Pediatric nursing ch 7

Question 1

Developmental milestones

Birth to 3 months

Answer 1

Weight: gains 5 to 7 oz weekly during the first month and then 1 to 2 lb per month
Feeding: Breastfed every 2 to 3 hours, formula-fed every 3 to 4 hours
Height: grows 1 inch per month for first 6 months of life
Head circumference: grows a half inch per month for first 6 months of life
Motor skills:
Wobbly at first, but soon can lift head when on abdomen
Grasps an object, kicks vigorously, and turns head from side to side
Needs to have the head and neck supported
Can get their hands and thumbs to their mouths
Musculoskeletal and orthopedic disorders occur during fetal development; the most common of these disorders are talipes equinovarus (club foot) and developmental hip dysplasia.
Reflexes: primitive reflexes remain
Hearing: should respond to parent’s voice and respond to loud noises by blinking, startling, frowning, or waking from light sleep
Vision: most newborns focus best on objects about 8 to 10 inches away, or the distance to your face during a feeding. Acuity is 20/100; they begin to recognize mother visually. Can track objects visually with more accuracy.
Communication: sensitive to the way they are held, rocked, and fed. By age 2 months, the infant should smile on purpose (social smile), blow bubbles, and coo when spoken to. At 3 months the infant may laugh out loud and express moods.

Question 2

Three to six months

Answer 2

Birth weight doubles by 6 months of age
Height increases 1 inch per month for first 6 months
Can raise head (Figure 7–16) and support it by 4 months
Reaches and grasps objects, plays with hands, moves objects to mouth, plays with toes
Rolls from abdomen to back
More stabilized sleeping patterns at 3 months
Opens mouth for spoon
Binocular vision: ability to see with both eyes coordinated
Primitive reflexes begin to disappear
Begins to drool, chew on toys as teething begins (6 months)
Can sit when propped at 6 months
Can support some weight when held in a standing position
Recognizes familiar objects and people, expresses displeasure when those objects or people are removed, babbles to self

Question 3

Six to nine months

Answer 3

All infants should be screened for developmental delays and disabilities at 9 months at the well-child visit
Rolls from back to stomach and stomach to back
Sits unsupported by 8 months
Transfers objects from hand to hand, points at objects, and picks them up at 9 months
Fine motor skills continue to develop
Puts feet in mouth, plays pat-a-cake, loves to see own image in a mirror
Develops and expresses taste preferences
Begins to understand differences between inanimate and animate objects
Displays stranger anxiety
Develops object permanence
Vocalizes with many-syllable vowel sounds and “m-m” with crying
Around 9 months, says “Dada” and “Mama” and understands bye-bye and no
Around 8 to 9 months begins to pull to stand, develops pincer grasp, crawls backward and then forward, and responds to own name (Figure 7–18)
Understands where to look for an object that has been dropped; practices grasp-release movements
Begins to test parent’s responses, such as watching the parent while dropping food on the floor
Distinguishes colors
Distance vision
Expresses emotions, including frustration and anger

Question 4

Nine to twelve months

Answer 4

Birth weight triples
Birth length increases by 50%
Head and chest circumference are equal
Total of six to eight teeth
Knows name
Creeps along furniture
Drinks from a cup; should be weaned from a bottle
Stands alone for brief periods of time; raises arms when wants to be picked up
May take first steps or walk alone
Eats with spoon and cup but prefers fingers
Enjoys familiar surroundings and people, expresses dissatisfaction with strangers or strange surroundings (stranger anxiety)
May develop security objects such as favorite toys or blankets
Enjoys books, especially board books
Can understand simple communication or direction; says two or three words beyond Dada and Mama
One or both feet may slightly turn in; the infant’s lower legs are normally bowed
At around 12 months of age can transition to whole cow’s milk; do not use 1% or 2% because the infant needs the fat content for continuing brain development

Question 5

Cognitive development

Answer 5

Cognitive development involves the infant’s processing of information, conceptual processes, intelligence, language development, memory, and perceptual skills.
Intellectual growth-begins at birth-memory-problem solving, exploring, concepts.
Primitive reflexes-disappear within months after birth(controlled by lower brain fuinctions)

Question 6

Cognitive development affected by

Answer 6

occurs quickly and may substantially vary from month to month. Infants develop on all levels and are influenced by cultural context, neurological development, and experience with others.

Question 7

Assessment models for infant cognitive development:

Brazelton Neonatal Behavioral Assessment Scale:

Answer 7

Tests an infant’s neurological development, behavior, and responsiveness. It is used only in the neonatal period.

Question 8

Gesell Developmental Schedules:

Answer 8

Test for fine and gross motor skills, language, eye-hand coordination, imitation, object recovery, personal-social behavior, and play response.

Question 9

Denver Developmental Screening Test

Answer 9

Used to identify problems or delays. It measures personal/social, fine and gross motor, language, and social skills.

Question 10

Bayley Scales of Infant Development

Answer 10

Test the cognitive, behavioral, and motor domains of the infant. The assessment is used to identify infants with developmental disabilities. It is a highly reliable tool that uses mental, motor, and behavioral scales to rate an infant’s functioning. The mental test screens for such items as whether the infant turns to a sound or looks for a fallen object. The motor test screens for gross and fine motor skill development.

Question 11

Developmental theorists:

Piaget(theory of cognitive development)

Answer 11

In sensorimotor stage, infants use five senses to explore their world; the theory includes six substages that describe the infant’s mental representation (see Chapter 6). Infants learn about their environments through their senses and begin to engage in goal-directed behaviors

Question 12

Vygotsky (social context of cognitive development)

Answer 12

Describes how complex mental functioning originates in infants through social interactions. Cultural factors influence attainment. There is a close correlation between language acquisition and the development of thinking

Question 13

Erikson (psychosocial development)

Answer 13

Highlights trust versus mistrust as the first psychosocial stage during the first year of life. This theory explains how the infant’s personality develops.
Trust requires a feeling of physical comfort and a minimal amount of fear and apprehension about the future. It is a time where the infant has certain expectations about the predictability of the environment. If this stage is not attained, the infant feels insecure and learns mistrust (see Chapter 6).
Trust in infancy provides lifelong expectation that the world will be a good and pleasant place to live.

Question 14

Mahler (social development):

Answer 14

Describes how an infant develops a sense of self through symbiosis and separation, or individualism

Question 15

Kohlberg (moral development):

Answer 15

Describes how moral reasoning aids in the development of ethical behavior and proceeds through six stages

Question 16

Sensory development:
Vision
smell
taste
Touch

Answer 16

Vision: least-developed sense; infants are attracted to bright colors and black and white because of limited vision; objects appear two-dimensional with poor peripheral vision until 2 to 3 months of age
Smell: well-developed sense; especially recognizes smell of own mother
Taste: well-developed sense; sweet tastes are preferred
Examination of the ears of an infant: Pull the pinnae straight back and down.
Communications with infants are similar in different cultures, with a higher-pitched voice used when attempting to get the infant’s attention; deaf mothers use a slower pattern and sign more often.
Touch: Touch is extremely important for the newborn; gentle touch or massage is calming and pleasurable. Pain is a protective device; the infant responds by extending and retracting the extremities and crying.

