NEONATE
FROM BIRTH
TO DISCHARGE
(Group 1B)
Objectives:
■ Describe the required setup at delivery room to take care of
new born.
■ Recognise the common normal/abnormal findings on neonatal
physical examination.
■ Understand normal neonatal physiological pattern such as
voiding, defecating and feeding.
■ List vaccines that are routinely given to neonates after birth.
■ Know common neonatal screening tests.
■ Recognize and manage common health problems during
infancy such as GERD, colic, and constipation.
■ To know about sudden infant death syndrome.
THE REQUIRED SETUP
AT DELIVERY ROOM
TO TAKE CARE OF
NEW BORN
Zainab Al-Faraj
After Delivery
■ Provide three major things:
 Dryness.
 Warmth.
 Suction.
■ Drying the baby and using warm
blankets and heat lamps.
After Delivery
■ Often a knitted hat is placed on the
baby's head.
■ Placing a baby skin-to-skin on the
mother's chest or abdomen also
helps to keep the baby warm.
■ This early skin-to-skin contact also
reduces crying, improves motherinfant interaction, and helps
mothers to breastfeed successfully.
■ Stimulating the baby to cry by
massage and stroking the skin
can help bring the fluid up from
the lungs where it can be
suctioned from the nose and
mouth
Health Assessment
Immediate resuscitation & life saving techniques
Resuscitation measure and monitoring
Physical Examination
Temperature, Heart Rate
and Respiratory Rate
Weight, Length and
Head Circumference
Cord Care
Bath
Footprints and
Identification Bracelets
COMMON
NORMAL /ABNORMAL
FINDINGS ON NEONATAL
PHYSICAL EXAMINATION
Zainab Al-Faraj
Before Examination
■ It is important to first take a
good perinatal history which
includes:
 The maternal background.
 The present pregnancy.
 Labour and delivery.
 Infant at delivery.
 Infant since delivery.
Before Examination
■ Whenever possible the infant’s
mother should be present.
■ A warm environment is essential to
prevent hypothermia.
■ A good light source is important for
the examiner to inspect the infant
thoroughly.
■ Hand washing is important before
any examination.
■ Full exposure of the infant is also
essential.
Order of Examination
 Measurements.
 General inspection.
 Regional examination.
 Neurological status.
 Examination of the hips.
 Examination of the placenta.
Measurements
Normal
Abnormal
Birth weight
2500g to 4000g
Below 2500g or above 4000g
Length
45 cm to 60 cm
Below or above the gestational age
Head circumference
32 cm to 38 cm
Micro or macrocephaly
Gestational age
Physical and neurological features
of term infants (37–42 weeks)
Immature features in preterm
infant (below 37 weeks). Postterm
infants (42 weeks and above) have
long nails.
Skin temperature
Abdominal wall (36–36.5 °C) or
axilla (36.5–37 °C)
Hypothermia (below 36 °C)
General inspection
Normal
Abnormal
Wellbeing
Active, alert
Lethargic, appears ill
Appearance
No abnormalities
Dysmorphic features (e.g. Down
Syndrome)
Wasting
Well nourished
Soft tissue wasting
Colour
Pink tongue
Cyanosis
Pallor
Jaundice
Plethora
Skin
Smooth or mildly dry
Vernix caseosa
Erythema toxicum
Dry, marked peeling
Meconium staining
Petechiae, bruising
Regional examination
Normal
Abnormal
Head
Caput succedaneum and
molding
Cephalohematoma
Subaponeurotic bleed Asymmetry
Anencephaly
Hydrocephaly
Encephalocoele
Eyes
Mild edema on the lids
Wide or closely spaced
Cataracts
Ptosis
Palate
Epstein's pearls
High arched or cleft palate
Teeth
None at birth
Extra or primary teeth
Tongue
Pink
Cyanosed, pale, or large
Neck
Usually short
Webbing, torticollis
Heart
Normal
Abnormal
Pulses
Brachial and femoral pulses
easily palpable. 120–160
beats per minute
Pulses weak, collapsing,
absent, fast or slow or irregular
Capillary filling time
Less than 4 seconds over
chest and peripheries
Prolonged filling time if infant
cold or in shock
Blood pressure
Systolic 50 to 70 mm at term
Hypertensive or hypotensive
Precordium
Mild pulsation felt over heart
and epigastrium
Hyperactive precordium
Apex beat
Heard maximally to left of
sternum
Heard best in right chest in
dextrocardia
Murmurs
Soft, short systolic murmur
common on day 1
Systolic or diastolic murmurs
Heart failure
Absent
Oedema, hepatomegaly,
tachypnea or excessive
weight gain
Lungs
Normal
Abnormal
Respiratory rate
40-60 breaths per minute.
