ø Can increase BP
tubules
Ø Measure BP before administering
§ ^levels of estrogen and progesterone = induce
Ø If above 140 mmHg = hold the drug; notify the
alveolar and duct growth
physician
=
prevent
hypertension
/
§ In pregnancy, milk sec is not stimulated because
cerebrovascular accidents
of low prolactin and ^estrogen secretion by the
Ø Orthostatic hypotension
placenta
§ Women who loss a lot of blood
Ø Letdown reflex (drought reflex)
§ Dizziness due to lack of adequate BV to maintain
§ Oxytocin induced
nourishment to the brain cells
§ The act of sucking a lactating breast stimulates
for
example,
from
lying
down
Ø Advice:
the flow of milk
to sitting down -> she has to
§ Change position gradually move slowly
§ Free flowing of milk
§ Dangle legs before attempting to walk
§ Affected by maternal emotions
Ø Milk ejection reflex
§ Controls the ejection of milk from the breast
Progressive Changes
tubules
vLactogenesis – human milk production
§ Under the influence of oxytocin
Ø The arterial venus and lymphatic venus
communicate medially with the internal mammary vReturn of Menstrual Flow
Ø Decrease in estrogen and progesterone (delivery of
vessels; laterally with axillary vessels
placenta) = ^FSH = delay of ovulation = normal
Ø In cancer of the breast = metastasis follows the
menstrual cycle -> decrease in hormone secretion
vascular supply both medially and laterally
Ø Non BF = 6-10 wks; BF = 3-4 mos.
Ø PROLACTIN = milk production hormone Ø Absence in menstrual flow will not guarantee no
Ø OXYTOCIN = let-down reflex arc
conception = may ovulate before menstruation
Ø Retained placenta can disrupt this process =
returns
continuation of progesterone = inhibits prolactin =
vLactation Amenorrhea – 3-4mos. w/o menstruation
inhibit milk production
vBreast care
Ø PHASES:
Ø cold compress – non-lactating; minimize pain and
§ I – 16 wks of gestation; milk synthesis; glandular
discomfort with engorgement; minimize swelling
luminal cells in the breast begin secreting
and pain
colostrum
Ø warm compress / warm showers or baths –
§ II – birth to 10 days PP; triggered at birth by the
lactating; vasodilation = facilitating letdown reflex
delivery of the placenta; progesterone and other
circulating pregnancy hormones decrease +
Post Complications
oxytocin sharply increase = infant suckling
• Oxytocin = helps the uterus shrink to pre- vPostpartum Hemorrhage
Ø Most common cause of maternal deaths assoc. w/
pregnancy size; mothers will feel uterine
childbirth
cramps when breastfeeding until the uterus
Ø Any blood loss in the uterus greater than 500ml
fully involutes
within a 24hr period
• milk has come and breast engorgement
Ø Hemorrhage that reaches 1000ml of blood loss
• Transitional milk
Page 100
The breast functions for lactation or milk section for nourishment and
maternal antibodies which is IgA and the source of pleasurable sexual
sensation.
Compiled by TEAM SHAWTIES
WEEK 11 – POSTPARTUM CARE
Mrs. Emma Dotillos || BSN || BATCH 2024
The uterus must remain in a contractive state after
childbirth to allow the open vessels of the placental site to
seal off
Ø Etiology: Uterine atony = relaxation of the uterus
Ø Risk factors:
§ Polyhydramnios,
macrosomia,
multiple
gestation and grand multiparity
§ Placental
complications
(placenta acreta,
placenta increta, and placenta percreta)
§ Blood clotting problems
§ Lacerations
§ Medications
§ Hematoma
§ Subinvolution
POST-PARTUM
HEMORRHAGE ->
Ø Nursing Care Management
§ Monitor for any placental fragments
§ Facilitate ambulation = accurately identify postpartum hemorrhage
§ Frequent lying down of the mother may cause
pooling of blood in the uterus
§ Ambulation = facilitates drainage of blood via
gravity
Retained placental fragments:
vAccreta
Ø Unusually deep attachment of the placenta to the
uterine myometrium; so deep that the placenta
will not loosen and deliver
vIncreta
Ø Implantation of the placenta deep into the
myometrium and into the perimetrium
vPercreta Ø Reaches towards the perimetrium
Ø associated with prev cesarean birth and in vitro
fertilization
Ø detected through UTZ during pregnancy
Ø removing these complications manually can cause
hemorrhage
Ø HYSTERECTOMY = surgical removal of the uterus
*treatment of method using
Ø METHOTREXATE = to destroy the still attached
tissue may be necessary
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MOTHER AND
CHILD CARE
Ø Nursing Management
§ Stay with the client
§ Fundal check – q 5-15mins (massage fundus
until firm = 1st NCM for uterine atony = expel
over massaging since this can tire the muscles
clots) avoid
causing relaxation
§ Lochia check / pad count q hour (assessing for
blood loss)
§ Bladder check (distended bladder can displace
the uterus to the side = uterine atony and
bleeding)and vital signs (q 5- 15mins)
monitoring
§ Encourage voiding – to void 4-6 hours after
birth
§ Ice pack application (on fundus) Breastfeeding
(or nipple stim = secretion of oxytocin)
§ Check lacerations for DNC
§ Maintain Asespsis
§ INO fluid and blood replacement and O2 admin
§ Fluids
up
to
4000-3000ml
if
not
contraindicated
§ Provide psych support
§ Look out for blood Admin of oxytocics
§ Antibiotics – broad spectrum antibiotics
administered prophylactily for c-section
§ Proper
positioning:
Fowler’s
/
Semi
fowlers Perineal hygiene
§ High CHO, Pro, and Iron diet
vNCM for mother with episiotomy
Ø Take note of:
§ Check appearance
§ Monitor for tearing or lacerations
§ Hematoma formation and hemorrhoids
Ø Use REEDA for assessment if the mother has any
of these
Ø ECCHYMOSIS
§ pinpoint blanching of the skin due to bleeding
Ø note infection of the site to prevent maternal
sepsis
Ø Nursing Management
§ the vagina may be edematous, bruised, thinwalled due to estrogen levels
§ few rugae, small lacerations
§ smooth @ 3-4wks – rugae may reappear @ 4wks
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WEEK 11 – POSTPARTUM CARE
Mrs. Emma Dotillos || BSN || BATCH 2024
§ return to pre-pregnancy state by 68- wks
6-8 WEEKS, not 68 !!!
§ perineal care
• infection should not occur
§ perilite treatment
• dry heating to promote early drying and
healing of the round; 20mins @ 20 inch
distance 3x/day
§ hot sitz bath
• for hemorrhoids
§ kegel exercise
• exercise the pubococcygeal muscle after
delivery
Postpartum Care
vNursing Management Diet
Ø high in protein and carbohydrates; 2500kcal (nonlactating), 3000kcal (lactating)
Ø Vitamin C and Iron
Ø Monitor vital signs and fundus for firmness and
descent
§ fundus is palpable until the 10th day and no
longer palpable as it descends behind the
symphysis pubis
Ø Monitor color, amnt of lochia
Ø Expect diuresis
Ø note for postpartal blues
§ drop of maternal hormones on the 4th-5th day
Ø Bowel & bladder function – Kegel exercise
§ Constipation
• Increase fluid and roughage intake
• Promote fresh fruits
• Promote regular bowl habits
• Glycerine / bisacodyl dulcolax as ordered =
bowels do not move after the 3rd morning of
delivery
Ø Provide psychological and physical support
Ø Meet the mothers needs so she can meet the NB’s
needs
Ø Assist with self-care and baby care
Ø Promote bonding
Ø Promote breastfeeding
Ø Start rooming in
Ø Verbalize positive neonatal traits and similarities
w/ the mother and father’s features
Ø Oxytocic drugs = uterine involution
Ø Strict asepsis = maternal teaching; pericare; front
to back technique of flushing and removal of
peripads
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MOTHER AND
CHILD CARE
Ø Handwashing - prior to breastfeeding; most
important practice to help prevent the spread of
infection
Ø Resumption of intercourse – would depend on the
couple; no prescribed time; factors in deciding
when
§ Maternal comfort
§ Perineal swelling
§ Desire to have sex
Ø Regular visit – for health maintenance
Ø RhoGam & Rubella vaccine
§ RhoGam – prophylaxis for unsensitized mothers
who are Rh negative and has given birth to and
infant who is Rh negative; immunoglobulin w/in
72hrs after delivery § Administered even after the mother has received
RhoGam after prev deliveries; or even when she
receives RhoGam in the antenatal period o
§ Rubella vaccine –if the mother is not immune to
rubella or german measles, she must receive
vaccine b4 discharge from the hospital bc of
potential teratogenicity of rubella virus = mother
signs informed consent before receiving the
vaccine and a written in: NOT TO GET
PREGNANT FOR 28 DAYS – 3 MONTHS
vEssential objectives during the puerperium Promote
uterine involution
Ø promote breastfeeding; oxytocin, knee-chest /
prone position; promote normal anteflexion;
Ø early
ambulation
=
prevents
bed
rest
prevent
common
discomfort
of
complications
puerperium, provide psychological
§ Thrombophlebitis
support, and initiate contraception,
and prevent complications
§ Pneumonia
§ Subinvolution of the uterus
Ø Regular voiding = bladder displaces uterus
Ø Note fundic height = pos. of the uterus is expressed
in finger breadth above and below the umbilicus to
promote accurate results; empty the bladder
before assessing
§ Positive sign – fundus above umbilicus
§ Negative sign – fundus above the umbilicus (ex.