Question 17

Hearing

Answer 17

Hearing: can hear beginning in the womb and can identify mother’s voice; differentiates between male and female voices; hearing is critical for language development
Hearing test is administered before discharge, either through otoacoustic emissions or auditory brainstem response.
All 50 states, as well as Puerto Rico, Guam, and the District of Columbia, require hearing screening for newborns.
Tests are noninvasive, conducted before discharge by a trained professional, and performed in a quiet environment. Vernix, other fluids, and a withdrawing infant may affect the test.

Question 18

Hearing tests:

Auditory brainstem response

Answer 18

Auditory brainstem response is a physiological measurement of the brainstem’s response to sound. A clicking sound is produced, and the electrical activity response from the nerve is recorded as waveforms on a computer. This noninvasive test requires electrodes to be placed on the infant’s scalp with adhesive and is conducted while the infant is sleeping

Question 19

Otoacoustic emissions method

Answer 19

The otoacoustic emissions method uses an earplug that measures the responses of the cochlea to clicking sounds produced by a microphone. The infant is sleeping during the test. It is a noninvasive procedure

Question 20

Soothing odors

Answer 20

Research has indicated that mothers pass on to their newborns chemosensory information that reveals her identity, the location of her breasts, and the composition of her milk. These pheromones help guide the newborn to finding the source of milk necessary for nutrition, fluids, and energy, and identify her to her newborn. Studies have shown that biologically meaningful odors such as amniotic fluid, colostrum, and breast milk are soothing to infants, particularly when obtained from the infant’s own mother. These odors support successful mother–infant bonding and increase breastfeeding success.

Question 21

Hearing screening at birth

Answer 21

Some degree of hearing loss occurs in 3 out of 1,000 infants (AAP, 2017c). Any infant who does not pass the newborn hearing screening has the potential for a developmental emergency (AAP, 2016c). Initial newborn hearing screening occurs in the hospital setting by specially trained nursing staff with any necessary follow-up testing recommended in the pediatric medical home (AAP, 2017c). The State Early Hearing Detection and Intervention (EHDI) Laws and Regulations list the screening mandated by all 50 states and the District of Columbia

Question 22

Language acuisition

Answer 22

is a partly innate and partly learned process.

Linguist Noam Chomsky (nativist theory) describes the infant’s acquisition of language as complex and not well understood; he coined the term language acquisition device.

Vygotsky proposed the interactionist theory of language acquisition, which states that language is learned through socialization within the family context.

Early speech is evidenced by crying, babbling, and mimicking of repetitive vowel sounds such as ma-ma-ma and da-da-da. Single words are then used and accumulate into the infant’s vocabulary. Children interact with other people and the environment, so favorable responses to speech encourage the infant to communicate.

Question 23

Discipline

Answer 23

Although it is impossible to spoil an infant, discipline at this age should focus on setting limits for the child’s safety and well-being.

At 6 months of age, when the child is more mobile, use distraction to keep the child away from dangerous areas.
Temper tantrums are the infant’s way of expressing frustration, hunger, anger, illness, or fatigue.
Reward good behavior.
Remain calm, firm, and consistent.
Maintain a set routine.

Question 24

SAFE AND EFFECTIVE NURSING CARE: Promoting Safety

Corporal Punishment

Answer 24

Corporal punishment of children, such as spanking or hitting, has been found to have negative consequences and is less effective than other forms of discipline, such as the withdrawal of positive reinforcement (loss of privileges, time-outs). Spanking has been associated with a higher incidence of aggressive behavior in children, increased substance abuse, and higher rates of crime and violence in older children (

Question 25

Colic

Answer 25

Some infants experience a great deal of intestinal gas, resulting in frequent crying known as colic. Colic usually happens at the end of the day. Usually no medical problem is present, but the infant should be assessed by a pediatrician if it continues.

Question 26

Parents of an infant with colic should be educated about the following:

Answer 26

Make sure the infant is burped frequently.

Parents should not change formula, unless directed by the pediatrician.

If the infant is breastfed, the mother should decrease the intake of spicy or gaseous food; dairy and corn can also cause gastrointestinal disturbances.

Infants tend to be sensitive to stimulation.
Try a car ride, movement, infant massage, carrying the infant in a carrier, or creating a white noise environment.
If a pacifier is used, it can help calm the infant; pacifiers have also been shown to decrease the incidence of sudden infant death syndrome (SIDS).
Colic usually disappears by about 12 to 16 weeks of age.

Question 27

CRITICAL COMPONENT

Diagnostic Criteria for Infant Colic

Answer 27

Paroxysms of irritability, fussing, or crying that start or stop without obvious cause
Crying is turbulent and dysphonic, with a higher pitch
Episodes last 3 hours or longer and occur 3 days a week for at least 2 weeks, peaking at 6 weeks of age
Infant thriving
Diagnosis of exclusion

Question 28

Care of the Infant With Colic

Answer 28

Swaddle infant.
Place in a safe area.
Remove yourself from the infant for a 10-minute break once the child is secured in a safe place.
Educate caregivers that colic is not a reflection of their caregiving skills.
Realize that it is a heightened time of stress for caregivers.
Simethicone drops have been prescribed to ease intestinal gas, but never give an infant an over-the-counter medication without consulting the child’s pediatrician.

Question 29

Play

Answer 29

Play is how infants learn about the world and themselves. Infants are primarily sensorimotor focused, so play should involve sensory stimulation.
Explore with their mouths and imitate others.
toys- safety is the number one consideration; avoid detachable or removable pieces or parts. Simple toys should be used because attention span is short. Opt for unbreakable mirrors, rattles, soft (nonremovable pieces) stuffed animals, large snap toys, and musical pull toys.

Place infants on their stomachs for supervised tummy time.
Engage the infant with soothing tones and use of facial expressions.
Use soothing music.
If other siblings’ toys are lying around, safety for the infant requires the caregiver to be aware of small pieces.
Toys should help the infant in physical and fine motor development.
Infants enjoy looking at themselves in mirrors.
Play is essential in a hospitalized environment. The theorist Watson described the importance of positive play in fostering attachment between the infant and the caregiver.

Question 30

Nutrition

Answer 30

The WHO recommends exclusive breastfeeding until the age of 6 months and to continue until the age of 2 years, with no supplementation of water, formula, or solids prior to this point . The decision to breastfeed versus bottle-feed is dependent on maternal knowledge, past exposure to breastfeeding, education level, perceptions of the benefits of breastfeeding, cultural factors, family and friend support, career barriers, husband or partner support, and support from health-care providers.

Question 31

nutrition 6months -1 year

Answer 31

For infants between 6 months and 1 year of age:

Sufficient protein is needed to support growth and development.
Fats are needed to provide calories and support brain development.
Carbohydrates are needed to provide energy.
Infants need 100 to 116 kcal/kg/day for basic growth and development.
Adequate fluid and electrolyte intake is necessary.
Fluids, mainly water, should total 120 to 150 mL/kg/day for infants.
Supplemental iron is not necessary for breastfed infants before 6 months of age.
All infants 6 months or older require iron supplementation. Iron can be supplied through lean red meats, fortified infant cereals, spinach, broccoli, green peas, or beans.
Do not feed cow’s milk until after 1 year of age.
Soy formula is used for galactosemia, lactose intolerance, and allergies to cow’s milk.
Soy formulas not used for preterm infants.