Irregular in REM sleep. Periodic
breathing with no change in
heart rate or color
Tachypnoea above 60 breaths per
minute. Gasping.
Apnoea with drop in heart rate,
pallor or cyanosis
Chest shape
Symmetrical
Hyperinflated or small chest
Chest movement
Symmetrical
Asymmetrical in pneumothorax and
diaphragmatic hernia
Recession
Mild recession in preterm infant
Severe recession in respiratory
distress
Grunting
Absent
Expiratory grunt in respiratory
distress
Stridor
Absent
Inspiratory stridor a sign of upper
airway obstruction
Percussion
Resonant bilaterally
Dull with effusion or
haemothorax. Hyperresonant
with pneumothorax
Adventitious sounds
Transmitted sounds
Crackles, wheeze or rhonchi
Abdomen
Normal
Abnormal
Umbilicus
2 arteries and 1 vein
1 artery, 1 vein. Infection.
Bleeding or discharge. Hernia.
Exomphalos.
Liver
Palpable 1 cm below coastal margin,
soft
Enlarged, firm, tender
Spleen
Not easily felt
Enlarged, firm
Kidneys
Often felt but normal size
Enlarged, firm
Masses
No other masses palpable. Full
bladder can be percussed
Palpable mass
Bowel sounds
Heard immediately on auscultation
Few or absent
Anus
Patent
Absent or covered
Stools
Meconium passed within 48 hours of Blood in stool.
birth. Yellow stools by day 5. Breastfed White stools in obstructive
stool may be green and mucoid
jaundice.
Offensive watery stools
Spine
Normal
Abnormal
Appearance
Coccygeal dimple or sinus.
Straight spine
Sacral dimple or sinus.
Scoliosis. Meningomyelocoele
Genitalia
Normal
Abnormal
Penis
Urethral dimple at center of
glans
Hypospadias
Testes
Descended by 37 weeks
Undescended
Scrotum
Well formed at term
Inguinal hernia. Fluid hernia
Vulva
Skin tags, mucoid or bloody
discharge
Fusion of labia
Clitoris
Uncovered in preterm or
wasted infants
Enlarged in adrenal
hyperplasia
Urine
Passed in first 12 hours
Poor stream suggests
posterior urethral valve
Neurological status
Normal
Abnormal
Behavior
Alert, responsive
Drowsy, irritable
Position
Flexion of all limbs at term
Extended limbs or frog position
Movement
Active. Moves all limbs equally when
awake. Stretches, yawns and twists
Absent, decreased or
asymmetrical movement. Jittery
or convulsions
Tone
Normal
Hyper or hypotonia
Cry
Good cry when awake
Weak, high pitch or hoarse cry
Vision
Follows a face, bright light or red
object
Absent or poor following
Hearing
Responds to loud noise
No response
Sucking
Good suck and rooting reflexes after
36 weeks gestation
Weak suck at term
Moro reflex
Full extension then flexion of arms
and hands. Symmetrical
Absent, incomplete or
asymmetrical response
NORMAL NEONATAL
PHYSIOLOGICAL PATTERN
Afnan Al-Qarni
Normal voiding pattern
■ Normal: 1 – 2ml/kg/hr
■ The infant's first urination nearly always occurs in the first 24 hours.
■ the appearance of newborn urine, which can initially be scant and darkly colored
■ Micturition, or urination, occurs involuntarily in infants and young children until the
age of 3 to 5 years, after which it is regulated voluntarily.
■ Voiding in the healthy neonate is characterized by small, frequent micturition of
varying volumes and interrupted voiding result in incomplete embtying of the
bladder.
■ Interrupted voiding is clearly an immature phenomenon since it is seen in 60% of
preterm neonates and disappears completely before the age of toilet training.
■ The reason for incomplete emptying in infancy is most likely a physiological form of
dyscoordination between the sphincter and detrusor, which interrupts the urinary
stream before the bladder is empty.
■ A decrease in voiding frequency, increase in bladder capacity and stepwise
improvement in sphincter–detrusor coordination as infants grow helps them to
achieve complete continence.