1 finger breadth below the umbilicus = -1, 2
finger breadths above the umbilicus = Positive 2,
level of umbilicus = 0)
vRecord fundus as firm, -3 central
Ø Lochial discharge
Ø Afterpains
Ø Normal involution of the uterus = after delivery
fundus is firm, midline, level of umbilicus
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WEEK 11 – POSTPARTUM CARE
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§ Day 1 – 1 finger breadth above umbilicus
§ Descends by one finger breadth/day
§ Day 10 – behind symphysis pubis, no longer
palpated
§ Easily displaced above the umbilicus, to the
right side by distended bladder = broad and
round ligament were greatly stretched during
pregnancy = MARKED LAXITY after delivery
vPromote successful breastfeeding
vPrevent common discomfort of puerperium
Ø Breast engorgement - wet compress application
§ Warm for lactating
§ Cold for non-lactating
Ø Afterpains – explains possible causes, signs of the
uterus involuting
§ Ice pack on the fundus (never hot water to
prevent bleeding) give analgesic as ordered
vUrinary retention
Ø Early ambulation 4-8 hrs after delivery can help
prevent urinary retention
Ø Increase fluid intake
Ø Straight catheterization = last resort
vHemorrhoids to prevent hemorrhoids
Ø Promote ambulation
Ø Cold packs on affected areas after delivery leave on
same position for 20 mins, repeat q 4 hrs
Ø Provide moist heat = sitz bath w/ water @ 38
degrees C for 20min (observe for signs of fainting)
Ø Small hemorrhoids – mother can be shown how to
place the hemorrhoid back into the anorectal canal
using a lubricated finger
Ø Avoid oily food
Ø Local heat
Ø Occasional analgesics
vProvide psych support
Ø Assurance that the condition will correct itself
once the increase blood supply and pressure of
pregnancy are diminished and the reg movement
of bowel is est.
Ø Understanding of the normal maternal psychologic
adaptations and reactions
vInitiate contraceptions
vPrevent complications
vFor Episiotomy
Ø Ice /cold pack = vasoconstriction effect, reduce
edema and discomfort, anesthetic effect reducing
pain
Ø Dry heat / Perilite
Page 103
MOTHER AND
CHILD CARE
§ 20 mins, position lamp 20 inches away from
perineum, 3x a day
§ 40 watt desk bulb – can be effective heat bath
Ø Moist heat: hot sitz bath 2x / day or more
Ø Anesthetic spray ointment / Analgesics
§ Given as ordered
PP Phases of Maternal Role Taking
vTaking-in Phase
Ø 1-3 days after delivery Ø Dependent phase
Ø Mother is talkative; verbalizes delivery experience;
dependent; concerned w/ own needs; selfcentered; passive
Ø Nursing Care Management
§ Meeting mothers’ physical needs
§ Verbalization
§ Listening = not the best time to focus on baby
care
vTaking-hold Phase
Ø 3 days-2wks after delivery
Ø Striving for independence Ø Impatient to have control over bodily functions and
to learn mothering tasks
Ø Mood swings
Ø Strong anxiety element
Ø Responds to positive reinforcement
Ø More in control
Ø Nursing Care Management
§ Provide teaching abt Baby care
§ Stay during care for positive reinforcement
§ Guard against fatigue
§ Complement generously
vLetting-go Phase
Ø 10 days- 2wks after delivery
Ø Independent phase
Ø Women gives up former roles and self-concept and
integrate formal role and self-concepts as a
mother
Ø Achieves independent - Accepts the baby as a
separate being
Ø May have feelings of insecurity, inadequacy, and
deep loss over separation of baby from her Ø Nursing Care Management
§ Verbalization of new roles
§ Provide positive reinforcement as she defines her
roles w/ her support system
§ Be understanding and supportive
Compiled by TEAM SHAWTIES
WEEK 11 – POSTPARTUM CARE
Mrs. Emma Dotillos || BSN || BATCH 2024
Page 104
MOTHER AND
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Compiled by TEAM SHAWTIES
WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024
Growth and Development
vGrowth
Ø increase in physical size (quantitative)
Ø Growth in weight is measured in pounds ( lbs) or
kg
Ø Growth and height is measured in inches or cm
vDevelopment
Ø progressive towards maturity ( qualitative)
Ø Increase in skill or function - Can be measured by:
§ observing a child perform specific tasks such as
how well a child picks up small objects E.g.
raisins
§ recording the parents description of the child's
progress
§ standardized tests:
• MMDST
Ø Maturation
vDevelopmental milestones
Ø major markers of normal development
Ø Are behaviors and physical skills seen in infants
or children as they grow and develop
§ Rolling over
§ walking
§ Talking
Ø Milestones are different in each range
vDevelopmental tasks
Ø skill or growth responsibility arising at a particular
time and an individual's life
Division of Childhood
Neonate - first 28 days of life Infant - 1mos - 1yr
Toddler - 1-3 yrs.
Preschooler - 3-5yrs
School-age child - 6-12 yrs Adolescent - 13-17 yrs
Late adolescent - 18-21 yrs
Theoretical Foundation
vFreudian Theory
Ø Psychosexual development
MOTHER AND
CHILD CARE
Ø Structural theory of personality gives great
importance on how conflicts among the parts of
the mind shape behavior and personality =
conflicts are mostly unconscious
Ø Psychosexual theory of development = According
to Freud personality develops during childhood
and is critically developed through five
psychosexual stages:
§ Oral
§ Anal
§ Phallic
§ Latent
§ genital
Ø During each stage a child is presented with a
conflict between biological drives and social
expectations
Ø Successful navigation of these internal conflicts
will lead to mastery of each developmental stage =
Fully mature personality
vErickson’s stages of Personality development
Ø Psychosocial development
Ø Personality develops in a predetermined order
through 8 stages of psychosocial development
from infancy to adulthood
Ø During each stage, the person experiences a
psychosocial crisis which could have a positive or
negative outcomes depending on the person
Ø Successful completion of each stage results in a
healthy personality and the acquisition of basic
virtues
Ø Basic virtues = Are characteristics strengths which
the ego can use to resolve subsequent crisis
Ø Failure to successfully complete a stage = reduced
ability to complete further stages → unhealthy
personality and sense of self
Ø Can be resolved at a later time
Ø Human behavior is the result of the interactions
among three components of the mind: id, ego and
superego
Page 104
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WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024
vKohlberg's theory of moral development
Ø Identify how children may feel about an illness
Ø Approximates the cognitive stages of development
Ø 3 stages of moral reasoning, each level has 2
substages
§ Post-conventional
§ Conventional
§ Preconventional
Ø People can only pass through these levels in the
order listed
Ø Each new stage replaces to reasoning typical of the
previous stage
Ø not everyone achieves all the stages
vPiaget’s Theory of cognitive development
Ø Explain how a child constructs a mental model of
the world
Ø Disagreed with the idea that intelligence is a fixed
trait
Ø regarded cognitive dev’t as a process which occurs
due to biological maturation and interaction with
the environment Ø Suggest that children move through four different
stages of intellectual development which reflect the
increasing sophistication of children’s thoughts
Ø focuses on understanding how children acquire
knowledge Regarding fundamental concepts such
as object permanence, number categorisation,
casualty, and justice
Ø Four stages:
§ Sensorimotor
§ Preoperational concrete operational
§ formal operational
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MOTHER AND
CHILD CARE
Ø Each child goes through the stages in the same
order and child development is determined by
biological maturation and interaction with the
environment
Ø No stage can be missed out = Individual differences
at which children progress through the stages
Ø Some individuals may never attain the later stages
Principles of Growth and Development
vGrowth and development are continuous processes
from conception till death.
Ø Rate of growth changes: growth during the first
year of life and the later years of life
Ø Increase of 50% in the growth rate in the first year
Ø If growth rate of the first year continues = a five
year old child will weigh 1000 lb and be12 feet and
6 inches tall
vGrowth and development proceed in an orderly
sequence.
Ø Growth in height is only one sequence = smaller →
larger
vChildren pass through the predictable stages at
different rates
Ø Sit → creep → stand → walk → run
Ø A child may skip a stage or passed through its so
quickly that the parents will not observe the stage
Ø Different children = different rates
Ø Range of time rather than certain point at which
they are accomplished
vAll body systems do not develop at the same rate
Ø Neurologic tissues experienced their peak growth
at the first year of life
vDevelopment is cephalocaudal.
Ø Proceeds from head to tail Ø Newborns can lift only their head off the bed when
they lie in a prone position
Ø By age 2 months, infants can lift both head and
chest up
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Ø By 4 months, the head, chest and part of the
abdomen
Ø By 5 months, infants have enough control to turn
over
Ø By 9 months, they can control legs enough to
crawl
Ø By 1 year, children can stand upright and perhaps
walk
Ø Motor development proceeds in cephalocaudal
order from head to lower extremities
vDevelopment proceeds from proximal to distal body
parts
Ø Illustrated by tracing the progress of upper
extremity development
Ø Newborn makes little use of arms and hands
Ø Any movement except to put a thumb in the mouth
is a flailing motion
Ø By age 3-4 months, the infant has enough arm
control to support the upper body, weight on the
forearms and the infant can coordinate the hand
to scoop up objects
Ø By 10 months, the infant can coordinate the arm
and thumb and index fingers to sufficiently well to
use a pincer like grasp to pick up objects as fine
as breakfast cereal on a high chair tray
vDevelopment proceeds from gross to refined skills
Ø Once the children are able to control distal body
parts, they are able to perform fine motor skills
Ø Ex. 3 year old colors best with a large crayon. 12
year old can write with a fine pen
vThere is an optimum time for initiation of
experiences or learning
Ø Children cannot learn tasks until their nervous
system is mature enough to allow that particular
learning
Ø A child cannot learn to sit no matter how much the
child’s parents have them practice until the
nervous system has matured enough to allow back
control
vNeonatal reflexes must be lost before development
can proceed
Ø An infant can not grasp with skill until the grasp
reflex has faded nor stand steadily until the
walking reflex has faded
Ø Neonatal reflexes are replaced by purposeful
movements
vA great deal of skill and behavior is learned by
practice
Ø Infants practice over and over
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MOTHER AND
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Ø Taking a first step before they can accomplish this
securely
Ø If children fall behind G&D because of illness, they
are capable of catch up growth to bring them equal
again to their age group
Factors Affecting Growth and Development
vGenetics
Ø From the moment of conception, when the sperm
and ovum fuse, the basic genetic makeup of an
individual is cast
Ø In addition to physical characteristics (eye color,
height potential), the inheritance determines other
characteristics such as learning style and
temperament
Ø Individual may also inherit genetic abnormalities
which could result in disability or illness at birth
or later in life
vGender
Ø On average, girls are born lighter by an 1-2 ounces
and shorter by 1-2 inches than boys
Ø Boys tend to keep this height and weight
advantage until prepuberty, at which girls surge
ahead because they begin their puberty growth 612 months earlier than boys
Ø By the end of puberty (14-16 years old), boys tend
to be taller and heavier
Ø Difference in growth patterns is reflected in
different growth charts used for boys and girls
vHealth
Ø A child who inherits a genetically transmitted
disease may not grow as rapidly or develop as fully
as a healthy child depending on the type of illness
and the therapy or care available for the disease
Ø Ex. Insulin was discovered in 1922, many children
with type I diabetes died in early childhood during
those times and those who lived were left
physically challenged. Currently with good health
supervision and advanced medicine, the effects of
type I diabetes can be minimized that children with
diabetes will thrive and grow.