Question 32

Non nutritive sucking

Answer 32

Nonnutritive sucking is a self-soothing or comforting measure used by infants.
The infant’s sucking ability is necessary for neurological development and survival.
Pacifiers, fingers, or fists are used in self-sucking.
Suckling, which the infant does at the breast, requires a different set of mouth movements than does bottle feeding or the use of fingers, fists, or a pacifier.
Avoid using pacifiers in the early days of breastfeeding.
Educate caregivers on the use of a pacifier, such as not using it as a substitute for feeding or holding.
Never tie or clip the pacifier to the child’s clothing because this can be a source of strangulation, even in older infants.
Limit the use of the pacifier as the infant gets older to prevent creating a habit that will be difficult to break; distract the infant with an alternative.

Question 33

Breastfeeding

Answer 33

Breastfeeding is the optimal method of feeding because it provides all necessary nutrients, minerals, and vitamins (Table 7–9).

Should begin within the first hour after birth during the initial period of reactivity
Infant should be fed on demand throughout the day and night
Reduces costs and preparation time
Promotes positive bonding between infant and mother
Decreases risk for obesity

Question 34

Composition of breastmilk

Answer 34

Breast milk development begins early in pregnancy through the hormones of estrogen, progesterone, and prolactin. It is high in IgA and IgG, and contains higher levels of a protein with a laxative effect that aids in the passage of meconium. No immunoglobulins are found in formulas. Concentration of nutrients differs among women. Infant allergic responses to breast milk are rare. Components of breast milk include:

Large water content; fat content accounts for 52% (Durham & Chapman, 2014)
Carbohydrates (lactose, 42% of calories in breast milk)
Protein, specifically whey (60% to 80%) and casein (20% to 40%), makes up approximately 6% of calories in breast milk (Durham & Chapman, 2014)
Antibodies, bifidus factor (which stimulates the growth of lactobacillus)
Lipase, amylase, and other enzymes
Epidermal growth factor, nerve growth factor, other growth factors, and interleukins

Question 35

Benefits of breastfeeding for mothers

Answer 35

• Decreased risk for breast cancer
• Lactational amenorrhea (although breastfeeding is not considered an effective form of contraception)
• Enhanced involution (due to uterine contractions triggered by the release of oxytocin) and decreased risk for postpartum hemorrhage
• Enhanced postpartum weight loss
• Increased bone density
• Enhanced bonding with infant

Question 36

Benefits of breastfeeding for infants.

Answer 36

• Enhanced immunity through the transfer of maternal antibodies; decreased incidence of infections, including otitis media, pneumonia, urinary tract infections, bacteremia, and bacterial meningitis
• Enhanced maturation of the gastrointestinal tract
• Decreased likelihood of development of insulin-dependent (type 1) diabetes
• Decreased risk for childhood obesity
• Enhanced jaw development
• Protective effects against certain childhood cancers such as lymphoblastic leukemia, Hodgkin’s disease

Question 37

Stages of Breast Milk

Stage 1

Answer 37

Stage one: Colostrum, a yellowish fluid, is present in the first 2 to 3 days after birth and can also be secreted in the last trimester of pregnancy. Colostrum has higher concentrations of protein and lower levels of fat, carbohydrates, and calories than mature milk. It contains large amounts of IgA and IgG, and assists in the passage of the infant’s first stool, known as meconium

Question 38

Stage 2

Answer 38

Stage two: The milk transitions from colostrum to more mature milk at about 3 to 10 days after birth. It consists of increasing fat, carbohydrates, and calories

Question 39

Stage 3

Answer 39

Stage three: Mature milk begins 10 days after birth. This mature milk has approximately 23 calories per ounce and is composed of foremilk and hind milk.
Foremilk is produced and released at the beginning of the feeding; it has a higher water and lactose content and a lower fat content.
The hind milk is released at the end of the feeding and has a higher fat content.

Question 40

Production of Breast Milk

Answer 40

Lactation is the process of milk production (Figure 7–20). Once the baby is born, the levels of estrogen and progesterone are eliminated and prolactin becomes the predominant hormone. Infant stimulation influences supply and demand—as the infant demands, the woman’s body supplies. Oxytocin is released from the posterior pituitary, which affects the breasts and the uterus. Oxytocin produces the letdown reflex, which forces milk into the lactiferous ducts of the breast. The letdown reflex is responsible for milk ejection. This reflex can occur during sexual stimulation, when hearing a baby cry, or when thinking of the infant. It can be inhibited by anxiety, stress, fatigue, and pain (Durham & Chapman, 2014). Infant cues and readiness to breastfeed are important adaptations that mother and infant need to make to facilitate the supply and demand.

Question 41

Early infant cues -

Answer 41

Rooting
Head bobbing up and down
Stirring and increased arm and leg movement
Burying head in mattress or mother’s chest

Question 42

Late infant cues

Answer 42

Crying—extended crying can inhibit latching on to the breast

Agitation

Question 43

Latching on

Answer 43

Hold the breast like a sandwich with the thumb on the top and the other fingers underneath. The baby should be held close; as the baby’s mouth is opened wide, place the breast fully (including the nipple and areola) into the baby’s mouth (Figure 7–22).
Encourage the infant’s mouth to open by stimulating the rooting reflex.
A successful latch is when the infant’s mouth is around the areola with the nipple at the back of the mouth.
The infant draws the milk forward in the breast.
The tip of the nose, cheeks, and chin should be touching the breast. Align the breast with the infant’s nose.
Suck and swallow should follow.
Often infants will feed from only one breast at a time for each feeding.
Latch Scoring System can help determine a successful latch

Question 44

Common positions for breastfeeding

Answer 44

Cradle hold, football hold, side lying position.

Question 45

Breastfeeding success

Answer 45

Feedings should last between 10 and 30 minutes—shorter times may indicate poor positioning or a sleepy infant; longer times can indicate nonnutritive sucking.
Removing an infant from the breast is accomplished by inserting a clean finger into the corner of the infant’s mouth to break the suction.
Successful breastfeeding results in the infant gaining 1/2 to 1 oz per day (International Lactation Consultants Association, 2017).
Expressed breast milk may be kept for 4 hours at room temperature, for 5 to 7 days in the refrigerator, and for 6 to 12 months in a deep freezer.
Never reheat breast milk in a microwave or leave it on the counter to thaw or warm up.
Thaw in the refrigerator.
The AAP recommends breastfeeding for a full year.

Question 46

Weaning an infant

Answer 46

Eliminate one feeding at a time.
Observe for signs that the infant is having emotional or physical issues.
Usually the last feeding to be eliminated is the nighttime feeding.