■ Bladder instability is rarely seen in healthy neonates and infants according to
urodynamic studies but hyperactivity is suggested in the neonatal bladder with
premature voiding contractions after only a few milliliters of filling and with leakage
of urine. This latter phenomenon probably explains the low cystometric bladder
capacity in this age group. High voiding pressure levels also accompany this low
bladder capacity.
■ The normal infant voids approximately 20 times per day.
■ Bladder capacity
– Newborn up to 1 week of age  BC: 25 ± 10 mL per day
– 1 week to 3 months of age  BC: 53 ± 13 mL per day
■ During the first 3 years of life the number of voiding episodes, including interrupted
voiding, post-void residual urine and voiding during sleep, decreased while bladder
capacity increased.
A- Sphincter relaxation is present
but less complete.
B- the start of sphincter relaxation,
which precedes the bladder
contraction by a few seconds, is
indicated (‘start’). Note that a
voluntary cessation of voiding
(‘stop’) is associated with an initial
increase in sphincter EMG and
detrusor pressure. A resumption of
voiding is associated with sphincter
relaxation and a decrease in
detrusor pressure that continues as
the bladder empties and relaxes.
Micturition reflex
•
When the bladder is full, stretch
receptors in the wall of bladder send
nerve impulses to the sacral region to
the spinal cord. Parasympathetic
response by sending signals to the
bladder and stimulate contraction of
Detrusor muscle and relaxation of the
internal urethral sphincter.
•
This part of the reflex is involuntary and
is predominant in infant and young
children.
Micturition reflex
•
As the central nervous mature, it
acquires voluntary control over the
external urethral sphincter.
•
Urination is controlled by the
micturition centre in the pons. This
centre receive sensory signals from the
bladder and communicates with the
cortex about the appropriateness of
urination at the moment. At times when
it not convenient to urinate, the centre
sends back an inhibitory signal to keep
sphincter closed and prevent voiding.
When decide to urinate this inhibition is
removed. The spinal cord instructs the
Detrusor muscle to contract and
sphincter to open.
Normal stooling pattern
■ The infant typically passes a first meconium stool shortly after birth, often within the
first hours and typically before 24 to 48 hours.
■ These black, tarry, and sticky stools transition as the mother's human milk
production increases.
■ This transition typically occurs in a pattern, often from green/brown to a seedy,
loose, mustard yellow appearance.
■ During the first week of life, infants pass a mean of four stools per day, although this
is variable depending upon whether infants are breastfed or bottle.
■ It is not rare for an infant to pass stool with nearly every breastfeeding when the
mother's milk is in because of the gastrocolic reflex signaling the colon to empty.
Normal oral feeding pattern
■ From birth throughout the first 6 months of life, infants will obtain their primary food
(milk) through nutritive sucking.
■ Nutritive Sucking Process: The process that allows an infant to obtain food, either
maternal milk or infant formula.
■ Sucking is a process integrated by three highly correlated phases: a) expressionsuction, b) swallow and c) breathing.
a) expression-suction:
■ Suction component: negative intra-oral pressure to draw milk in the mouth.
■ Expression component: compression of nipple to eject milk into mouth.
b) Swallow
■ Oral phase: voluntary part of swallowing. Food bolus is formed and push it to the
back of the throat.
■ Pharyngeal phase: starts with the stimulation of tactile receptors in the oral phyranx
by the food bolus, the swallow reflex is initiated and is under involuntary control. The
tongue blocks the oral cavity to prevent food going back to the mouth, the soft
palate blocks entry to the nasal cavity and the vocal cords close to protect the airway
to the lungs. The larynx pulled up with epiglottis flipping over covering entry to the
trachea. UES opens to allow the passage of food bolus
■ Oesophageal phase: the food bolus is propelled down the oesophagus by peristalsis,
the larynx moves down back to the original position.
c) breathing
■ During sucking and breathing air does not enter the digestive system. Relaxation of
the soft palate and vocal cords allow air entering the nose to move towards the
lungs. Contraction of the cricopharyngeus prevents air entering the oesophagus.
Infants must cease breathing for approximately half a second to swallow.
■ Respiratory rates during breastfeeding range from 40 to 65 breaths/minute7 and
reduce due to increased swallowing during NS.