Ø Diabetes is still a major factor in children as more
and more children become obese, type II diabetes
has now begun to occur in children beyond school
age
vIntelligence
Ø children with high intelligence do not generally
grow faster physically than other children but tend
to advance faster in skills
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WEEK 12 – INFANT AND TODDLER
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Ø occasionally, children of high intelligence fall
behind in physical skills because they spend their
time with books or mental games rather than
games that develop motor skills so they don’t
receive practice in this area
vTemperament
Ø Usual reaction pattern of an individual or an
individual’s characteristic manner of thinking,
behaving or reacting to stimuli in the environment
Ø Unlike
cognitive/moral
development,
temperament is not developed by stages but is an
inborn characteristic set at birth
Ø Understanding that not all children are alike, some
adapt quickly to new situations while others adapt
slowly or react intensely or passively
Ø Parents it’s good for them to better understand
why their children are different from each other
and help them care for each child constructively
Ø Although individual children show characteristics
from all group, most children can be categorized
Ø Categories:
§ The easy child
• Child who
is
rhythmic, approaching,
adaptable, mild and positive in mood
§ The intermediate child
• Having some characteristics coming from both
groups are to follow
§ The difficult child
• Child that is arrhythmic with growing, low in
adaptability, intense and negative in mood
§ The slow-to-warm up child
• Inactive, low in approach and adaptability and
negative in mood
Ø Characteristics of Temperament:
§ Activity level
• level of physical activity, motion or
restlessness or fidgety behavior that a child
demonstrates in daily activities
§ Rhythmicity
• presence or absence of a regular pattern for
basic physical function such as appetite, sleep
and bowel habits
§ Approach
• (and withdrawal)
• the way a child initially responds to a new
stimulus, whether it may be people, situation,
places, food, changes in routine and other
transitions
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MOTHER AND
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§ Adaptability/adaptability:
• the degree of ease or difficulty with which a
child adjust or change to a new situation and
how well they can modify the reaction
§ Intensity of reaction:
• energy level with which a child responds to a
situation whether positive or negative
§ Distractibility:
• ease which a child can be distracted from a
task by the environmental stimuli
§ Attention span and persistence:
• ability to concentrate and stay with a task with
or without distractions
§ Threshold of response:
• the amount of stimulation required for a child
to respond. Some children respond to the
slightest stimulation and others require
intense amount
§ Mood quality:
• positive or negative mood or degree of
pleasantness and unfriendliness in a child’s
words or behaviors
vEnvironment
Ø Although children cannot grow taller than their
genetically programmed height potential allows
their height to be considerably less than genetic
potential if their environment hinders their growth
in some way
Ø Ex. A child could receive inadequate nutrition
because of a family’s low socioeconomic status. A
parent could lack child care skills and are not able
to give attention or a child could have a chronic
illness
Ø Many illnesses lowers the child’s appetite
Ø Endocrine disorders directly alter the growth rate
Ø Having a parent who abuses alcohol or other
substances can cause inconsistency in care and
affects mental health
Ø Environmental influences are not always
detrimental.
Ø Ex. People with phenylketonuria, an inherited
Ø metabolic disease can achieve normal growth and
development in spite of their genetic make up if
their diet is properly regulated
Ø Environmental influences most likely to affect
growth and development:
Ø Socioeconomic level
§ The parent-child relationship
§ Ordinal position in the family
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WEEK 12 – INFANT AND TODDLER
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§ Health
§ Nutrition
Needs for Growth and Development
vPhysical and biologic needs
Ø in order for a child to fully grow and develop
physiologically, there must be enough sunlight,
food, water, air ventilation and all physical needs
should be attended
vLove and affection
vSecurity
Ø Must be able to provide the child may grow
psychologically and emotionally
vDiscipline and authority
Ø Balance between the sense of freedom and
discipline
Ø To morally and intellectually grow and have a
sense of discipline
vDependence and independence
Ø Promote autonomy towards them
Ø Balance by making them feel secured and making
sure that their independence is within the control
while promoting growth
vSelf esteem
Ø Psychologically grow
Ø Be able to boost and push themselves to grow and
develop
vCommunication
Ø Promote social growth or social development
vPlay
Ø Good avenue for children to practice their skills,
thinking and socialization with others
Ø Classifications of play
§ Social-affective play
• Infants take pleasure in relationships with
people
• As adults talk, touch nozzle and various ways
elicit a response from an infant, the infants will
learn to provoke parental emotion and
response for such behaviors (smiling, cooing or
initiating games or activities)
§ Sense-pleasure play
• Nonsocial
stimulating
experience
that
originate from without
• Objects and environments such as light, color,
taste, odors, textures and consistencies
attracts children’s attention to stimulate their
senses and give pleasure
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MOTHER AND
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§ Skill play
• After infant develops the ability to grasp and
manipulate, they persistently demonstrate and
exercise their newly acquired abilities through
skill play or repeating an action over and over
again
• Ex. Building a tower using cups. Picking up
cubes.
§ Unoccupied behavior
• Activity when a child actually isn’t playing at
all
• They maybe engaged in seemingly random
movements with no objective
• despite appearances, this is play and sets
stage for future play exploration
• may not be playful but focusing their attention
momentarily on anything that strikes their
interest and stay focused on
• ex. Daydreaming. Fiddle with clothes or other
objects. Walk aimlessly
§ Dramatic or pretend play
• Symbolic play
• Predominant amongst preschool
• After children begin invest situations and
people with meaning and to attribute affective
significance to the world, they pretend and
fantasize almost anything
• Acting out daily events, children learn and
practice the roles and identities modeled by
members of family and society
• Ex. Using the telephone, rocking a doll, driving
a car, pretending to be a doctor or superhero
or policeman
§ Games
• Competitive play
• Apparent in cases wherein sibling may beat his
sibling
• Rules, turn taking and functioning as part of a
team are big lessons taken from this type of
play
• Important to guide children in dealing with
winning and losing
§ Onlooker play
• A child in play observes other children playing
and doesn’t participate in the action
• Common in younger children who are working
on their developing vocabulary
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WEEK 12 – INFANT AND TODDLER
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• Children watch what other children are doing
but make no attempt to enter into the play
activity
• There is an active interest in observing the
interaction of others but no movement towards
participating
• Should not worry because it could be a child
feels shy, needs to learn the rules, or is the
youngest and wants to take a step back for a
while
§ Solitary play
• Child plays alone
• Teaches the child to keep himself entertained
and eventually setting the path to being self
sufficient
• any child can play independently
• most common in younger children around 2-3
years old or toddlerhood. At that age they are
still pretty self centered and lack good
communication skills
• if the child is shy, and don’t know playmates
well he may prefer this type of play
§ Parallel play
• No group association
• Play independently but among other children
• Put 2 3 year olds in a room together
• Having fun side by side in their own little
world
• doesn’t mean they don’t like each other but are
just engaging in parallel play
• despite little social contact, children who
parallel play learn from one another like taking
turns and other social necessities
• even though it appears that they are not paying
attention to each other, they are and are
mimicking the other’s behavior
• important bridge to the other stages of play
§ Associative play
• Children play together and are engaged in a
similar or identical activity but there is no
organization, division of labor, leadership
assignment or mutual goal
• Each child acts according to their own wishes
and no group goal
• Features children playing separately from one
another but are involved in what the others are
doing
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MOTHER AND
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• Ex. Children building a tower of blocks. As they
are building their own building they are talking
to each other and engaging in each other
• Helps little ones to develop skills like
socialization, problem solving, cooperation and
language development
• How children begin to make real friendships
§ Cooperative play
• All stages come together
• Children start playing together
• Common in older preschoolers or in younger
preschoolers who have older siblings or have
been around a lot of children
• Uses all of social skills that the children has
been working on and puts them into action
• Sets the stage for future interactions as a child
matures into an adult
Ø Functions of play
§ Sensorimotor development
• major components of play at all ages and its
predominant form of play in infancy
• active play is essential for muscle development
and serves a useful purpose in the release of
surplus of energy
§ Intellectual development
• Through exploration or manipulation, children
learn colors, shapes, sizes and textures and
significance of objects
• Books, stories, films and collections extend
knowledge and provide enjoyment
• Puzzles help with problem solving abilities
§ Socialization
• Learn to establish relationships - Initial social
contact
• Establish social relationships and solve
problems associated with relationships
• Learn to give and take, roles that the society
expects to fulfill and approved patterns of
behavior and deportment
§ Creativity
• Children experiment and try out their ideas in
play through every medium at their
disposable
• Product of solitary activity
• Creative thinking is often enhanced in group
settings
• listening to others ideas stimulates further
exploration of one’s own ideas
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• experiment and try out new ideas
§ Self-awareness
• Children learn who they are and their place in
the world
• The process of developing a self identity is
facilitated through play activities
• They become increasingly able to regulate their
own behavior to learn what their abilities are
and to compare their abilities to those of
others
• Test ability to assume and try out various roles
and to learn the effect of their behavior on
others
§ Therapeutic value
• Important at any age
• Can express emotion and relieve unacceptable
impulses in a socially acceptable fashion
• Learn to express emotion and intention
• Moral value
• Enforcement of moral standards of right and
wrong in the culture, interaction with peers
• If they are to be acceptable members of a
group, children must adhere to accepted codes
of behavior of the culture
Infancy
vFor the first year after birth a baby is called an
infant
vInfancy = the first year of life after birth
vThe infant is born with certain abilities already
developed
Ø e.g. they have a well-developed sense of smell, they
can also communicate their needs by crying when
they are hungry, uncomfortable, bored, or lonely.