Question 47

Bottle feeding

Answer 47

Breast milk is the recommended method for infant feeding; however, if a mother chooses to bottle-feed her infant, never make her feel guilty for this choice. Often mothers may choose to bottle-feed and breastfeed, while waiting until they develop a milk supply.
When feeding a newborn formula, carefully dilute with water based on the manufacturer’s mixing instructions. Some preparations are ready to feed. Bottles and nipples must be washed thoroughly; use a dishwasher or boil all bottles, rings, and nipples. If formula needs to be heated, put it in a pan of hot water (not boiling) or use an electric warmer. Never microwave, because this can cause uneven heat distribution. Facilitate parent bonding by holding the infant close. Never prop a bottle because this can cause choking. Burp the infant frequently to prevent emesis.
Liquid formulas are sterile due to the manufacturing process. Powdered formulas are not sterile, and thereby increase the incidence of infections. Parents should be provided detailed instructions on hand hygiene, preparation, and equipment sterilization to prevent disease.

Question 48

Advancing feeding in infants

Answer 48

An infant’s requirement for calories is determined by size, rate of growth, activity, and energy needed for metabolic activities. Calorie needs per pound of body weight are higher during the first year of life than at any other time (Durham & Chapman, 2014). An infant is ready for solid foods at around 6 months of age. At this time, babies are able to move food around in their mouths. Breastfeeding should be on demand and average four to seven feedings per day; bottle feeding should average 24 to 32 oz of formula. No fruit juices should be given.

Question 49

introducing new foods

Answer 49

All foods should be placed on a spoon, not put in a bottle. Baby rice cereal is usually indicated for the first solid food (2 to 3 teaspoons) because it is iron fortified and associated with a decreased incidence of allergic reactions. At around 8 months, strained fruit, vegetables, and strained meats can be introduced
The caregiver should be taught to introduce a single type of food for 2 to 3 days to observe for reactions such as rashes, diarrhea, abdominal cramping, or vomiting. Use single-ingredient foods and do not add sugar, sweeteners, or corn syrup. The infant should receive only home-cooked food.
Self-feeding should begin when infants can sit up alone, hold their necks steady, draw in their lips when food is introduced into the mouth, and keep the food in their mouths and not push it back out. The extrusion reflex should be gone. Offer soft, mashed table food. Always cut up the infant’s food into small pieces to prevent choking. The first teeth are biting teeth, not grinding teeth.

Question 50

Choking prevention

Answer 50

Foods that result in a decreased risk for choking in the infant include:

Cooked macaroni
Small pieces of cheese
Soft cooked vegetables such as potatoes
Small pieces of fruit such as bananas, peaches, or pears
Small pieces of toast
Grapes cut into fourths
Best practices to prevent choking include:

Thoroughly cook and cut all foods into small pieces.
Remove pits or seeds from fruit.
Grind, mash, and add liquid to foods for younger infants.

Question 51

Weaning from bottle

Answer 51

When weaning the infant from a bottle at around 1 year of age, advance to a double-handled cup with a snap-on lid. The nighttime feeding is the last feeding to be removed because it is a source of comfort for the infant. Between 10 and 12 months, the infant will mimic the feeding habits of other family members. Do not feed an infant cow’s milk until after 12 months of age. Cow’s milk is deficient in iron, and the infant will experience development of anemia.

Question 52

Avoiding Clostridium botulinum Contamination

Answer 52

Infants younger than 1 year should never be given honey or corn syrup because this may result in the ingestion of Clostridium botulinum bacteria, which is a spore-producing organism. The spores are found in improperly stored foods, home-canned foods, processed foods such as potato salad, restaurant-prepared foods, and bottled garlic

Question 53

Sleep

Answer 53

Newborns sleep on average 8 to 9 hours per day and 8 hours at night. Infants normally do not sleep through the night until age 3 months, when their stomach size has increased so that they can take in more breast milk or formula
Newborn infants spend substantial time in rapid eye movement (REM) sleep indicative of rapid brain growth. At 3 months of age, REM sleep decreases and non-REM sleep occurs (AAP, 2014). Non-REM sleep has four stages:
Stage 1: drowsiness
Stage 2: light sleep
Stage 3: deep sleep
Stage 4: very deep sleep
Around 6 months of age, the infant may begin to sleep 8 to 12 hours at night. Sleep patterns for infants, as in adults varies, from infant to infant

Question 54

Sudden infant death syndrome

Answer 54

Sudden infant death syndrome (SIDS) and sudden unexplained infant death (SUID) are the leading cause of death from 1 month to 1 year of age, peaking between 2 and 4 months
These are infant fatalities from an unknown cause and are not associated with infection, choking, vomiting, or abuse. SIDS/SUID occurs more often in male infants, in winter months, and in African American and American Indian infants. It is also more common among infants of mothers who did not have prenatal care and those who smoke. The “Safe to Sleep” program aims to prevent SIDS through caregiver education.

Question 55

Safe to sleep campaign

Answer 55

The “Safe to Sleep” campaign highlights the following points:

Always place babies to sleep on their backs during naps and at nighttime.
Do not cover the heads of babies with a blanket or overbundle them in clothing and blankets.

Avoid letting the baby get too hot, indicated by sweating, damp hair, flushed cheeks, heat rash, and rapid breathing. Dress the baby lightly for sleep. Infants placed in sleep sacks should not wear a hat; sleep sacks are sleeveless to prevent overheating, a risk factor for SIDS.

Place your baby in a safety-approved crib with a firm mattress and a well-fitting sheet. (Cradles and bassinets may be used, but choose those that are certified for safety by the Juvenile Products Manufacturers Association [JPMA].)

Place the crib in an area that is always smoke free.

Do not allow babies to sleep on adult beds, chairs, sofas, waterbeds, or cushions

Toys and other soft bedding, including fluffy blankets, comforters, pillows, stuffed animals, bumpers and wedges, should not be placed in the crib with the baby. These items can impair the infant’s ability to breathe if they cover the infant’s face..

Breastfeed your baby. Experts recommend that mothers feed their children human milk at least through the first year of life.

Question 56

Baby boxes

Answer 56

In many U.S. states, new parents receive free “baby boxes.” These boxes are portable, sturdy cardboard boxes that have firm foam mattresses with tight-fitting sheets, designed to encourage parents to place their infants on their backs to sleep. Most infants can sleep in the baby box until they outgrow it, usually at around 6 months of age. The highest incidence of sudden infant death is between 2 and 4 months of age. The AAP cautions that these boxes are not bassinets with firm frames and supports. Additional research on the impact on SIDS needs to be performed.

Question 57

Bumper pads

Answer 57

In 2016, the AAP reaffirmed that bumper pads never be used in the cribs of infants. This organization states that there is no clinical evidence that bumper pads prevent injuries, but they do pose a significant risk for suffocation or entrapment because infants do not have the motor skills to turn their heads.

Question 58

Sleep cont..

Answer 58

Newborns sleep from feeding to feeding; with age, the amount and length of wakeful periods increase. Newborns can sleep up to 17 hours a day in 3- to 4-hour intervals. Sleep deprivation is a factor for caregivers of newborns.
By 3 months of age, the infant begins to sleep 6 to 8 hours a night.
At 6 months, an infant takes two naps a day.
At 1 year of age, the infant sleeps 15 hours a day—3 hours during the day and 11 hours at night.
Infants’ increase in sleep patterns is tied to growth spurts (Samson & Yetish, 2017).
Infants, like adults, progress through REM and non-REM sleep cycles.
The AAP and the U.S. Product Safety Commission recommend against co-bedding, or allowing the infant to sleep with parents/caregivers or siblings. No benefits were demonstrated through research on weight gain or vital signs.

