Health Perception and Health Management of the Infant

Introductory Information

Institution: Manchester Community College
Instructor: Prof. Judee Landry, MSN Ed., RN, CPN
Topic: Infant Health Perception and Health Management

Major Theories of Growth and Development

Erik Erikson: Stages of Psychosocial Development

Erikson’s theory details specific conflict stages and the virtues (strengths) or mal-adaptations associated with different life periods.

Infant Stage:
- Conflict: Basic Trust vs. Basic Mistrust
- Virtues/Strengths: Drive and Hope
Toddler Stage:
- Conflict: Autonomy vs. Shame and Doubt
- Virtues/Strengths: Self-control and Willpower
Pre-schooler Stage:
- Conflict: Initiative vs. Guilt
- Virtues/Strengths: Direction and Purpose
School-ager Stage:
- Conflict: Industry vs. Inferiority
- Virtues/Strengths: Method and Competence
Adolescent Stage:
- Conflict: Identity vs. Role Confusion
- Virtues/Strengths: Devotion and Fidelity
Young Adult Stage:
- Conflict: Intimacy vs. Isolation
- Virtues/Strengths: Affiliation and Love
Middle Age Stage:
- Conflict: Generativity vs. Stagnation
- Virtues/Strengths: Production and Care
Older Adult Stage:
- Conflict: Ego-integrity vs. Despair
- Virtues/Strengths: Renunciation and Wisdom

Lawrence Kohlberg: Moral Development

Kohlberg's theory encompasses Six Stages of Moral Development focusing on justice and ethical reasoning.

Jean Piaget: Stages of Cognitive Development

Sensorimotor Stage: Birth to $2$ years. Infants experience the world through senses and actions.
Preoperational Stage: $2$ to $7$ years.
Concrete Operational Stage: $7$ to $11$ years.
Formal Operational Stage: $12$ years and up.

Health Assessment of Newborns and Infants

Appointment Schedule

Standardized health assessments are conducted at specific ages:

Newborn
$1$ Month
$2$ Months
$4$ Months
$6$ Months
$9$ Months
$12$ Months

Assessment Techniques and Interactions

Perform the assessment while the infant is on the caregiver's lap to maintain comfort.
Auscultate First: Listen to heart and lung sounds before the infant starts crying.
Involve Parents and Caregivers: Explain every step of the assessment to the caregivers.
Procedure Ordering: Perform the most invasive procedures last (e.g., checking ears or throat).

Physical Findings in Health Assessment

Fontanelles: Assessment includes checking both the Anterior and Posterior fontanelles.
Chest and Breathing: Newborns are typically barrel-chested and exhibit diaphragmatic breathing.
Cardiac Function: Heart rate may be irregular; asymptomatic murmurs are common and monitored.

Physical Growth and Sensory Development

Growth Parameters

Length:
- Growth of $1.5$ to $2.5\text{ cm}$ per month for the first $6$ months.
- Growth of $1\text{ cm}$ per month for months $6$ to $12$ .
Weight:
- Infants typically lose $10\%$ of their body weight during the first week of life.
- Birth weight doubles by $4$ to $6$ months.
- Birth weight triples by $12$ months.
Head Circumference: Increases rapidly during the first $6$ months, then slows until $12$ months.

Neurological and Physiological Development

Myelination: Myelination of the spinal cord begins at birth and continues until $24$ months of age.
Primitive Reflexes: Present in infancy; includes Sucking, Rooting, Babinski, Moro, Stepping, Palmar Grasp, Plantar Grasp, and Tonic Neck.
Protective Reflexes: These develop after $12$ months of age.

Sensory Development

Vision: Infants do not have color vision until $7$ months of age.
Hearing: Infants prefer high-pitched voices.
Taste: Infants prefer sweet tastes over sour tastes.
Touch: Infants prefer a soft, gentle touch.

Pain Assessment of Newborns and Infants

Clinical Observation

Assess pain through objective observations.
Incorporate caregiver feedback into the assessment.

FLACC Scale

Used for behavioral pain assessment, measuring five domains scored from $0$ to $2$ , with a total maximum score of $10$ :

F: Face
L: Legs
A: Activity
C: Cry
C: Consolable

Neonatal Infant Pain Scale (NIPS)

Assesses specific physiological and behavioral cues:

Dimensions Scored (0 or 1): Facial Expression, Breathing Pattern, Arms, Legs, and State of Arousal.
Cry: Scored from $0$ to $2$ .
Maximum Score: $7$ .