vDuring the first year they develop many abilities
Ø Ability to smile, make vocal sounds, spend time
bubbling, sit, and crawl until they are able to
stand and walk.
v“Trust vs mistrust”, “oral stage”
Ø TRUST: When an infant is hungry the parent feeds
and makes the infant comfortable again, when the
infant is wet a parent changes his or her diaper
and infant is dry again, When an infant is called
the parent holds the baby closely = The infant will
trust that when he or she has needs or distress a
parent will come and meet that need
Ø MISTRUST: If care is inconsistent, inadequate, or
rejecting → Infants learn mistrust
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§ They become fearful or suspicious of people and
then the world
Ø Not all children achieve developmental tasks
readily; each task need not be resolved each time
it arises
Ø The developmental issue of TRUST vs MISTRUST
arises again at such successive stage of dev’t
Ø NURSING RESPONSIBILITY:
§ Constant caregiver / the mother must always be
there most of the time to promote trust of the
infant
§ Accdg to Freud; infant belongs to the oral stage
= child explores the world using the mouth
§ Oral stimulation using pacifiers
§ Do not discourage thumbsucking
§ health care visits: 2 weeks, 2 months, 4 months,
six months, 9 months, 12 months
§ Provide time for immunizations and health
assessments
§ Provide opportunity for parents to ask questions
about the child’s growth patterns and
developmental progress
§ Opportunity for healthcare providers to asses for
potential problems as they first appear
§ aspiration prevention
§ Chief injury threat to infants in the first year
§ Round cylindrical objects are more dangerous
than square or flexible objects in this regard. § 1 inch or 3.2 cm cylinder such as a carrot or a
hotdog is particularly dangerous because it can
totally obstruct an infant's airways.
§ A deflated balloon can be sucked into the mouth
and obstruct the airway in the same way
§ Educate the parents who need infant formula
not to prop bottles (milk may overflow fast) =
They are overestimating is there infants' ability
to push the bottle away
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§ Sit up, turn the head to the side, cough and clear
the airway if milk flows through rapidly in the
mouth to aspirate
vfall prevention
Ø NURSING RESPONSIBILITY
§ Instruct the parent to never leave an infant in an
unprotected surface such as bed or couch even
if the infant is in an infant seat
§ Place a gate at the top and bottom of stairways
§ Do not allow the infant to walk around with a
sharp objects in the hands or mouth
§ Raise crib rails and lock before walking away
§ Never leave an infant unattended in a high-chair
§ Avoid using infant walker near a stairway
vsafety with siblings
Ø Infants become fun to play with @ 3mos of age,
older brother/sister grow more interested in
interacting with them
Ø Important to remind parents that children >5 yrs
of age are not responsible or knowledgeable
enough about infants to be left unattended w/
them: may introduce unsafe toys or engage in play
that is too rough for an infant
Ø Preschoolers = may be jealous of a new baby and
may physically harm if left alone
vChildproofing
Ø Preparing the infant arrival towards the end of the
pregnancy
Ø Use of diff gadgets / tools to prevent any injury to
the child may occur
Ø Bassinet = used in the hospital; used until 2 mos
only
Ø Rear facing seat = in the car; until they reach the
height allowed by care safety seat manufacturer;
children ride rear-facing for 2yrs or more
Ø The first year caring for an infant as feeding,
bathing, dressing ,and so forth occupies what may
seem like nearly all of the parents' waking hours.
All of these basic care-related activities provide
important opportunity for parents and infants to
get to know one another and to be coming into
each other's unique personalities and patterns
Bathing
vit is very important to never leave the baby
unattended on bath seats
vCheck the temperature of bath water for comfort and
to prevent chilling as babies begin to develop good
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back support many parents begin to babe them in
an adult tub:
vNever leave and infant unattended even when
propped up ou of the water or sitting in a bath ring
or bath seat
vNormal wiggling can cause the baby to slip down
under the water = applies to the hospital setting as
well
vBeing able to swim momentarily may cause children
to lose their instinctive fear of water = be in more
danger that children more cautious of water
vHypothermia
vMicroorganisms = infants at this age are nt=ot yet
toilet trained
vExposure to chlorinated water = damages lung
epithelium → precursor to asthma
vInfant does not need a bath everyday = face, hands,
and diaper area washed
vSome infants need their head and scalp washed
frequently everyday or every other day to prevent
SEBORRHEA = Scaly scalp condition often called
cradle cap; Adhere to the scalp in yellow crusty
patches; skin beneath the lesions may be
erythematous ; Touches can be softened with
mineral oil or petroleum jelly and leaving it on
overnight → Crust can be removed by shampooing
the hair the next morning (Soft toothbrush or fine
tooth comb can be used to help remove the crusts)
vbathtime should be fun for an infant and can serve
many functions other than just the obvious one of
cleanliness especially during the second half of the
first year:
Ø infant enjoys poking at soap bubbles on the
surface of the water
Ø playing with bath toys
Ø helps an infant learn different textures and
sensations
Ø provides an opportunity to exercise and kick
Ø good opportunity for parents to touch and
communicate with a child
vteach parent to not leave the infant alone in tubs as
they could easily slipped under the water
vPotential Sources of Injury
Ø Accdg. To the CDC
Ø WATER: such as in the bathroom, kitchen,
swimming pools, hot tubs
Ø HEAT: in the kitchen, in a fireplace, or at a bbq
grill
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Ø TOXIC SUBSTANCES: like under the kitchen sink,
in the medicine cabinet, in a garage or garden
shed, in a purse or where medications are stored
Ø POTENTIAL FALLS: on stairs, the slippery falls,
from high windows, from tipping furniture that is
why childproofing is very important
Teething
vBegins at 5-6 mos
vInfants chew on any object within reach to lessen
gum line pain
vRemind parents to check for possible sources of lead
paint
vWander into elevators, out of the hospital, into
laboratory area, down a flight of stairs if not
supervised
vInstruct parents to keep guns out of reach
vKeep coin lithium batteries/ coin batteries and any
devices that contain them out of reach of children =
fat if swallowed
vKeep choking hazards (toxic substances, hot/sharp
items) out of reach
vHave your child use safety glasses if involved in
activities = woodworking, science projects, involving
chemicals, racquetball, paintball, enterprises w/
flying debris
vNever leave young kids unattended in a bath
vSafety latches and locks for cabinets and drawers =
Prevent poisoning or other injuries
vOutlet covers could also be used in areas in the wall
vAnchors to prevent furniture such as tv or gas
ranges from tipping over and crushing children
vCorner and edge bumpers to help prevent injuries
from falls against sharp edges on walls, furniture,
and fireplaces
vKnob covers which snap over door knobs to prevent
young children from turning them
vCordless window coverings to prevent strangulation
could also be of use
vInfant have little difficulty with teething but some
appear very distressed
vgenerally the gums are sore and tender before a new
tooth breaks the surface, as soon as a tooth is
through the tenderness passes
vTooth and gum pain = infants can be resistant to
chewing for a day or two and differently cranky
(possibly because they are a little hungry from not
eating as much as usual)
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vAbnormal signs (not signs of teething)
Ø high fever
Ø seizures
Ø vomiting or diarrhea
Ø earache
infant with any of these symptoms has an underlying
infection or disease process requiring further
evaluation
vmany otc medications are sold for teething pain, use
should be discouraged if they contain BENZOCAINE
(topical anesthetic) → because if applied to far back
in the throat interferes with the gag reflex
vTeething rings that can be placed in the refrigerator
= provides soothing coolness against tender gums
vAn infant who is teething will place almost any object
in the mouth
Ø parents must screen articles within the babies
reach to be certain they are edible or safe to chew
Nutrition
vWeaning at 6 mos
Ø WEANING = transition from breastmilk /
commercial iron fortified formula → solid food
vOffer new foods one at a time and let the child eat
the item for about 1 wk before introducing another
new food
vDetect possible food allergies
vEstablish sense of trust in infants = minimizes
experiences in any one day
vTake note of the important nutrients taken by the
infants
vFeed the first solid food in the parent’s arms such as
breastfeeding / bottle feeding = reduces the newness
of experience; reduces the amnt. Of stress
associated w/ it
vcow's milk needs vitamin c, iron and fluoride
supplementation
vNormal infant can survive on breastmilk /
commercial iron-fortified formula w/o the addition
of any other solid food until 4-6mos
vDelaying solid food at this time:
Ø prevent overwhelming infant kidneys w/ heavy
solute load (occurs when protein is ingested)
Ø May delay food allergies in susceptible infants
Ø May prevent obesity
vhigh-protein and high -calorie
vRapid growth of the 1st yr
vCommercial Formula and breastmilk
Ø 20cal/oz
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vCalorie levels can be reduced
Ø 120/kg body weight @ birth → 100/kg body weight
@ end of 1st yr to prevent babies from being
overweight
vbreastfeeding every 2-3 hours per demand, cup
feeding
Ø Should still be encouraged - CUP-FEEDING =
prevent nipple confusion
vallergy-precaution
Diaper Area Care
vMost effective means of promoting good diaper
hygiene is to change diapers frequently about every
to 2-4 hours
vhowever it is rarely good practice to interrupt childs
sleep to change diapers
vif an infant develops a rash from sleeping in wet
diapers = air drying or sleeping without in diaper
may be as solution
vAt each diaper change the parents should wash the
skin with clear water or with a commercial alcoholfree diaper wipe then pat or allowed to air dry
vroutinely use and ointments such as Desitin or A
and D ointment to keep urine and feces away from
an infant skin is a good prophylaxis
vparents do not need to use baby powder, if they
choose to advise them to sprinkle the powder on
their hands first and then apply it to the infant skin
vcaution them not to shake the powder on an infant
to reduce the possibility of aspiration
vthey should place the container out of the infants
reach after applying it
vparent should always watch carefully while infants