Question 59

Co-bedding

Answer 59

Sleep patterns and behaviors are governed by cultural and societal norms Co-bedding is practiced in many cultures . The nurse can provide anticipatory guidance to safe sleep practices by encouraging room sharing of sleeping as a safe alternative to co-bedding. The risks of co-bedding should be discussed with the family.

Question 60

Infant Sleep and Parental Behavior

Answer 60

Infant sleep patterns undergo dramatic evolution during the first year of life. This process is driven by underlying biological forces but is highly dependent on environmental cues, including parental influences. There are links between infant sleep and parental behaviors, cognitions, emotions, and relationships, as well as psychopathology. Parental behaviors are closely related to infant sleeping patterns

Question 61

Circumcisions

Answer 61

Circumcision is the removal of the prepuce of the penis performed for religious, cultural, hygienic, or social reasons (Figure 7–23). There is no identified medical reason for circumcision. There are two main types of circumcision procedures: Gomco and plastibell
Infants with congenital hypospadias (the urethral opening is on the underneath portion of the shaft of the penis) or congenital epispadias (the urethral opening is on the top portion of the shaft of the penis) are not circumcised until after correction of the condition. Otherwise, circumcision is performed before the neonate is discharged from the hospital.

Question 62

Nursing functions when assisting with circumcisions

Answer 62

Administer acetaminophen 1 hour before the procedure.
Provide pain relief with a topical prilocaine-lidocaine (EMLA) cream applied to the distal half of the penis 60 to 90 minutes before the procedure. EMLA can be used for all painful procedures in children with a gestational age of 37 weeks or older.
The infant is positioned on a circumcision board, which positions the arms and legs in a straddled position. The upper body should be covered to minimize heat loss.
Suction should be available in case of emesis.
Dorsal penile blocks are used.
Small needles are used.
Swaddling aids in increasing comfort.
Sucrose (24% sugar water) solution can help to relieve pain.
Nonnutritive sucking can also help to relieve pain.
Decrease environmental stimuli (AAP, 2016b).
Infant must be hospitalized for procedure if older than 1 month.
After the procedure, a petroleum gauze should be applied to the head of the penis to prevent irritation from the diaper.
The penis is assessed every 15 minutes for the first hour and then every 2 to 3 hours depending on institution policy.
The neonate should void within 24 hours of the procedure or before discharge.
Instruct parents not to remove the gauze but to allow it to fall off, fasten diapers loosely, observe for bleeding every 4 hours during the first day, and observe for signs and symptoms of infection.
Acetaminophen orally may be ordered every 4 to 6 hours for 24 hours after the procedure for pain (Figure 7–25).
Educate caregivers that the healing penis develops a yellowish eschar, which should not be wiped off or removed because doing so will start the healing process over again.

Question 63

Sucrose solution

Answer 63

Sucrose solution, which is 24% sucrose and water, provides analgesia for minor procedures.
A pacifier, or a gloved finger if breastfeeding, used in conjunction with sucrose water enhances the analgesic effect.
Do not use more than three doses during a single procedure.
Do not use for infants who require ongoing pain relief; these infants will require acetaminophen or an opioid such as fentanyl or morphine.
Although an infant may cry and show signs of pain when 24% sucrose water is used, studies have consistently shown that the sensation of pain and its negative effects will be diminished
The analgesic effect of 24% sucrose water appears to be reduced after 46 weeks’ postconceptual age.
Sucrose water needs to be ordered by a practitioner and documented as an administered medication.
The administration of sucrose and the application of nonnutritive sucking are theorized to activate endogenous opioid pathways (natural pain relievers produced in the brain), with resulting calming and pain-relieving effects. The analgesic effects of nonnutritive sucking are thought to be activated through nonopioid pathways by stimulation of orotactile and mechanoreceptor mechanisms

Question 64

Circumcision and culture

Answer 64

Circumcision has religious foundations dating to the Egyptians, who instituted the practice to ensure fertility, as a rite of passage, or for hygiene purposes. Jewish culture adopted circumcision as a religious ritual from prehistoric times into the modern world. In 2009, 55% to 65% of newborn infants in the United States and Canada were circumcised within 48 hours to 10 days following birth. Circumcision is more common in the United States, Canada, and the Middle East and is rare in Asia, South America, Central America, and Europe. Worldwide, one third of males are circumcised before adulthood (CircInfo, 2016). Prior to World War II, the male population in the United States was very infrequently circumcised. In recent years, the trend not to circumcise has witnessed a resurgence (Freedman, 2016). In 1997, the AAP and the American College of Obstetricians and Gynecologists reclassified circumcision from routine to elective (CIRP, 2011).

Question 65

Discharge Care for the Circumcised Infant

Answer 65

Notify the physician in the case of:

Persistent bleeding or blood on diaper (more than quarter-sized)
Increasing redness
Fever
Other signs of infection, such as increased swelling or discharge, or the presence of pus-filled blisters
Not urinating normally within 12 hours after the circumcision

Question 66

Care of the Uncircumcised Male

Answer 66

Do not force the foreskin over the penis.
Make sure that the penis is cleaned meticulously to prevent infection.
Do not insert any objects under the foreskin to clean it, such as cotton-tip applicators.

Question 67

Medication administration

Answer 67

Children are not little adults. Pediatric dosing must be precise to ensure adequate therapeutic levels; dosing is based on weight. When possible, caregivers should use syringes to measure and administer liquid medications. Caretakers should be discouraged from using household spoons because they may vary in size, which can lead to inaccurate dosing.

Question 68

ANTICIPATORY GUIDANCE FOR THE FAMILY OF A NEWBORN

Answer 68

Nurse education for caregivers must include information about the following:

Developmental milestones
Healthy and safe habits related to injury and illness prevention, such as childproofing the home
Nutrition
Oral health
Family relationships and how they will change
Sibling transition, including regressive behavior such as thumb sucking or bedwetting and aggressive behavior toward the infant (both normal responses); parents can address this transition by showing the child pictures of his or her new sibling, having someone other than the parents bring the new baby into the home, providing a gift from the infant to the sibling, and including the child in small tasks such as bringing the parent diapers
Infant care
Home infection-control measures, such as encouraging hand washing, limiting sick visitors, and keeping their infant in a car seat to limit handling by visitors; encourage all members of the household to get immunized for influenza and pertussis
Parent–infant interactions, including playing, cuddling, the importance of talking to the child, and separation anxiety
The importance of learning infant/child CPR

Question 69

Understanding medication

Neonates and Medication Administration

Answer 69

In neonates, there is an absence of hydrochloric acid, which may interfere with absorption of some medications.

Variable weight and differences in body surface area affect medication administration.
Infants are at greater risk for toxic levels that produce untoward effects.
Infants have smaller amounts of pancreatic enzymes.
Kidney function is immature in infants.
When administering medication to infants:

Approach infant slowly, at eye level.
Handle infant gently, keep infant on caregiver’s lap, and use distraction.
Do not put medications in a bottle of formula or breast milk because the infant must drink the entire amount to receive the appropriate dosage.
Hold the infant in the nursing position, allowing him or her to swallow in between squirts of the medication in the buccal area of the mouth; do not lay the infant down until he or she swallows.
Never give an infant over-the-counter medication. Instruct caregivers to call their practitioner with concerns.