References
■
Wen, J. G., Lu, Y. T., Cui, L. G., Bower, W. F., Rittig, S., & Djurhuus, J. C. (2015). Bladder function development and its urodynamic
evaluation in neonates and infants less than 2 years old. Neurourology and urodynamics, 34(6), 554-560.
■
Fowler, C. J., Griffiths, D., & de Groat, W. C. (2008). The neural control of micturition. Nature reviews. Neuroscience, 9(6), 453-66.
■
SillÉn, U. (2001). Bladder function in healthy neonates and its development during infancy. The Journal of urology, 166(6), 23762381.
■
Warren, J. B., & Phillipi, C. A. (2012). Care of the well newborn. Pediatrics in Review, 33(1), 4-18. doi:10.1542/pir.33-1-4
■
Duong, T. H., Jansson, U. B., Holmdahl, G., Sillén, U., & Hellstrom, A. L. (2010). Development of bladder control in the first year of
life in children who are potty trained early. Journal of pediatric urology, 6(5), 501-505.
■
den Hertog, J., van Leengoed, E., Kolk, F., van den Broek, L., Kramer, E., Bakker, E. J., ... & Benninga, M. A. (2012). The defecation
pattern of healthy term infants up to the age of 3 months. Archives of Disease in Childhood-Fetal and Neonatal Edition, 97(6),
F465-F470.
■
Geddes, D. T., & Sakalidis, V. S. (2016). Breastfeeding: how do they do it? Infant sucking, swallowing and breathing. Midirs
Midwifery Digest, 26(1), 95.
■
Rendón Macías, M. E., & Meneses, G. J. S. (2011). Physiology of nutritive sucking in newborns and infants. Boletín Médico del
Hospital Infantil de Mexico, 68(4), 319-327.
Vaccine and drugs that are routinely given
after birth
shaikha alsayel
Newborn screening
■ Hearing loss
■ Metabolic and genetic disorders
■ Critical congenital heart disease
■ Eyes
Hearing loss
■ Automated Auditory Brainstem Response (AABR)
■ Otoacoustic Emissions (OAE)
Metabolic and genetic disorders
■ Blood spot" testing, the screen is obtained by analyzing drops of blood placed on
special paper.
■ Blood is collected for an initial screen between 24 and 48 hours of life
Critical congenital heart disease
■ Using pulse oximetry
Eyes
■ Response to light.
■
Pupil response.
■ Ability to follow a target.
■ Visually evoked response testing.
■
Red reflex test
References
■ Www-uptodate-com.library.iau.edu.sa. (2018). Login e-Resources Portal | IAU. [online]
Available at: https://www-uptodate-com.library.iau.edu.sa/contents/overview-of-theroutine-management-of-the-healthy-newborninfant?search=overview%20of%20rotation%20management%20of%20healthy%20newb
orn%20Infants&source=search_result&selectedTitle=1~150&usage_type=default&displ
ay_rank=1 [Accessed 12 Nov. 2018].
■ Chop.edu. (2018). Types of Visual Screening Tests for Infants and Children | Children's
Hospital of Philadelphia. [online] Available at: https://www.chop.edu/conditionsdiseases/types-visual-screening-tests-infants-and-children [Accessed 12 Nov. 2018].
■ HealthyChildren.org. (2018). Purpose of Newborn Hearing Screening. [online] Available
at: https://www.healthychildren.org/English/ages-stages/baby/Pages/Purpose-ofNewborn-Hearing-Screening.aspx [Accessed 12 Nov. 2018].
COMMON HEALTH
PROBLEMS IN INFANCY
Norah jamal alromaih
2150007912
What are we going to cover?
GERD
Colic
constipation
Colic
■ Definition and difference between colic and normal crying
■ Epidemiology
■ risk factors
■ Etiology
■ Evaluating the patient and diagnosis
■ Complications
Colic
■ Persistent or excessive crying
Criteria is
Crying for no apparent reason for 3 or more hours in 3 or more days in an
apparently healhty infant less than 3 months old
Difference between colic and normal
crying
■ Paroxysms
■ Qualitative differences
■ Hypertonia
■ Difficulty consoling
Epidemiology
■ Prevalence is between 8-40%
Risk factors
■ Dissatisfaction in the marital relationship
■ parental perception of stress
■ lack of parental self-confidence during the pregnancy
■ dissatisfaction with the delivery
■ family stress
Etiology
Unknown
– Gastrointestinal disturbance
■ Faulty feeding techniques
■ Cow's milk protein intolerance
■ Lactose intolerance
– Biological factors
■ Immature motor regulation
■ Increased serotonin
■ Tobacco smoke exposure
– Psychosocial phenomena
Evaluation and diagnosis
Colic is suspected from history but confirmed retrospectively as it runs
the characteristic course
History
■ When does the crying occur?