and toddlers are in the tub as well
vsome infants have such sensitive skin that
vDIAPER DERMATITIS OR DIAPER RASH is a
problem from the first few days of life that occurs for
several reasons:
Ø frequent diaper changing
Ø applying A and D or Desitin ointment and exposing
the diaper area to air may relieve the problem
Ø some infants may have to sleep without diapers at
night to control the problem
vWhenever the entire diaper area is erythematous
and irritated so that the outline of diaper on the skin
can be identified = one must suspect and allergy to
the material in the diaper or to laundry products if a
commercial washed or home wash diaper is being
used
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Ø changing the brand or type of diaper or washing
solution usually alleviate this problem
vFUNGAL / CANDIDA INFECTION = if a diaper area
is covered with lesions that are bright red with or
without oozing; last longer than 3 days and appear
as red pinpoint lesions → suspect a fungal or
candida infection
Dental Care
vexposing developing his to fluoride = is one of the
most effective ways to promote healthy tooth
formation and prevent tooth decay
vMost important time for children to receive fluoride:
between 6mos and 12 years of age
vwater level of 0.6 ppm fluoride is recommended =
because this is the level that protects tooth enamel
yet does not need to staining of teeth
vcommunities where the water supply does not
provide enough fluoride:
Ø the use of oral fluoride supplements beginning at
6 months
Ø the use of fluoride toothpaste
Ø rinses after tooth eruption is recommended
Ø teach parent to ask about the presence of fluoride
in the drinking water in the community to help
them determine if supplementation is necessary
Ø breastfed infants do not receive a great deal of
fluoride from breast milk so it may be
recommended by be given for fluoride drops once
a day
Ø teach parents to begin brushing even before teeth
erupt by rubbing off a washcloth a soft wash cloth
over the gum pads = this eliminates plaque and
reduces the presence of bacteria creating a clean
environment for the arrival of the first tooth
vOnce teeth erupt all surfaces should be brushed
with a soft brush or washcloth once or twice a day
vchildren lack the coordination to brush effectively
until they are school age = parents must be
responsible for this activity past infancy
vtoothpaste is not necessary for an infant because it
is the scrubbing that removes the plaque
vinitial dental check up = 1year of age should
continue a 6-month intervals until adulthood
Dressing
vClothing for infants should be:
Ø easy to launder
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Ø simply constructed so dressing and undressing is
not a struggle
Ø clothing should not be Binding = infants enjoy
kicking and making gross body movements
Ø when they begin to creep = they need long pants to
protect their knees
Ø soft-soled shoes = until they begin to walk merely
socks or booties to keep their feet warm
Ø when they begin walking = the soles of their shoes
need only be firm enough to protect their feet
against rough surfaces
vextremely hard soles and high ankle sides are
unnecessary
Sleep
v10-12hrs
vSleep need and habits vary greatly among infants
vMost require 10- 12 hours of sleep at night
v1 or several laps during the day
vparents are usually advised to let a baby sleep in a
separate space rather than in their bed so the
parents do not awaken at every toss and squeak
vdoing so allows infants to learn to quiet themselves
and go back to sleep should they awaken break
briefly
Ø this may help prevent sleep problems such as
night walking in the future
vother parents prefer to have infant sleep with them
in a family dad and they believe this practice for
moves a feeling of security
vBED SHARING = also promote breastfeeding but
also has a danger of accidental suffocation
Ø caution parents not to place pillows in an infant's
bed = avoid suffocation
Ø SUPINE POSITION = always place and fans on
their back to sleep because this position markly
reduces the incidence of SUDDEN INFANT DEATH
SYNDROME / SIDS
Ø use of pacifier = while and infant sleeps may
further reduce the risk
vTHUMB- SUCKING
Ø
surprisingly strong need in early infancy
Ø
many infant begin to suck a thumb or finger at
about 3mos of age and continue the habit through
the 1st year of life
Ø
THE SUCKING REFLEX - peaks at 6-8mos
Ø
THUMB-SUCKING = peaks at about 18 mos parents can be assured that that thumb-sucking is
normal :
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Ø
does not deform the jaw in infancy
Ø
it does not cause baby talk or any of the other
speech concerns commonly attributed to it
Ø
children you continue the habit into school age
= however can have changes in their dental arc that
leads to asymmetric concern such as crossbite
vthe best approach for parents is to be certain and
infant has adequate sucking pleasure and then to
ignore thumbsucking
Ø making an issue of it really has a child to stop = it
may intensify and prolong it
vwhether to use pacifiers is a question that parents
must settle for themselves depending on how they
feel about them and their infants needs benefits of
pacifiers include the following:
Ø they appear to be comforting to an infant
Ø may may aid in pain relief
Ø decrease the risk of SIDS Ø infant who completes a feeding and still seems
restless and discontent who actively searches for
something to put into the mouth or who sucks on
hands and clothes = may need a pacifier
Ø Risks associated with pacifiers:
§ increased incidence of acute otitis media or ear
infection
§ Possibly a negative impact on breastfeeding
§ dental malocclusion particularly if usage is
greater than 2 to 3 years old
§ Theoretically, a child who sucking needs are met
and infancy will not craves much oral
stimulation later in life and is less likely to
become a pencilchewer, cigarette smoker,
nailbiter or the like
§ a major drawback for pacifiers is a problem of
cleanliness, others:
§ they tend to fall on the floor or sidewalk and are
then put back into an infant's mouth
§ if not well constructed they may come apart and
the nipple part may be aspirated
§ hanging a pacifier on a string around and infants
neck could cause strangulation
Ø parents should attempt to wean a child from
pacifier anytime after 3 months of age and
certainly during the time that sucking reflex is
fading @ 6 -9 mos; weaning after this age is
difficult because a pacifier becomes a comfort
mechanism like a warm blanket or fuzzy toy to
which a child may continue to cling
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Head Banging
vStarts at the 2nd half of infancy until preschool
vassociated with nap time or bedtime
vLasting under 15 minutes = normal
vchildren use this measure to relax and fall asleep
vinvestigating stress factors operating in the house
may be helpful
Ø if some to stress can be relieved such as:
Ø a parents overestimation of the child's
development
Ø marital discord
Ø illness in another family member
Ø head banging may be decreased
Ø ingrained habit = that it will persist for months or
even years
vadvise parents to pad the rails of cribs so infants
can't hurt themselves
vreassure them that is a normal mechanism for the
relief of tension in children of this age
vno therapy should be necessary Suggests pathologic
basis such as the following may need referral for
further evaluation :
Ø excessive head banging done to the exclusion of
normal development or activity
Ø head banging past the preschool period
Ø if associated with other symptoms
Bowel Pattern
vCONSTIPATION
Ø May occur in formula fed infants
Ø If the diet is deficient in the fluid
Ø This can be corrected simply with the addition of
more fluid.
Ø Some parents misinterpret the normal pushing
movements of a newborn to be constipation when
infants defecate:
§ their faces do turn red
§ Grimace and grunt
vas long as stools are not hard and contain no
evidence of fresh blood (as might occur with a rectal
fissure) = normal infant behavior
vif constipation persist beyond 5 or 6 mos of age =
encourage parents to check with the infant's health
care provider about measures to relieve this
Ø adding foods with both such as fruits or
vegetables
Ø increasing fluid intake generally relieves the
problem
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vMany new parents also are unfamiliar with the
consistency or color of normal newborn stools so
they may mistakenly report normal stooling as
diarrhea
Ø stool of breastfed infants = are generally softer
than those of formula fed
Ø if a mother takes a laxative while breast feeding an
infant stool may be very loose
Ø infant who is formula fed = can have loose stool if
the formula is not diluted properly
Ø occasionally loose stools me begin with the
introduction of solid food such as fruit
vwhen talking to a parent about loose stools ask
about:
Ø the duration of the loose stools
Ø the number of stools per day
Ø color and consistency
Ø whether there is any mucus or blood in them
Ø is their associated fever cramping or vomiting
Ø does an infant continue to eat well
Ø appeared well seem to be thriving
Ø is an infant wetting at least 6 diapers daily
Ø Infants with associated signs and symptoms such
as:
§ Fever
§ Cramping
§ Vomiting
§ loss of appetite
§ decreasing in voiding
§ weight loss
§ should be examined by their health care provider
because this suggests an infectious process.
DEHYDRATION occurs rapidly in a small infant
who is not eating and is losing body fluid for
loose stools.
Colic
vParoxysmal abdominal pain that generally occurs in
infants under 3 mos of age
vMarked by:
Ø loud intense crying
Ø an infant cries loudly and pulls the legs up against
the abdomen
Ø the infant’s face becomes red and flushed
Ø the fists clenched
Ø Abd becomes tense
Ø if offered a bottle the infantile stuff vigorously for a
few minutes as if starved then stop as another
wave of intestinal pain occurs
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vthe cause of colic is unclear it may occur in
susceptible infants from:
Ø Overfeeding
Ø from swallowing too much air while drinking
vformula fed babies are more likely to have colic in
breastfed babies possibly because they swallow
more air while drinking or because formula is harder
to digest
valthough infants continue to thrive despite colic the
condition should not be dismissed as unimportant
vit is a distressing and frightening problem for parent
not only because an infant appears to be in acute
pain but also the distress persists for hours usually
into the middle of the night so no one in the family
gets adequate rest
vNR:
Ø help in determining the ladies feeding pattern is it
breastfed or bottle fed
Ø If bottle-fed ask about the type of formula and how
is it prepared
Ø ask parents if you're holding the baby up right so
air bubbles can rise
Ø whether they burp the infant adequately after
feeding
Ø for breastfed baby, a change in maternal diet such
as avoiding gassy foods like cabbage might be
helpful to reduce or limit colic periods.