Question 70

For rectal medications

Answer 70

For rectal medications, lubricate the blunted end with water-soluble gel, insert approximately 1/2 inch, and hold the buttocks closed for approximately 10 minutes to allow for dissolution and absorption of the medication.

Question 71

For injections

Answer 71

In small infants, the nurse should use a 5/8-inch needle with up to 0.5 mL of fluid; with infants, a 1-inch needle with a maximum of 1 mL of fluid should be administered in the vastus lateralis. For adolescents, the nurse should use a 1- to 1.5-inch needle (22- to 27-gauge) up to 3 mL of fluid maximum.

Question 72

Umbilical Cord Blood Banking

Answer 72

Umbilical cord blood banking is a fee-for-service option that stores cord blood obtained at the time of delivery to provide possible future reimplantation through the cryostorage of stem cells from the cord blood. Stem cells can produce cells that can be used in the future to replace bone marrow destroyed by disease, radiation, or chemotherapy. A strict protocol must be followed in stem cell recovery. Cord blood banking is not compatible with a delay in cord clamping; harvesting of the stem cells prevents them from returning to the infant.

Question 73

Need for immunizations

Answer 73

The benefits and risks associated with using immunobiologics should be discussed. Adult immunization behavior influences how these caregivers immunize their children. From a public health standpoint, encouraging immunization is good for society
The 2017 immunization schedule has been updated to recommend that the hepatitis B vaccine now be given within 24 hours after birth, rather than in the first 2 weeks of life (Frellick & Barclay, 2017). Evidence has indicated that up to 90% of infants of chronically infected mothers could be infected. In addition, DTaP (diphtheria, tetanus, acellular pertussis) cannot be administered before the infant is 2 months of age.

Question 74

Taking temperature

Answer 74

Instruct caregivers to take the infant’s temperature if they suspect a fever.
Digital, tympanic, or temporal thermometers are preferred over mercury-filled thermometers.
Rectal temperatures are taken for children younger than 3 years only in the emergency department, newborn nursery, and pediatric units for accuracy. For rectal temperatures, lubricate the end with a water-soluble solution and insert the rectal thermometer no farther than 1/2 inch (2 to 2.5 cm) into the rectum. Hold buttocks and thermometer for safety. Parents are instructed not to take temperatures in this manner.
For axillary temperatures, place the nonlubricated end in the armpit and hold the infant’s arm at his or her side for approximately 1 minute; use with infants 3 months or older. This method can be 2 degrees lower than a rectal temperature.

Question 75

Signs of Illness in the Newborn and Infant

Answer 75

Psychosocial and behavior assessments should be managed with a family-centered approach to include an evaluation of caregivers and social determinants of health
Parents should be instructed to notify the health-care practitioner with any of these concerns:

Axillary temperature greater than 99.3°F or rectal temperature greater than 100.3°F
Vomiting
Decrease in the number of wet diapers
Sunken or bulging fontanels
Loss of appetite
Foul odor or bleeding from the cord or circumcision
Decreased level of consciousness; lethargy
Increased irritability
Blue or cool hands and feet
Skin rash
Drooling not associated with teething
Refusal to lie down if 8 months of age or older

Question 76

Sibling rivalry

Answer 76

Sibling rivalry may occur because of changes in family structure and routine; it is not indicative of maladjustment or lack of preparation
Encourage older children to attend sibling classes.
Instruct caregivers to include siblings in the supervised care of the infant as appropriate.
Do not leave the young infant alone with unsupervised young siblings.
Foster opportunities for siblings to bond with the infant.
Educate the caregiver on the need to spend alone/quality time with each of the siblings.

Question 77

Milestone Concerns or Red Flags

Answer 77

Developmental concerns for this age group that require intervention by a health-care provider include the following:

No attempts by the infant to lift head when lying facedown
No improvement in head control
Does not respond to loud noises
Extreme floppiness
Lack of response to sounds or visual cues, such as loud noises or bright lights
Inability to focus on a caregiver’s eyes
Poor weight gain
Does not crawl by 12 months

Question 78

Fostering Positive Parenting Skills

Answer 78

Encourage parents of neonates to:

Talk to the infant.
Respond to infant’s sounds by repeating and adding words.
Read to the infant; this helps to develop and foster understanding of language and sounds.
Sing to or play music for the infant.
Praise the infant and give the infant attention.
Spend time cuddling and holding the infant so that the infant feels cared for and secure.
Play with the infant when he or she is alert and relaxed. Watch for signs of being tired or fussy so that the infant can take a break

Question 79

EMERGENCY CARE FOR THE INFANT AND NEWBORN

Answer 79

Nurses should provide parent education about the following emergency care measures:

Stay calm—most serious illnesses provide warnings.
Begin rescue breathing if infant is not breathing.
Call 911.
Apply pressure with a clean cloth to an area that is bleeding.
If the infant is having a seizure, lower the infant to the floor, turn his or her head to the side, and do not put anything in the infant’s mouth.
Do not move a seriously injured infant unless he or she is in an unsafe situation, such as in a burning house, in a car, or underwater.
Stay with the infant until help arrives.
Bring all medication and/or poisons to the emergency department.
Provide an accurate history of the preceding events, including the last time that the child ate and what was eaten.

Question 80

HOSPITALIZED INFANT AND NEWBORN

Answer 80

Infancy is a period of rapid growth and development. When infants or newborns require hospitalization, the pediatric nurse must be able to care and develop nursing interventions that meet the unique needs of the infant and newborn in a hospital setting. By the age of 6 months, the infant becomes aware of the absence of their parent and can often sense anxiety in their parents as a result of the hospitalization. The pediatric nurse is in a unique position to attend not only to the needs of the infant or newborn, but to the family unit.

Question 81

Nursing care; hospitalized infant

Answer 81

Encourage caregivers to room-in.
Educate caregivers on the normal developmental milestones and stages, noting that a hospitalized infant may regress in behavior. Child life specialists are essential in describing developmental aspects related to play.
Encourage caregivers to provide security items such as a favorite toy or blanket.
Educate caregivers on safety risks in the hospital, such as lowered crib rails, the infant’s crawling on the floor, or the presence of items that may not be in the infant’s home.
Reinforce the importance of therapeutic play.
Perform the least invasive and least painful procedures first.
Invasive procedures should be performed in the treatment room, not at the crib site.
At 6 months of age, infants suffer separation anxiety and can be sensitive to caregiver cues.

Question 82

The child life specialist

Answer 82

A child life specialist is a trained individual who works in a hospital or outpatient facility and is responsible for assisting in the stabilization of the psychological aspects of the child, the child’s parents/caregivers, and the child’s siblings in the health-care environment. The goal of the child life specialist is to reduce stress by explaining procedures, preparing the child for procedures, and comforting the child throughout procedures or hospitalizations. With infant patients, the specialist may focus on the family unit or the siblings.

Question 83

Pain management

Answer 83

Ongoing assessment is essential for type of pain, origin of pain, and behavioral responses to pain.

