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Pediatrics Ch 16
The Infant
| Question | Answer |
|---|---|
| What are milestones | General patterns of achievements at various stages of infancy AKA milestones & norms |
| Why must the nurse understand to normal range for milestone achievements | To assess the progress of growth and development of the infant and initiate early referral for follow up care |
| What effect may unmet hunger needs have on an infant | may become irritable, not perceive feeding as pleasurable, and not develop trust in the caregiver |
| When does parental bonding and social interaction begin | In the neonatal phase |
| When does parental bonding and social interaction heighten | When the infant begins to respond with a social smile |
| What effect does a social smile have on the caregiver | Makes them feel loved |
| When should positive parental interaction be visible and obvious | 4 to 6 months |
| What evidence should there be that there is effective positive parental interaction | The parent should appear to enjoy the interactions with the infant and appear relaxed during interactions |
| When might feeding become an issue of conflict between the parent and infant | 9 months |
| How should the parent handle an issue conflict regarding feeding | Let go and introduce the infant to finger foods, initiate drinking from a cup |
| What type of behavior during mealtimes for a 9 month old infant should alert a nurse that parental guidance may be necessary | An overly neat and orderly approach |
| When should separation anxiety be expected | 9 months |
| How should a nurse handle separation anxiety in an infant | spend time playing with the infant |
| What is the key to successful parent teaching and counseling | Repetition |
| What is the most common cause for concern about a child | Sudden slowing, not typical for age, of any aspect of development |
| What brings the infant comfort and relief from tension | Sucking |
| What should the nurse do during feedings to allow for the oral stage of personality to develop | Hold the infant and allow sufficient time to suck |
| What do infants who are warm and comfortable associate with food | Love |
| If an infant is fed IV fluids, what is done to allow for the oral stage of personality to develop | Extra attention and a pacifier |
| When does the infant begin to bite | When teeth appear |
| When do infants become able to derive pleasure from sources other than sucking | When they can use their hands more skillfully |
| What is the grasp reflex | the palms of the infant’s hands flex when touched |
| When does the reflex grasp disappear | 3 months |
| What is prehension | Ability to grasp objects between the fingers and the opposing thumb |
| When does prehension occur | 5 to 6 months |
| What is the parachute reflex | Protective arm extension that occurs when an infant is suddenly thrust downward when prone |
| When does the parachute reflex appear | 7 to 9 months |
| When is pincer grasp coordination of the finger and thumb well established | 1 year |
| What must be established for trust to develop | Consistency |
| Consistently picking up an infant in response to crying has what effect on later life | Fewer crying episodes when they are toddlers and less aggressive behavior at age 2 years |
| What is the foundation of emotional growth | A sense of trust |
| What should parents do while providing infant care | Talk, sing, and touch their infant |
| What kind of personality will the infant who is left in a crib or playpen without being provided a variety of learning experiences development | Shy and withdrawn |
| What is essential for the development of the infant’s thought processes and perceptual abilities | Sensory stimulation |
| What should personnel do if the mother is unable to room in with the inant | Imitate her care by promptly fulfilling the infant’s physical and emotional needs |
| What is more important than the exactness of time or the method of bathing or feeding | The care with which it is done |
| What aspects of care are important throughout the entire year of infancy | Safety |
| The nurse should explain to the parents that ___ patterns can not be separated from ___ patterns | physical – social |
| Do changes in development occur abruptly | No |
| What does the schedule for additions of various solids foods and immunizations depend on | Infant’s health & Physician’s protocol |
| What is of the utmost importance and includes all measures that improve the physical health and adjustment of the child | Prevention of disease during infancy |