Ø it may be helpful to recommend that both breast
and formula fed infants received small frequent
feedings = to prevent distension and discomfort
Ø offering a pacifier may be comforting
Ø AVOID HEAT = some parents try placing a hot
water bottle under infant stomach for comfort but
this should be discouraged a basic rule for any
abdominal in case of appendicitis is developing
§ Highly unlikely in so young an infant but parents
will remember they won't use heat may use it
again when the child is older
§ hot water bottles and heating pads also might
burn the delicate skin of infants
Spitting Up
vRolls down the chin
vAlmost all infants hiccup although formula fed
babies appear to do it more than breastfed babies
vparents who did not handle their infant much in the
healthcare facility where the child was born may
discover spitting up only after they take the baby
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home; they may interpret this as vomiting or think
an infant is developing an infection
Ø ask them to describe carefully what they mean by
spitting up
Ø how long the baby been doing it
Ø how frequently
Ø what is the appearance of the spit up milk
valmost all note that is spit up smells at least faintly
sour but it should not contain blood or bile
va baby who spits up a mouthful of milk rolling down
the chin 2 or 3 times a day or sometimes after every
meal = normal early infancy spitting up
vassociated signs suggests illness such as:
Ø Diarrhea
Ø Abd cramps
Ø Fever
Ø Cough
Ø Cold
Ø Loss of activity
vbeginning pyloric stenosis ( the abnormal tight valve
between the stomach and duodenum) = if an infant
is spitting up so forcefully that milk is projected 3 or
4ft away it may be; which require surgical
intervention
vburping a baby thoroughly = after feeding often
limits spitting up;
vparents me try sitting and infant in an infant chair
for half an hour after feeding
vchanging formulas generally is of little value
vreassure parents that spitting up decreases in
amount as a baby becomes better at coordinating
swallowing and digestive processes in the meantime
a bib can protect the babies clothing and the parent
vafter a few months the child will naturally stay in an
upright position longer and gravity will help the
correct the problem
Milaria
vMILIARIA or prickly heat rash = most often in warm
weather or when babies are overdressed or sleep in
overheated rooms
vCluster pinpoint reddened papules with occasional
vesicles and pustules surrounded by erythema
usually appear on the neck first and may spread
upward to around the ears and on to the face or
down into the trunk
vbathing & infant twice a day during hot weather
particularly if a small amount of baking soda is
added to the bath water = may improve the rash
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veliminating sweating = by reducing the amount of
clothing on an infant or lowering the room
temperature should bring almost immediate
improvement and prevent further eruption
Baby-Bottle Tooth Decay
putting an infant to bed with a bottle of formula,
breast milk, orange juice, or glucose water can result
in aspiration
vit can also lead to decay of all the upper teeth and
the lower posterior teeth
vteeth decay occurs because while an infant sleeps
liquid from the prop bottles continuously soaks the
upper front teeth and lower back teeth the problem
is called baby-bottle syndrome
vBABY-BOTTLE SYNDROME = occurs because the
carbohydrates in solutions such as formula or
glucose water ferments two organic acids that
demineralize the tooth enamel until it decays
vPrevention:
Ø Advise parents never to put their baby to bed with
a bottle
Ø If parents insist that a bottle is necessary for the
baby to fall asleep, encourage them to fill it with
water and use a nipple with a smaller hole to
prevent the baby from receiving a large amount of
fluids
Ø If the baby refuses to drink anything but milk, the
parents must dilute the milk with water more and
more each night until the bottle is down to water
only
Toddler
During the toddler period, the age at span from 1- 3
years enormous change has taken place on a child
and consequently in a family.
vDuring this period children accomplish a wide array
of developmental tasks and change from a largely
immobile and pre-verbal infants who are dependent
on caregivers
vfor the fulfillment of most needs to walking, talking
young children with a growing sense of autonomy or
independence
vto match this growth parents must also change
during this period, if a parent enjoyed being the
parent to an infant because time could be spent
rocking or singing to the child they may not enjoy
being a parent of a toddler as now their task is to
support their child’s growing independence with
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patience and sensitivity and to learn methods for
handling child’s frustration that arise for the quest
of autonomy
v“Autonomy vs Isolation”
Ø The developmental task of toddler years according
to Erickson is a development of a sense of
autonomy vs. shame / doubt
Ø children who have learned to trust themselves and
others during the infant year are better prepared
to do this than to those who cannot trust
themselves or others.
Ø To develop a sense of autonomy is to develop a
sense of independence
vPoisoning
Ø never take medication in front of child
Ø place all medication and poisons in lock cabinets
or overhead shelves where child cannot reach
them
Ø never leave medication in parents purse or pocket
where child can reach it
Ø always store food and substances in their original
containers
Ø Know the names of house plant and find out if they
are poisonous
Ø hang plants or set them in high surfaces beyond
toddlers grasp
Ø be certain at small batteries or magnet that are out
of reach
Ø post telephone numbers of nearest poison control
centers by the telephone
Ø inspect toys to be certain there are free of
leadbased paint
vAspiration
Ø piration - Examine toys for small parts that could
be aspirated
Ø Remove toys that appear dangerous
§ Do not feed toddler popcorn, peanuts, etc
§ Urge children not to eat while running
§ do not leave taller alone with a balloon
vMVA (Motor vehicular accidents)
Ø maintain child in car seat Ø do not be distracted from safe driving by a child in
a car Ø do not allow child to play outside unsupervised
Ø do not allow child to operate electric garage doors
Ø supervised toddler who is too young to be left alone
on the tricycle
Ø Teach safety w/ pedaling toys
Ø look before crossing driveways
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Ø do not cross streets
Ø Do not expect not expected the toddler will obey
these rules at all times = it is important that the
provider should stay close by
vPlayground injuries
Ø do note that some children are more active curious
and impulsive and therefore more vulnerable to
unintentional injury than others
Child Proofing
vBABY GATE or FENCE = The best baby proofing
solution to prevent the child climbing the stairs.
vwill prevent the child from going anywhere near the
staircase
vA properly installed baby gate will hamper the
curious child’s access even when the guardian is not
watching
vit is important that we teach the parents to keep the
house windows closed or keep secure screens in
vPlace gates at top and bottom of stairs
vsupervised @ playing grounds
vDo not allow child to work with sharp object in
parent or mouth
vraise crib rails and check to make sure they are
locked before walking away from crib
vSince children want to cruise around the house, they
may wander into the kitchen:
Ø Hot pots and cause burns
Ø it is important to teach the parents to cook on the
back burners of stove if possible
Ø turn handles of pots toward back of stove to
prevent toddler from reaching up and pulling them
down
Fire and Burn Hazards
vif a vaporizer is used use a cold mist type rather than
steam vaporizer so child cannot be scalded
vkeep screen in front of fireplace or heater
vmonitor toddlers carefully when they are near lit
candles
vdo not leave toddlers unsupervised near hot water
faucets
vcheck temperature setting for hot water heater so
thermostat is not over 125 degrees fahrenheit
vDo not leave coffee or tea pots on the table where
child can reach them
vnever drink hot beverages when a child is sitting on
the lap or playing within reach vbuy flame retardant clothing
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vdo not allowed toddlers to blow out matches
vstore matches out of reach
vkeep electric wires and cords out of toddler’s reach
so cover electric outlets with safety plugs
vdo not allow toddler to approach strange dogs
vsupervise child's play with family pets
Nutrition
vFinger-food
vProvide options
v1000kcal/day = sedentary lifestyle
v1400kcal/day = active lifestyle
vToddler’s appetite decrease over time so food
consumption will be less
valways remember that recommended calorie intake
for toddlers would be
Ø 1000 kcal per day for toddlers with sedentary
lifestyle
Ø 1400 kcal per day for hyperactive toddler
vbecause the actual amount of food eaten daily varies
from one child to another it is important that we
teach parents to place a small amount of food on a
plate and allow the child to eat it and ask for more
rather than serving a large portion the child cannot
finish
vallow self-feeding which is a major way to strengthen
independence in a toddler
vFINGER FOODS= offer finger foods and allow each
choice between two types of food helps promote
independence while exposing children to varied
foods
vnutritious finger foods that toddlers enjoy include:
Ø Pieces of chicken
Ø slices of banana
Ø pieces of cheese and crackers
vmost others insist on feeding themselves and
generally will resist eating if a parent insist on
feeding them
van individual child may react after repeated
attempts at being fed by refusing to eat at all
vmany toddlers prefer to eat the same type of food
over and over because of the sense of security this
offers
vfrequently they eat all of one item before going on to
another
vthey often prefer brightly colored foods to bland
colors
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Dressing
vparents will be reluctant to encourage toddlers to
dress themselves because it is easier and quicker for
a parent to do so
valso a toddler who is dressed by parents will usually
be wearing clothes in the correct way
vwhen toddlers dress themselves they invariably put
shoes on the wrong feet and shirt and pants on
backward
vencourage parents to give a perfection for the benefit
of the child's developing sense of autonomy
vif they feel they must change the child's clothes, urge
them to begin with a positive statement such as “you
did a great job!” before making the switch
vas soon as children are off on their feet and walking
they need shoe soles that are firm enough to provide
protection from rough surfaces however toddlers do
not need extremely firm or ankle high shoes because
a toddler’s arcs are still developing
vit is better for their arc to provide foot support rather
than having it provided by shoes
vSNEAKERS = are an ideal toddler shoe because the
soles are hard enough for tough or for rough
surfaces and arcs support is limited
Sleep
vThe amount of sleep children he gradually decreases
as they grow older
vThey may begin the toddler period nappings 2x/day
and sleeping 12 hours each night and end it with
one nap/day and only 8 hours of sleep at night
vparents who are not aware that the need for sleep
declines at this time made you a child's disinterest
in sleeping as a problem
vif a child has difficulty falling asleep at night = omit
or shorten and afternoon nap
vif a child is so short-tempered at dinner time that
eating is impossible = perhaps the child needs 2
naps/day
vsome toddlers begin having night terrors or awake
crying from a bad dream → so may receive little sleep
because they are reluctant to fall back asleep
vother toddlers resist nap time as part of their
developing negativism = parents might minimize this
by including a nap as part of lunchtime routine not
as a separate activity
Ø E.g the child always goes from the table directly to
bed as if the two things are connected
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Ø the parent and say simply “it's nap time now”and
then give a secondary choice “do you want to sleep
with your teddy bear or your ragdoll?”