Anything that would be painful to an adult will also be painful to an infant. Assessment of pain in the infant should be based on behavioral and physiological responses. Repeated exposure to painful stimuli can increase the response to noxious stimuli.
Pain is assessed in newborns and infants by observing facial expressions such as bulged brow, eyes squeezed shut, open mouth, and quivering chin.
Physiological responses are increased heart rate, respiratory rate, elevated systolic blood pressure, and decreased oxygen saturation.
Pain causes increased fluid and electrolyte losses.
Pain causes depression of the immune system through the depletion of mature white blood cells because of heightened stress responses.
Gastric acid production increases.
Dilated pupils and sweating may be observed.
Newborns and infants are susceptible to the detrimental effects of pain because of their inability to communicate (Freedman, 2016).
Pain relief for infants should be intravenous or oral; if administering opioids, closely monitor respiratory rate and pulse oximetry (Freedman, 2016).
Use EMLA cream or similar topical anesthetics when starting IVs. EMLA requires a physician order and should be administered 60 minutes (90 minutes for darker skin) before the procedure.

Question 84

Pain scales

Answer 84

Children’s Hospital of Eastern Ontario Pain Scale (CHEOPS) (Table 7–11)
Neonatal Infant Pain Scale (NIPS): measures five behavioral items and one physiological indicator
FLACC: faces, legs, activity, crying, and consolability (Table 7–12)
Riley Infant Pain Scale: based on similar criteria as FLACC; used on infants younger than 36 months and those with cerebral palsy
Premature infant pain profile (PIPP): one of the most reliable and validated tools to assess pain in premature infants (Verklan & Walden, 2015)
CRIES (Crying Requires Oxygen Increased Vital Signs Expression Sleep): a tool for measuring postoperative neonatal pain

Question 85

Nonpharmacological Pain-Prevention Methods

Answer 85

Breastfeeding
Nonnutritive sucking
Kangaroo care
Swaddling
Limiting environmental stimuli
Attention to behavioral cues

Question 86

Infant Massage

Answer 86

A position statement by the American Massage Therapy Association in 2008 recognizes that newborns benefit from massage therapy, especially premature infants (Cooke, 2015). Infant massage:

Stimulates organized sleep patterns
Enhances growth
May assist with colic in infants
Promotes bonding with caregiver

Question 87

Music therapy

Answer 87

Research supports the use of music to improve sucking, weight gain, sleep, and recovery from painful procedures, especially in premature infants
Music therapy promotes sleep patterns and circadian rhythms, and slows heart rate. Singing by a caregiver has positive emotional and physiological benefits that aid in communication and language acquisition, and assist in concentration.

Question 88

CHRONIC CARE FOR THE INFANT AND NEWBORN

Answer 88

Although most infants grow and thrive, some children die in infancy. For every 1,000 infants born, 6 will die before the age of 1 year (CDC, 2016b). The five leading causes of infant deaths or chronic care needs are complications of prematurity, birth defects, maternal complications during pregnancy, SIDS, and accidents or unintentional injuries

Question 89

Premature infants

Answer 89

Prematurity is the primary reason for low birth weight and carries a high risk for developmental and motor delay. Ballard scoring is 37 weeks or less
Developmental and neurological examinations are performed at routine and serial visits. Mortality and morbidity are influenced by numerous factors such as prenatal, intrapartum, and fetal issues. The lower the gestational age, the more complications that can occur.
Respiratory syncytial virus (RSV) is an acute infection limited to the lower respiratory tract and sometimes accompanied by fever in most healthy full-term infants. In 25% to 40% of RSV infections, the lower respiratory tract becomes infected, and bronchiolitis or pneumonia may develop. Very young infants, preterm infants, or high-risk infants with chronic conditions such as congenital heart disease or chronic lung changes are at increased risk for hospitalization
The prevention for RSV is palivizumab (Synagis) prophylaxis immunization. There are significant benefits to premature infants and infants who are less than 35 weeks and 6 out of 7 days gestation with chronic diseases (AAP, 2014b). Palivizumab is given in no more than five monthly doses during RSV season

Question 90

SAFETY MEASURES FOR INFANTS AND NEWBORNS

Answer 90

Accidents and injuries are the leading cause of death in children younger than 19 years (CDC, 2017c). Parents and caregivers are responsible for providing a safe environment for infants to decrease the incidence of these events. Injuries and accidents can include:

Falls
Car accidents
Drownings
Electrocution
Suffocation
Choking
Burns

Question 91

Anticipatory Guidance for Injury Prevention

Answer 91

Make and keep infant appointments for medical checkups and vaccinations (2 months, 4 months, 6 months, 9 months, and 1 year).
Immunizations are important because children are susceptible to many potentially serious diseases. Consult a local health-care provider to ensure that childhood immunizations are up to date
Use “Safe to Sleep” positioning.
Infants spend most of their time in cribs, which must be safe—no bumper pads, slats no more than 2-3/8 inches apart (JPMA approved).
Prevent diaper rash with frequent diaper changes, and wipe front to back in girls.
Childproof the home.
Have doctor, police, fire, and poison control numbers at caregiver’s fingertips.
Use childproof locks, safety gates, and window guards to prevent accidents and falls. Encourage good hand washing for anyone in contact with the newborn or infant. This includes siblings.
Keep anyone with a cough, cold, or infectious disease away from the infant.
Call a physician if the infant appears to be sick.
Call a physician if the infant has a fever, refuses to eat, or has vomiting and/or diarrhea.
Call a physician if the infant is more fussy or quieter than usual, or looks jaundiced.
Call the infant’s physician or health-care provider if worried or have questions about the infant’s growth or development.
Keep the infant in a smoke-free area.
Keep firearms in a locked cabinet.
Never leave the child home alone or in an enclosed, nonrunning car. The temperature inside the car can change dramatically.
Pay attention to product recalls of both infant equipment and toys.
Install fire/smoke and carbon monoxide detectors on every level of the home.

Question 92

Pets

Answer 92

Acclimate any pets to the new room setup before the baby is coming home. Make sure that the pet does not attempt to bite or unintentionally suffocate the infant, and never leave the infant alone with a pet.

Question 93

Drowning

Answer 93

Never leave the infant alone in water or near standing water.
Do not leave the infant to answer the phone or doorbell.
Keep toilet lids closed.
Empty buckets immediately.

Question 94

Limiting Submersion Time

Answer 94

Prolonged submersion in water, such as through infant swimming classes, increases the risk for water intoxication, as well as exposure to Escherichia coli contamination, both of which can be fatal. Many learn-to-swim programs limit an infant’s pool time to 30 minutes. In addition, contamination of the pool from diapers may result in higher incidence of diarrhea

Question 95

Burns

Answer 95

Do not hold infant when smoking, drinking hot liquids, or cooking.
Do not heat formula or breast milk in the microwave because it causes uneven heating and may also inactivate nutrients in breast milk.
An infant’s skin is very sensitive to the sun.
Keep infants out of direct sunlight to prevent sunburn.
Use sunscreen for infants older than 6 months.
Infants should wear hats when out in the sun.
Turn pot handles away from the outside of the stove, where they can be pulled on by infants beginning to pull themselves to a standing position.
Check the water temperature before putting a child in the tub.
Reduce the water heater setting to less than 120°F to lessen the chance of an accidental burning.
Keep electrical cords out of infant reach; cap electrical outlets.
Use flame-retardant sleepwear for the infant.

