Pediatric Nursing Care: Health Problems of Infants

Skin Disorders

  • Diaper Dermatitis

    • Caused by prolonged contact with irritants such as urine, feces, and friction.

    • Education:

      • Change diapers as soon as they become wet or soiled to minimize skin irritation.

      • Expose skin to air by allowing diaper-free time, which helps prevent further irritation and promotes healing.

      • Use absorbent, disposable paper diapers that can wick moisture away from the skin.

      • Consider barrier creams containing zinc oxide to protect the skin from irritants.

  • Atopic Dermatitis (Eczema)

    • A chronic relapsing inflammatory skin disorder characterized by intense itching, dry skin, and lesions.

    • Goals of Management:

      • Hydrate the skin: Use emollients regularly to maintain skin moisture and improve the skin barrier function.

      • Relieve pruritus (itching): Utilize topical corticosteroids or antihistamines as prescribed by a healthcare professional.

      • Reduce flare-ups: Identify and avoid triggers such as harsh soaps, allergens, or extreme temperatures.

      • Prevent secondary infections: Keep nails trimmed to reduce skin damage from scratching; consider topical antibacterial treatments if needed.

  • Seborrheic Dermatitis (Cradle Cap)

    • A chronic inflammatory reaction usually occurring on the scalp, characterized by yellowish, greasy scales.

    • Preventable by:

      • Shampooing the infant’s hair frequently with mild, non-irritating shampoos to reduce buildup and desquamation.

      • Utilizing baby oil or mineral oil to loosen scales before washing may also help.

Sudden Infant Death Syndrome (SIDS)

  • Defined as the sudden death of an infant less than 1 year old that remains unexplained after an autopsy.

  • Etiology is largely unknown, with several hypotheses regarding genetic, environmental, and physiological factors.

  • Risk Factors:

    • Maternal smoking during pregnancy or postnatally, increasing the risk of SIDS.

    • Co-sleeping, especially on soft surfaces, can increase the risk of suffocation.

    • Prone sleeping position (infants sleeping on their stomachs) is associated with a higher risk.

    • Soft bedding, such as pillows, comforters, or stuffed toys, should be avoided in the infant's sleep environment for safety.

  • Safe to Sleep Recommendations:

    • Infants should always be placed on their backs for sleep.

    • The sleep area should be free of soft bedding and toys.

    • A firm sleep surface is advised.

  • BRUE vs. ALTE - Both terms refer to events concerning an infant's health but have distinct definitions:

    • BRUE (Brief Resolved Unexplained Event): An event lasting less than 20 minutes, during which an infant experiences a change in color, tone, or responsiveness, followed by a complete recovery without intervention.

    • ALTE (Apparent Life-Threatening Event): Involves significant indicators such as apnea, color change, or alterations in muscle tone, requiring medical evaluation.

Apparent Life-Threatening Event (ALTE)

  • Occurs suddenly and is frightening to the observer, potentially leading to emergency interventions.

  • Signs/Indicators:

    • Apnea (temporary cessation of breathing)

    • Change in color (cyanosis or pallor) or muscle tone (floppiness)

    • Choking, gagging, or coughing behaviors

  • Typically involves significant interventions, including resuscitation measures if necessary.

  • Parental Support and Education: It's crucial to provide emotional support and information to parents on recognizing signs of distress in infants.

  • Broselow Tape: A color-coded, water-resistant tool used for medication dosage calculations in emergencies based on an infant's weight, aiding in prompt and accurate treatment.

Food Safety

  • Introduction of Foods:

    • Introduce only 1 food at a time, with a gap of 3-4 days to effectively monitor for any allergic reactions or intolerances.

  • High Allergy Foods to be Careful With:

    • Common allergens include nuts, fish, soy, eggs, chocolate, strawberries, and pineapples, which should be introduced with caution in pediatric diets.

  • Cow Milk:

    • Evaluated carefully for allergies or intolerance in infants. Whole cow's milk should typically not be introduced until after 1 year of age due to potential intolerance and nutritional needs.

  • Monitor for Failure to Thrive (FTT):

    • Adequate growth is crucial during infancy. Regular assessments of height and weight are necessary to identify potential issues early.

  • Anaphylaxis:

    • Recognized as a medical emergency requiring immediate action, including the use of epinephrine auto-injectors if available.

Other Health Problems

  • Failure to Thrive (FTT):

    • Characterized by a deceleration in growth concerning height and weight for age.

    • Causes include:

      • Inadequate caloric intake (insufficient feeding or poor feeding techniques)

      • Inadequate absorption (conditions such as cystic fibrosis or celiac disease)

      • Increased metabolism (conditions like hyperthyroidism)

      • Defective utilization (metabolic disorders)

  • Food Sensitivity/Intolerance:

    • IgE-mediated Immune Response:

      • Commonly seen with cow’s milk allergy, which requires avoidance of dairy in the diet to prevent allergic reactions.

    • Non-IgE-mediated Immune Response:

      • Lactose intolerance, which may require a reduction of lactose-containing foods rather than complete avoidance of dairy, as tolerated based on individual symptoms.