vAlthough toddlers need to be independent they also
need a feeling of security just as adults like to know
there are guardrails along steep mountain roads =
toddlers like to see parents as firm consistent people
you can be counted on to be reliable over and over
especially when they are tired
vBy the end of toddler period = Many toddlers are
ready to be moved out of a crib into a youth bed or
regular in bed with protective side rails or a chair
strategically placed beside it
vremind parents/ stress that sleeping in the regular
bed does not give children the right to get in and out
of bed as they choose
Ø some toddlers do well if they are allowed to sleep
in a regular bed and a folding gate is placed across
the door to their room = this arrangement gives
them a feeling of independence but still keep them
safe
Ø when first moved to a bed without side rails many
children are found sleeping on the floor of the room
in the morning = no harm in this unless it is cold
or drafty
Ø dressing the child in warm pajamas or putting a
blanket on the floor might be solutions to help
parents accept this
Bathing
for parents
vStill not safe
to leave toddlers
unsupervised
Ø Might slip and get head underwater
Ø Reach and turn on hot water faucet
vDo not add bubble bath to water
Ø Associated with vulvovaginitis and UTI especially
in girls
Dental Care
vTo help prevent dental caries from frequent snacking
vEncourage parents to offer fruits or protein foods
vRather than high carbohydrate items such as
cookies
vLimit exposure to carbohydrates
vCalcium
Ø Especially important for development of strong
teeth
Ø Good as snack foods
vContinue to drink fluorinated water
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Ø If not available
§ Use fluoride supplements
Ø So that all new teeth form with cavity resistant
enamel
vDo not put a child to bed with a bottle of milk or juice
Ø Help prevent development of caries
vToddlers need a toothbrush that they recognize is
theirs
vToward the end of toddler period
Ø Can begin brushing themselves under supervision
until 8 years old
vReminder:
Ø Better for a child to brush thoroughly once a day
at bedtime and do it poorly at other times
Ø After brushing
§ Parents can use dental floss to clean between the
child's teeth and remove plaque
vFirst dental visit
Ø 12 months of age
Ø Dentist skilled with pediatric dental care
Ø Screening and assessment of dentition
§ 6 months of age
§ Should not go beyond 24 months of age
Ø Dental services can begin by aged 3 years
Ø Parents can prepare child for first and subsequent
dental visits
§ Reading stories
Ø Children rarely have any cavities this early
§ First dental visit are painless
§ Sets positive stage for future dental supervision
visits
Toilet Training
vOne of the biggest task a toddler tries to achieve
Ø It is important to explain to parents that toilet
training is an individualized task for each child
and should begin and completed with the child's
ability to accomplish it and not according to a set
schedule
vBefore children can begin toilet training, they must
reach three important developmental levels
Ø One is physiologic and the other two are cognitive
Ø They must have control of rectal and urethral
sphincters, usually achieved at the time they walk
well
Ø They must have a cognitive understanding of what
it means to hold urine and stools until they can
release them at a certain place and time
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Ø They must have a desire to delay immediate
gratification for a more socially accepted action
vSome toddlers smear or play with feces
Ø Often at the time toilet training has started
§ Occurs because they have become fully aware of
body excretions but do not have adult values
towards them
Ø Stool seem a little different than the modelling clay
that they play with
Ø Solution:
§ Provide toddlers with substances of similar
texture
§ Changing diapers immediately after defecation
§ Teach parents to accept this behavior for what it
is, an enjoyment of the body and of the self and
the discovery of new substances
§ After child is toilet trained
§ Playing with feces rarely happens
Negativism
vDo not want to do anything a parent wants them to
do
vReply to every request is no
vSolution:
Ø Reduced by limiting number of questions asked to
the child
§ Father: are you ready for dinner?
Meaning = come to the table. Its dinner time
§ Mother: will you come take a bath now?
Meaning = its time for a bath
Making a statement instead of asking question can
avoid many negative responses
vToddler needs experience in making choices
vTo provide opportunity to do this, a parent could give
a secondary choice
Ø No is not an allowed answer for major task
Ø Example:
§ Parent: its bath time now. Do you want to take
your duck or your toy boat into the tub with
you?
§ Parent: its lunch time. Do you want to use a bib
or a small plate?
§ Parent: its time to go shopping. Do you want to
wear your jacket or sweater?
Discipline
vSetting roles or road signs so children know what is
expected of them
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vPunishment
Ø Consequence that results from breakdown in
discipline or child's disregard of role that were
learned
vTwo general rules needs to be followed
Ø Parents need to be consistent
Ø Rules are learned best if correct behavior is
praised rather than wrong behavior punished
vTime-out
Ø Technique to help children learn that actions have
consequences
Ø To use this effectively
§ Parents must be certain that child understands
the rule that they are trying to enforce
Ø Parents should give one warning
§ If child repeats the behavior, parents select an
area that is non stimulating (corner of room or
hallway)
• Child is directed to go immediately to timeout
space
• Child then sits there for a specified period of
time
• If child cries or begin to do disruptive behavior,
timeout does not begin until it is quiet
• When specified time has passed, child can
return to the family
• Using a timer that rings when time is up
(Effective way to let children know when they
can return with the family)
v1 minute = 1 year of age
Separation from anxiety
vFear of being separated from parents begins at 6
months of age throughout the preschool period
vToddlers who have this have
Ø Difficulty accepting being separated from a
primary caregiver to spend the day at a daycare
center
Ø Or if primary caregiver is hospitalized
vReact best if regular babysitter is employed or if
daycare center have consistent caregivers
vHelps if toddlers are given fair warning that they will
have a babysitter
Ø Example: Mommy is fixing dinner because mommy
and daddy are going to visit some friends tonight.
Maria will come and babysit for you. She'll put you
to bed. When you wake up in the morning, mommy
and daddy will be here again
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Ø May cry when seeing the babysitter or greet the
babysitter when she arrives but cries when toddler
sees the parents grabbing their coats
Ø Solution:
§ Say goodbye firmly and repeat the explanation
and then leave
§ Prolonged goodbyes
§ lead to more crying
§ Sneaking out (must be discouraged)
§ may prevent crying and ease parents guilt but
can strengthen fear of abandonment
Temper Tantrums
vChild may kick, scream, stomp feet, shout, flail arms
and legs, bite, or bang head on the floor
vNatural consequence of toddler's development
vOccur because they are independent enough to
know what they want but does not know how to
express their feeling in a more socially accepted way
vResponse to difficulty making choices or decisions or
to pressure to activities such as toilet training
vExpress their feelings in some way and do so with
temper tantrum
Ø Hold breath until they become cyanotic
§ Distended chest
§ Often has air filled cheeks
§ Shows increasing distress as body registers
oxygen want
vIgnoring child makes it an ineffective technique for
expressing frustrations or getting what they wanted
vBreathing holding
Ø Unprovoked neurologic problem
Ø Children under stress appear to forget to breathe
or halt breathing after expiration
§ Usually at the peak of anger
§ Become so short of breath they slump to the floor
vTrue breath holding
Ø Needs to be separated from temper tantrums
vSolution:
Ø Tell child that they disapprove of the tantrum and
ignore it
§ I'll be in the bedroom. When you're done kicking,
come into the bedroom too.
§ Children who are left this way will not usually
continue their tantrum but will stop after one or
two minutes and rejoin their parents
Ø Parents should then accept the child warmly and
proceed as if the tantrum had not occurred
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§ Also helps with nurses taking care of tantrums
in hospitals
Autism Spectrum Disorder (ASD)
vComplex range of neurodevelopmental disorder
vCharacterized by
Ø Communication difficulties
Ø Poor social interactions
Ø Frequent, repetitive and stereotyped movement
vSymptoms begin to appear in infancy
vObvious enough in toddler years
Ø Child tend not to speak any words
Ø Does not make eye contact with others
Ø Has difficulty interacting with playmates
§ Prefer to watch spinning toy, water swirling
down the toilet or repeating song phrases
vScreened for autism symptoms by 12 months of age
v18 and 24 months of age by observation and parent
report
Adolescence
vperiod between 13 – 20 yrs old
vtime serves as transition from childhood to
becoming a late adolescent
vdivided to:
Ø early period (13-14yrs old)
Ø middle period (15-16)
Ø late period (17-20)
vduring all periods adolescence is defined not so
much by chronological age as by physiologic,
psychological and sociological changes
vthe drastic change in physical appearance and the
change in expectations of others, esp parents that
occur during the period can lead to both emotional
and physical health concerns
Promotion of Safety
vMotor vehicle accidents are the most leading cause
of death among adolescents
vAlthough teenagers are at the peak of physical and
sensory motor functioning, their need to rebel
against authority or to gain attention through risktaking leads them to take careless action such as
speeding or driving while intoxicated. Some
adolescents dismiss seat belts as childish and so
need extra instruction that is why to use every safe
precaution available when in a motor vehicle.