Question 96

Choking

Answer 96

Do not attach pacifiers or other objects to the crib or body with a string or cord.
Keep small objects away from infants, including toys or stuffed animals with small breakaway parts.
Never leave plastic bags or wrappings where the infant can reach them.
Keep objects that are choking hazards away from the infant, such as batteries (especially watch batteries), magnets, and balloons.
Cut or remove pull cords on blinds and drapes.
Anything smaller than an adult pinky finger can cause a choking situation. This includes foods such as hot dogs, whole grapes, raw carrots, raw celery, peanuts, popcorn, chips, candy, marshmallows, pretzels, and peanut butter.
Cut all foods into small-sized bites.

Question 97

Poisoning

Answer 97

Keep the poison control number at every phone.
Keep all medicines, cleaning products, nail polish remover, alcohol, and other household chemicals locked in their original containers and out of reach.
Take all suspected poisons to the phone when poison control is called to be able to read the ingredients to the center.
Remove lead paint from older cribs, infant furniture, walls, and window sills.
Never leave an infant alone in a yard.
Do not apply sunscreen or perfumed creams or lotions, because they will be absorbed in an infant younger than 6 months of age.
Keep indoor plants out of the infant’s reach.

Question 98

Falls

Answer 98

Never leave the infant alone on a changing table, couch, chair, or bed.
Always keep a hand on the baby.
Use gates at the top of stairwells.
Do not use walkers; they have resulted in serious injuries and even death if they cause the infant to fall down stairs.
Make sure that heavy furniture is secure and cannot be toppled over on top of an infant.
Educate caregivers on how young children should hold an infant and protect their head and necks.

Question 99

Car Seat Safety

Answer 99

Each state has its own specific laws related to car seats.
Always use a car seat when traveling in a car or airplane.
Use approved car seats correctly.
Check the age and weight limits for the seat.
Put the car seat in the backseat of the car and secure it facing backward. Check state laws.
Never put the infant in a front seat with a safety airbag.
Rear-facing infant seats are used from birth up to 2 years of age, per 2017 AAP guidelines (AAP, 2017b).
Parents can contact a certified child passenger safety technician (CPST) to correctly install infant car seats.
Caregivers should never leave an infant in the car unattended.

Question 100

Car seat challenge test

Answer 100

Physiological monitoring studies indicate that some preterm infants experience episodes of oxygen desaturation, apnea, or bradycardia when seated in standard car safety seats. The AAP recommends that all preterm infants younger than 37 weeks or less than 5 lb 8 oz should be assessed for cardiorespiratory stability in their car seat before discharge or the “car seat challenge.”

Question 101

Electrocution

Answer 101

Keep cords unplugged when not needed.

Watch for chewing marks on electrical cords.

Question 102

Suffocation

Answer 102

Remove excess bedding from crib.
Remove stuffed toys from crib.
Keep all plastic garbage bags, shopping bags, and dry cleaning bags out of reach of the infant.
Monitor for issues in sling carriers; make sure that infant does not get wrapped up in clothing and that the head does not fall forward, cutting off the airway

Question 103

CHild abuse considerations

Answer 103

Abuse consists of intentional, improper actions that result in harm or injury and can be physical, sexual, or mental. Neglect is failure to provide the infant with his or her basic needs. The nurse’s job in cases of suspected abuse is to advocate, protect, and care for the pediatric patient, not to investigate.

Question 104

Shaken Baby Syndrome (Abusive Head Trauma)

Answer 104

With shaken baby syndrome, head trauma results from injuries caused by vigorously shaking a child. The anatomy of infants puts them at risk for injury from this kind of action.

Most victims are infants younger than 1 year; the average age is between 3 and 8 months.
Pay special attention when choosing a babysitter.
Research suggests that teenage fathers are more likely to cause shaken baby syndrome.
Contrecoup, injuries to the opposite side of the head, are common.
Detached retinas may result.
Permanent brain damage may result.
Death may result.

Question 105

Daddy boot camp

Answer 105

These programs, taught by men for men, aim to support dads and foster improved relationships that translate into improved caregiving behaviors. Programs stress that babies cry and educate fathers about proper responses. For example, if frustrated, the father should place the infant in a safe place and remove himself from the room. Educators also:

Instruct fathers-to-be and new fathers on the care and handling of the new infant.
Explain importance of providing neck support, holding an infant correctly, and monitoring of soft spots.
Discuss shaken baby syndrome and methods to deal with frustrations of new parenthood.
Discuss postpartum depression.

Question 106

Abduction prevention

Answer 106

Educate the caregiver as follows:

In the hospital, infants will be banded with electronic tags to prevent abduction.
Hospital staff should be properly identified with hospital badges to identify that they have access to the postpartum and newborn areas.
Be suspicious of casual acquaintances or strangers who attempt to befriend the parent.
Learn hospital procedures for care after discharge if a visiting nurse is to come to your home.
Demand positive identification before allowing anyone into your home.
Do not post information about the infant on social media.
Under no circumstances should the caregiver give the baby to a stranger.
Do not allow casual acquaintances or strangers to babysit the infant.
Never leave the infant alone at home.
Do not place birth announcements in the newspaper.
In shopping areas, do not turn your back on the infant. Make sure the infant is secured in a car seat that is buckled into a shopping cart.
Place the infant in the car seat in the car, lock the doors, and then load your groceries or items from the store.
Educate family members and friends who babysit the infant about infant security.
Call police anytime you are suspicious or concerned about the infant’s safety.

Question 107

Sexual abuse

Answer 107

Warning signs of sexual abuse in infants include:

Stained or bloody diapers
Genital or rectal pain, swelling, redness, or discharge
Bruises or other injuries in the genital or rectal area
Difficulty eating or sleeping
Excessive crying
Withdrawing from others
Failure to thrive

Question 108

Physical abuse

Answer 108

Warning signs of physical abuse in infants include:

Unexplained or repeated injuries such as welts, bruises, burns, fractured skull, and broken bones, especially spiral fractures
Injuries in the shape of an object (e.g., belt buckle, electrical cord, cigarette)
Injuries that are unlikely given the age or ability of the child, such as broken bones in a child too young to walk or climb
Disagreement or inconsistency in parent/caregiver explanation of the injury
Unreasonable explanation of the injury
Fearful or detached behavior by the infant

Question 109

Emotional abuse

Answer 109

An infant may be subject to emotional abuse in the presence of these warning signs:

Aggressive or withdrawn behavior
Shying away from physical contact with parents or adults
Basic needs of food, warmth, and cuddling not met

Question 110

Neglect

Answer 110

Infant neglect may be indicated by:

Consistent failure to respond to the child’s need for stimulation, nurturing, encouragement, and protection, or failure to acknowledge the child’s presence
Actively refusing to respond to the child’s needs, such as refusing to show affection
Parents/caregivers expressing the fact that they are not going to spoil the baby or referring to the baby as evil
Infant with malnourished appearance
Obvious neglect of the child (e.g., dirty, undernourished, inappropriate clothes for the weather, lack of medical or dental care)
Failure to provide necessary medications for chronic conditions, such as inhalers for children with asthma
Delays in calling for help or taking infant to the doctor