– Typically during the evening
■ How long does the crying last?
■ What do you do when the baby cries?
– Elicit information about soothing techniques
■ How and what do you feed the baby?
– Underfeeding, over feeding and inappropriate feeding
■ How do you feel when your baby cries?
■ How has the colic affected you family?
History
■ Feeding, stooling, urination and sleeping patterns
■ Vomiting
■ Prenatal and perinatal history
■ Psychosocial hitory
– Parent infant interactions
Examination
■ Observe the infant and parent interaction during a bout of
crying
■ Assessment of temperament and responsiveness to stimuli
■ Plot growth parameters
Examination
■ Assess identifiable causes of prolonged crying in infants
– Assess hydration and subcutaneous fat
– Assessment of tongue tie
– Eye examination
– Ear examination
– Oropharyngeal examination
– Cardiovascular evaluation
– Abdominal evaluation
– Perineal evaluation
– Evaluation of skin and musculoskeletal system
– Evaluation of the nervous system
Management goals
help the parents
cope with the
child's symptoms
prevent longterm sequelae in
the parent-child
relationship
Management
■ Mainstay management is parental support and education
■ Fist line interventions
– Address feeding problems and suggest techniques to
sooth the infant
– Decrease environmental stimuli
Complications
■ Child abuse
■ Post partum depression
■ Early cessation of breast feeding
What are we going to cover?
GERD
Colic
constipation
GER and GERD outline
■ Definitions and basic concepts
■ Clinical manifestations of GERD
■ Clinical approach
■ Treatment
What is the difference between
regurgitation and vomiting?
■ Regurgitation is effortless reflux
■ Vomiting is forceful expulsion with involvement of abdominal
and respiratory muscles
Physiological infantile gastroesophageal
reflux
■ Effortless retrograde movement of gastric contents upward
into the esophagus or oropharynx
■ Common under 12 months up to 30 regurgitations, but
declines as age approaches 12 months
Factors playing part in GER
■
■
■
■
■
■
Liquid diet
Horizontal body position
Short narrow esophagus
Small non compliant stomach
Frequent large volume feedings
Immature lower esophageal sphincter
How to differentiate between GER and
GERD?
Esophagitis
Respiratory
complications
Poor weight
gain and
failure to thrive
Clinical manifestations of GERD
GI related
Respiratory related
■ Heartburn
■ Cough
■ Epigastric abdominal pain
■ Wheezing
■ Dysphagia
■ Aspiration pneumonia
■ Failure to thrive
■ Hoarse voice
■ Recurrent hiccups and belching
MOTHER COMING TO YOU
WORRIED ABOUT HER CHILD WITH
FREQUENT REGURGITATION
WHAT WILL YOU DO?
Uncomplicated GER
■ No warning signals
■ No complications {good weight gain, good feeding, not
irritable}
■ History and physical examination is enough, laboratory
testing is not required
■ Educate and reassure parents, symptom usually resolve by
one year
■ Periodically re-evaluate the patient for new symptoms or
warning signals
■ If no improvement by 18-24 months, re-evaluation is
required
Treatment
■ Mainly lifestyle management, pharmacotherapy is NOT
indicated
Treatment: lifestyle changes
■ Avoid tobacco smoke exposure
■ Smaller feeding size
■ Empiric trial of milk free diet
■ Thickening feeds
■ Keeping an infant upright for 20 to 30 minutes
What are we going to cover?
GERD
Colic
constipation
Constipation
■ Definition
■ Differential diagnosis
■ Clinical evaluation: history and physical examination
■ Investigations
■ Treatment
Definition of constipation
■ two or fewer stools per week
Or
■ Passage of hard pellet like stools for at least 2 weeks
Constipation in infants
Mostly due to dietary changes
However, most important organic causes will be Hirschsprung
disease and cystic fibrosis.