vSo instruct them to always use a seatbelt whether a
driver or passenger
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vNever use a cellphone or text while driving
vDo not drink alcohol while driving
vAlways refused to ride with anyone who is has been
drinking
Adolescent and MMDST
vName a designated driver or arrange with the
parents to be picked up or provide money for a taxi
vWear a helmet and long trousers as driver or
passenger on a motorcycle except there has no place
in safe driving
vTake the driver program seriously so child learn safe
driving habits for both two wheel and four-wheel
vehicles
vFor sports, it is important to use protective
equipment such as face mask for hockey and pads
and helmet for football ●
vDo not attempt to participate beyond physical limits
vKeep well hydrated by drinking fluid before and after
play
vCareful preparation for sports through training is
essential to safety and recognize and set one's own
limit for sports participation
vOther common causes of death in adolescents are
homicide and self-harm or suicide these are related
to easy accessibility of guns when adapt added to
depression binge drinking and impulsivity
vGang violence and the desire to protect themselves
are additional factors
Nutrition
vAdolescents experience such rapid growth that they
me always feel hungry if their eating habits are
unsupervised because of peer pressure and when in
hurry to get to other activities they tend to eat fattish
or quick snack foods rather than more nutritional
ones
vAdolescents who are slightly of obese because of
prepubertal changes may begin low-calorie or
starvation diets during adolescence to lose weight
some diet so excessively they develop eating
disorders such as bulimia or anorexia nervosa
vAnorexia often stems from a distorted body image
which may result from an emotional trauma
depression or anxiety some people may view extreme
dieting or weight loss as a way to regain control in
their lives
vThere are many different emotional behavioral and
physical symptoms then can signal anorexia
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vWhile someone with bulimia may develop an
unhealthy relationship to food over time they may
get caught up in damage in cycles of binge eating
and then panic about the calories dave consume this
may lead to extreme behavior to prevent weight gain
vWeight loss diet is appropriate during adolescence
but it must be supervised to ensure the adolescent
is consuming sufficient calories and nutrients for
growth
vFor example many adolescents entirely omit breads
and cereals to lose weight rather than just reducing
the amount they eat
vDiet can be deficient in vitamin B - thiamine and B2
- riboflavin which are necessary for growth
vSometimes adolescents may be unaware that their
food intake is excessive because they have been told
they need excess nutrients for healthy and
adolescent growth and everyone in their family eats
large portion
vHealth teaching with adolescents need to begin with
a discussion of a normal weight and standard food
because they do not begin to own this problem as
adolescent they run a high risk of becoming obese
adults
vSo general measures to help adolescent decrease
overeating include making a detailed log of the
amount they eat the time and the circumstances and
then changing those circumstances always eating in
one place like the kitchen table instead of while
walking home from school or watching television
vSlowing the process of eating by counting mouthfuls
and putting the fork down between bites or being
served food on small plate so helping it look larger
Health Problems
vHYPERTENSION
Ø is present if the blood pressure reaches above 127
over 81 mmhg for 16 year old girls and 131/81 for
16 year old boys for two consecutive readings in
different settings all children older than three
years of age should have a blood pressure
routinely taken at all health assessments to detect
this. this is particularly important for adolescents
because new medications + education can help to
greatly reduce the incidence of cardiovascular
disease as they reach adulthood
vPOOR POSTURE
Ø Urge children of both sexes to use good posture
during these rapid growth years. assess posture at
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all adolescent health appraisal to detect the
difference between simple poor posture and the
beginning of spinal dysplasia or scoliosis
vBody piercing and tattoos
Ø are a strong mark of adolescents. Body piercings
and tattoos have become a way for adolescents to
make a statement of who they are and that they
are different from their parents. Be certain they
know the symptoms of infection at a piercing or
tattoo site such as redness, warmness, swelling
and mild pain and to report these to their
healthcare provider if they occur because serious
staphylococcal or streptococcal infections can
occur at piercing sites. It is important to caution
adolescents that sharing needles for piercing or
tattooing carries the same risk for contracting a
blood borne disease as sharing needles for
intravenous drugs
vFatigue
Ø because so many adolescents comment that they
feel fatigued to some degree it can be considered
normal for the age group however fatigue may also
be a beginning symptom of disease so it is
important that it is not underestimated as a
concern. always assess a diet sleep patterns and
activity schedules of fatigued adolescence. be
aware that is affecting a short period of extreme
tiredness it suggests disease more so than a long
ill defined report of always feeling tired. Blood tests
may be indicated to rule out anemia and common
infections in adolescents such as infectious
mononucleosis.
chronic
fatigue
syndrome
although not seen as often in this age group as in
adults may also need to be ruled out.
vMost common menstrual irregularities would be
Acne
Ø Acne is a self-limiting inflammatory disease that
involves the sebaceous glands which empty into
hair shafts. it is the most common skin disorder of
adolescents and it's frequently occurring in boys
than girls. Changes associated with puberty that
cause acne to develop include the increase in
androgen level in both sexes and sebaceous glands
become active. The output of sebum which is
largely composed of lipids mainly triglycerides
increases. trapped sebum causes whiteheads or
closed comedones. As trap sebum darkens from
accumulation of melanin and oxidation of the fatty
acid components on exposure to air, blackheads
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are open comedones. leakage of fatty acid causes
a dermal inflammatory reaction. bacteria lodge
and thrive in the retained secretions and ducts.
Ø Acne is categorized as:
§ Mild - made up of comedones , those are blocked
hair follicle
§ Moderate - such as papules and pustules are
also present
§ Severe - is when there is a cyst present
Ø Risk factors
§ emotional stress
§ menstrual periods
§ use of makeup and harsh hair
§ Treatment
§ Decrease table formation
§ Prevent comedones
§ Control bacterial proliferation (there are
systemic medications and external medications
that can be applied as ordered by the doctor).
Sexuality
vStalking refers to repetitive intrusive and unwanted
actions such as constant threatening, pursuit
directed at an individual to gain the individual's
attention or to evoke fear. Electronic media can be
used for cyber stalking, internet harassment and
internet bullying to embarrass, harass or threaten
adolescents. This is one of the concerns regarding
sexuality and sexual activity that can threaten
especially female adolescents. to avoid stalking
adolescents should be aware of and avoid situations
where they will be vulnerable to be alone with a
stalker and with assistance reports talking to law
enforcement
vDuring school age, can easily continue into
adolescence and actually becomes more serious
because this can be the time the bullied child has
the ability to retaliate through self destructive
behavior or school violence.
vHazing is a form of organized bullying that refers
to the degrading or humiliating ritual that
prospective members have to undergo to join
sororities fraternities and adolescent gangs or
sports teams.
vTo help prevent this from happening or the
dangers of bullying and hazing to happen to the
child urge parents to be aware of what clubs or
organizations their adolescent joints and what
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requirements
for
membership
are.
help
adolescents make sound decisions about what
type of hazing their organization advocates by
asking them about the subject at all health
assessments. Substance use disorder formerly
referred to as substance use disorder refers to the
use of chemicals to improve a mental state or
induce euphoria. This is so common among
adolescents that as many as 50% of high school
seniors report having experimented with some
form of drug according to the CDC in 2012. Of the
many the view substances would include
prescription and over-the-counter drugs alcohol
tobago steroids marijuana amphetamine cocaine
hallucinogens, opiates
vIt is important to promote therapeutic
communities or 24-hour facilities in which
adolescents can live while they recover from a
chemical dependency which may be necessary for
some adolescents
vThe aim of all these programs is to increase
adolescent’s sense of self-esteem, improve solving
ability and realign them. adolescents should be
encouraged to seek care for themselves or others
whenever an overdose situation is apparent as
prompt treatment can be life-saving.
Self-injury includes a range of self destructive
actions from cutting to suicide, the plan or intent to
end one’s life. Cutting is found more frequently in
girls than boys and can begin as early as grade
school. successful suicide occurs more frequently in
males than in females. Although more females
apparently attempt suicide than males, adolescent
suicide stand to be attempted most often in the
spring or in the fall reflecting school stress at this
times of year and between 3 p.m. and midnight.
Reflecting depression that increases with the dark.
Because suicide usually reflect a problem in family
interaction, a family assessment is helpful. A
thorough family history may reveal conflict with one
or both parents or reveal how little support the
adolescent receives at home. School friends may
often be the ones who are first aware that an
adolescent is contemplating suicide. Caution
parents not to discount reports from their child's
friends who tell them they are concerned. Close to
the chosen time of suicide some adolescents
demonstrate characteristic behaviors that show
they are making preparations to end their life. Teach
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family & friends these typical danger signs. When
caring for a child after a suicide attempt, ask as
enough questions on a health history so you can
help to analyze whether an adolescent made a
detailed suicide plan.
Metro Manila Developmental Screening Tool
(MMDST)
vScreening is a presumptive identification of an
recognize disease or defect it is used for early
detection and test child with problem facilitates
early referral and treatment and detects
developmental disabilities
vThe MMDST is indicated for children 6 and a half
years old and below
vMMDST is a simple and clinical useful tool that is
used to determine early serious developmental
delays and is organized by Dr. William K.
Frankenberg and modified and standardized by Dr.
Phoebe DauzWilliams from DDST or the Denver
Developmental Screening Tool to MMDST. It is
developed for health professionals such as doctors,
nurses, etc. It is not an intelligence test, it is a
screening instrument to determine if a child's
development is within normal. The objectives of
MMDST is to measure developmental delays and to
evaluate four aspects of development such as:
Ø Gross motor adaptive - this includes task which
indicate the child's ability to sit walk and jump
Ø Fine motor adaptive - covers tasks which indicate
the child's ability to see and use his hands to pick
up objects and to draw
Ø Language - this covers tasks which indicate a
child's ability to hear follow directions and to
speak
Ø Personal social - covers tasks which indicate the
child's ability to get along with people and to take
care of himself
vMaterials to be used:
Ø Bright red yarn pom pom
Ø Rattle with narrow handle
Ø Eight 1-inch colored wooden blocks (red, yellow,
blue, green)
Ø Small clear glass/bottle with ⅝ inch opening
Ø Small bell with 2 ½ inch-diameter mouth
Ø Rubber ball 12 ½ inches in circumference
Ø Cheese curls
Ø Pencil
Ø Mat to play on
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vGuidelines
Ø if the child is less than 6 months it is best if your
place on the lap of the provider or by the examiner
Ø Associate play - introduced during the whole test
Ø identify the age of a child based on the date of
examination and consider the prematurity if the
child is 2 years old and below
Ø start and task below the child's age level
Ø allow three trials per task
vScoring and point system:
Ø “P” - pass
Ø “F” - failure
Ø “R” - refusal/pass by report (instances we cannot
elicit the test however the examiner can testify that
the child can do it in some instances)
Ø “N.O.” - no opportunity
vFailure of an item that is completely to the left of the
child age is considered a developmental delay
vFailure of an item that is completely to the right of
the child's age line is acceptable and not a delay
vSpecial considerations in this test manner in which
test is administered must be exactly the same as
stated in the manual words or direction may not be
changed
vIf the child is premature subtracted number of
weeks of prematurity
vBut if the child is more than two years of age during
the test, subtracting may not be necessary
vIf the child is shy or uncooperative the caregiver may
be asked to administer the test provided that the
examiner instruct the caregiver to administer it
exactly as directed in the manual
vIf the child is very shy or uncooperative the test may
be deferred.
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WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024
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MOTHER AND
CHILD CARE
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