Communication and Speech

Newborn: Communicates through crying; different pitches indicate different needs.
2 Months: Cooing begins.
6 Months: Babbling begins.
9 Months: Copies sounds made by others.
12 Months: Uses a few words, simple gestures, and can follow simple directions.

Nutrition and Oral Health

Feeding Options and Cues

Choices: Breastfeeding or Formula feeding.
Hunger Cues: Look for rooting, sucking, crying, opening the mouth, and moving hands toward the mouth.

Introduction to Solid Foods

Solid foods should be introduced at $6$ months of age if these milestones are met:

Disappearance of the tongue extrusion reflex.
Ability to sit independently.
Good head control.

Starting Food: Iron-fortified cereal is typically first, followed by slowly adding pureed foods.
Always watch for cautionary items/choking hazards.

Oral Care and Teething

Tooth Eruption: The first tooth usually appears between $4$ and $7$ months.
Teething Symptoms: Fussy, irritable, increased salivation, low-grade fevers, and difficulty sleeping.
Hygiene: Use a washcloth or toothbrush until tooth eruption; do NOT use toothpaste.
Prevention: Avoid refined sugars and never prop bottles.
Supplemental Care: Fluoride drops are recommended for infants over $6$ months of age.

Sleep and SUID Prevention

Sleep Duration: Infants require approximately $16$ hours of sleep per day.
Safety Practices:
- Room sharing is recommended until $6$ months of age.
- SUID (Sudden Unexplained Infant Death) Prevention: Infants should always sleep on their back.

Immunizations

General Principles

Immunizations protect against communicable diseases.
Nurses must provide Vaccine Information Sheets (VIS) and use a Vaccine Administration Record.
Vaccine Types:
1. Live Attenuated
2. Inactivated
3. Toxoid
4. Conjugate
Barriers to Immunization: Lack of transportation, financial concerns, and safety concerns/misinformation.

Nursing Documentation and Care

Documentation: Manufacturer, Lot Number, Expiration Date, and Administration Site.
Side Effects: Redness or soreness at the injection site and a mild, low-grade fever.
Contraindications: Febrile illness, immunodeficiency, or allergy to the vaccine or egg whites.
Pain/Fever Relief: Administer Acetaminophen or Ibuprofen.
Aspirin Warning: Never give Aspirin to a pediatric patient under age $19$ due to the risk of Reye’s Syndrome.

Pediatric Vaccination Schedule (Picmonic Mnemonics)

Age 2 Months ("2 Be DR. HIP"):
- Be: Hepatitis B (B)
- D: DTaP (Diphtheria, Tetanus, acellular Pertussis)
- R: Rotavirus (RV)
- H: HIB (Haemophilus Influenzae Type B)
- I: IPV (Inactivated Polio Vaccine)
- P: PCV (Pneumococcal)
Age 4 Months ("4 DR. HIP"):
- D: DTaP
- R: Rotavirus
- H: HIB
- I: IPV
- P: PCV
Age 6 Months ("Be DR. HIP IN 6 months"):
- Be: Hepatitis B
- D: DTaP
- R: Rotavirus (if part of a 3-dose series)
- H: HIB
- I: IPV
- P: PCV
- IN: Influenza
Age 1 Year - 15 Months ("1 Very MAD HIP-ster"):
- Very: Varicella Zoster
- M: MMR (Measles, Mumps, Rubella)
- A: Hepatitis A
- D: DTaP
- H: HIB
- I: IPV (If missed at 6 months)
- P: PCV
Age 4-6 Years ("Very DIM BETWEEN 4-6 pm"):
- Very: Varicella Zoster
- D: DTaP
- I: IPV
- M: MMR

Safety Considerations

Accidental Injury Prevention: General vigilance required for all developmental stages.
Choking: Monitor small objects and food textures.
Fall Safety: Preventing falls from changing tables, stairs, or furniture.
Burn Safety: Checking bath water temperatures and keeping hot liquids away.
Car Seat Safety: Proper installation and rear-facing positioning according to safety guidelines.
Look Before You Lock Campaign: Public health initiative to prevent infants from being left in vehicles.