| What are milk stations | Locations throughout the 1800s providing safe water and milk for infants in an effort to reduce the number of deaths from infant diarrhea |
| What can impair parenting skills | Socioeconomic factors, physical and mental problems |
| What is a prime responsibility of the nurse in a community based clinic | Guide the parents and assist in the development of the skills necessary to ensure the proper growth and development of their child |
| What should be done if an irritable infant responds negatively (turns away, squirms, grimaces, puts hand in front of face) to stimuli | Stop and reduce environmental stimuli |
| How should a parent handle the annoying, repetitious banging of toys on a table by an infant | encourage it – this is a developmental phase of motor activity |
| What characterizes colic | Periods of unexplained irritability and crying in a healthy, well fed infant |
| When can colic interfere with parent-infant interactions | If the infant is not soothed by holding or carrying and parental fatigue and guilt develop |
| What is the colic carry | Holding the infant face down and close to the body while supporting the abdomen and providing a gentle rocking motion that often soothes the colicky infant |
| Approximately how long does colic last | 3 months |
| What can mimic the symptoms of colic | Intestinal obstruction and infection |
| Other than the colic carry, what are some other techniques that may soothe an infant with colic | Abdominal massage, wind-up swing, car ride, burping before and after feedings, place upright after feeding |
| What is thought to cause colic | A combination of infant, parental, and environmental factors |
| What are two methods infants use to cope with being over stimulated | Becoming irritable and lethargic |
| What is the pattern and progression of newborn sleep | 4 hour intervals increasing to 8 hours by 4 to 6 months of age |
| What sleeping position is best for infants to avoid sudden infant death syndrome | On the side |
| How do infants under 6 months return to sleep after wakening during the night | Parents soothe them |
| Why should a parent not use pacing or car rides before 6 months to get an infant to sleep | The infant will rely on that method after 6 months |
| How should parents soothe the infant to sleep during the night | With self soothing behaviors |
| Where can resources for children with special needs be found | Day care nursery school, special classes in public school, counseling, psychologist, neurodevelopmental therapy, occupational or physical therapist, speech therapy, auditory testing |
| During the first year, when should the infant be seen in the clinic | 2, 4, 6, 9, and 12 months |
| Why are well baby checkups as important for parents as for children | They provide caregiver support and reassurance as well as information and anticipatory guidance for developmental changes and health issues |
| What is a common concern for infants during the first year | Diaper rash |
| What can be applied to avoid skin breakdown | A&D ointment, Desitin |
| When does the 1986 Amendment to the Education of All Handicapped Children require testing for developmental disabilities | By age 5 |
| When do most pediatricians initiate their testing for developmental disabilities | At birth |
| What does the Denver Developmental Screening Test (DDST) test | Social, fine motor adaptive, language, and gross motor abilities from birth to age 6 |
| What is the Denver Home Screening Questionaire used for | Providing information concerning the child rearing environment |
| What does the Early Language Milestone (ELM) Scale test | Expressive, receptive, and visual language from birth to 3 |
| When is the Ages and Stages Questionnaire (ASQ) administered | Between 4 and 48 months |
| What is the Brazelton Neonatal Behavioral Assessment Scale | Helps describe the infant’s emerging personality and evaluates reflexes, general activity, alertness, orientation to voice, and response to stimuli |
| How is localization of sound assessed during infancy | Standing behind the child seated on the mother’s lap and ringing a bell or repeating voice sounds |
| How is vision assessed during infancy | Light perception – penlight in the eyes and note blinking, following to midline, and other responses |
| How can a nurse stress the importance of immunizations | Tell them the infant can become sick, causing missed work, physician and hospital expenses, and is required before school entry |
| What is the period of time between a series of immunizations’ doses before the series must be restarted | It is not necessary to restart any series, regardless of the length of delay |