Differential diagnosis
■ Hirschsprung’s disease
■ Congenital anorectal malformations
■ Neurologic disorders
■ Encephalopathy
■ Spinal cord abnormalities: myelomeningocele, spina bifida, tethered
cord
■ Cystic fibrosis
■ Metabolic causes: hypothyroidism, hypercalcemia, hypokalemia,
diabetes insipidus
■ Heavy-metal poisoning
Clinical evaluation: history
The alarming signs
Alarming signs
Acute signs
Chronic signs
■ Delayed passage of meconium
■
Constipation since birth
■ Fever, vomiting and diarrhea
■
Ribbon stools
■
Urinary incontinence or bladder disease
■
Weight loss or poor weight gain
■
Delayed growth
■
Congenital anomalies
■
Family history of hirschsprung disease
■ Rectal bleeding
■ Severe abdominal distension
Clinical evaluation: physical
examination
■ General
■ Neurological
■ Digital rectal examination
Investigations
■ Laboratory
– Celiac screening
– Urine analysis and culture
– TSH
– Electrolyte and calcium
– Blood lead level
■ Imagine
– Abdominal x ray
– Barium enema
– Spine radiographs
■ Anorectal manometry
Treatment of acute constipation
■ Infants who did not start solid food
– sorbitol-containing juices (eg, apple, prune, or pear) can be added to formula
■ Infants who did start solid food
– sorbitol-containing fruit purees
Treatment of chronic constipation
■ Glycerin suppositories or rectal stimulation with a lubricated rectal thermometer.
■ Osmotic laxatives (ex. PEG) for those older than 6 months
References
■ Nelson’s essentials of pediatrics
■ Up to date
Case
■ A 3-month-old boy is discovered not breathing in his crib this morning. Cardiopulmonary
resuscitation was begun by the parents and was continued by paramedics en route to
the hospital. You continue to try to revive the child in the emergency center, but
pronounce him dead after 20 minutes of resuscitation. You review the history with the
family and examine the child, but you are unable to detect
a cause of death.
How should you manage this situation in the emergency department?
What is the most likely diagnosis?
What is the next step in the evaluation?
DO NOT FORGET THE PARENTS!
SUDDEN INFANT
DEATH SYNDROME
SIDS
Sara Abdullah Al Arhain
2150007225
Definition
The unexpected death of an infant younger
than 1 year of age in which the cause remains
unexplained after an autopsy, death scene
investigation, and review of clinical history.
SIDS is diagnosed by exclusion.
Risk factors
■ Premature.
■ Low birth weight.
•Winter
•It is common between 2 and 4
■ Smoking mothers
months.
■ Drug addict mothers
-
■ African American & Native American
■ Infants that have siblings who have
died of SIDS
Rarely before 4 weeks or
after 6 months of age.
Causes
Divided into two:
✤ Congenital
‣
Cardiac anomalies (arrhythmia, congenital heart disease).
‣
Metabolic disorders
‣
CNS etiologies
✤ Acquired conditions.
‣
infection
‣
accidental trauma
‣
intentional trauma.
Mechanism of SIDS
( It is still not very clear)
■ Prone position during sleep, especially on soft bedding. CO rebreathing from
sleeping face down
2
■ Brainstem abnormalities.
■ Maturational delay related to neural or cardiorespiratory control.
■ Prolongation of the Q-T interval
■ Abnormal CNS control of respiration
DDX of SIDS
Prevention
■ Prenatal measures
-
Avoid smoking and other substances
Mothers should avoid use of tobacco, alcohol, and illicit drugs
during pregnancy, as well as after birth.
-
Regular and continues Prenatal care
z
Prevention
■ Sleep position and environment
- Supine sleep position
- Firm sleep surface
- Room-sharing without bed-sharing
- Avoid soft objects and bumper pads in the bed
- Avoid overheating
- Pacifier use
Prevention
■ Hospital setting
-
Perinatal care and precautions
Immediately after birth, the infant should
be given to the mother for skin-to-skin
contact.
Professional staff should instruct and
observe closely during skin-to-skin contact
and breastfeeding, to ensure that the
infant's face is clear and that the airway is
not obstructed, and that the mother remains
alert.
Appropriate position in
the nursery
Prevention
■ Other
-
Breast feeding.
-
“ Tummy time”
when the infant is awake and observed
to facilitate the development of
shoulder girdle strength and avoidance
of occipital plagiocephaly.
■ References
Nelson’s essentials of pediatric, 7th edition
Pediatric case file, 3rd edition
Up To Date
THANK YOU ANY
QUESTIONS?