| What is the extrusion reflex | Protrusion that pushes food out of the mouth to prevent intake of inappropriate food |
| When does the extrusion reflex disappear | 3 to 4 months |
| The stomach capacity of an infant expands from 10 to 20 ml at birth to ____ ml by 12 months | 200 |
| When does the child master spoon feeding | 2 years |
| What is the parental guide to determine the adequacy of the diet | Gains 4 to 7 ounces/week for the first 6 months, 6 wet diapers/day, sleeps peacefully for several hours after feedings |
| Why is whole cow’s milk not recommended for infants under 1 year | Curd is hard to digest, may contribute to iron deficiency anemia by causing gastrointestinal blood loss |
| What is satiety | Hunger satisfaction |
| Do breast or bottle fed infants gain more weight | Bottle |
| When do taste buds develop | 8th week gestation |
| What tastes do infants prefer | Sweet |
| Why is it recommended for solid food to be introduced at 6 months | The tongue extrusion reflex completely disappears, and the gastrointestinal tract is mature enough to digest foods |
| When does munching begin | 4 to 6 months |
| Why is rice cereal the first recommended food | It is less allergic |
| How much food is offered to infants | 1 teaspoon |
| Where is an infant’s food placed in the mouth | On the back of the tongue |
| At what rate are new foods offered | Only 1 in every 4 day to 1 week period |
| What should the response be if the infant refuses a food | It should be temporarily omitted |
| When are fruit juices typically offered | 5 to 6 months |
| What fruit juice is not offered at 5 to 6 months, and when is it offered | Orange juice – 1 year |
| What foods are withheld from an infant, and why | Fish, nuts, strawberries, chocolate, egg white, orange juice – they are highly allergenic, honey |
| What food is not given until a child is 2 years of age and why | Honey – to prevent botulism development |
| Why should new solid foods be introduced before giving an infant milk | To encourage the infant to try the new experience |
| How is juice initially prepared for an infant | it is diluted |
| What is the recommended liquid intake for a 3 month old | 140 – 160ml/kg/day |
| What is the recommended liquid intake for a 6 month old | 130 – 155ml/kg/day |
| What is the recommended liquid intake for a 1 year old | 120 - 135ml/kg/day |
| What is the recommended liquid intake for a 6 year old | 90 – 100ml/kg/day |
| What kind of diet will compromise the growth and development in infants under 2 years | Low-fat |
| When can whole cow’s milk be introduced | 1 year |
| When can low-fat cow’s milk be introduced | 2 years |
| When buying vacuum packed baby food in jars, what should the parent inspect | Safety seals and expiration dates |
| Where are expiration dates typically found on baby food | On the caps of jars and on the sides of cereal and bakery items |
| What behavior does a 0 – 3 month old exhibit to show hunger | Cries, hands fisted, body tense |
| What behavior does a 3 – 5 month old exhibit to show hunger | Grasps and draws bottle to mouth, tongue protrudes, fusses, brings hands to mouth |
| What behavior does a 6 – 9 month old exhibit to show hunger | Reacts to food preparation, reaches for bottle |
| What behavior does a 10 – 12 month old exhibit to show hunger | Vocalizes, grasps utensils, fussy |
| How does a 0 – 3 month old communicate hunger | Roots in search of nipple |
| How does a 3 - 5 month old communicate hunger | Reaches with open mouth to receive nipple |
| How does a 6 - 9 month old communicate hunger | Vocalizes hunger, pulls spoon to mouth, hold bottle |
| How does a 10 - 12 month old communicate hunger | Attempts to feed self, purses lips to cup’s edge |
| What feeding behaviors will a 0 – 3 month old exhibit | Strong suck reflex & needs to be burped |
| What feeding behaviors will a 3 – 5 month old exhibit | Strong suck, holds nipple firmly, preference for taste, pats bottle |
| What feeding behaviors will a 6 – 9 month old exhibit | Picks up small food with raking, then pincer action – draws food from spoon with lips – chewing begins |
| What feeding behaviors will a 10 to 12 month old exhibit | Skilled pincer action, drink from cup, chews food |
| What behaviors will indicate a 0 – 3 month old has reached satiety | Falls asleep when full, hands and body relaxed, withdraws head from nipple |
| What behaviors will indicate a 3 – 5 month old has reached satiety | Tosses head back, ejects nipple, easily distracted by surroundings, plays with nipple |
| What behaviors will indicate a 6 – 9 month old has reached satiety | Changes posture, closes mouth, plays with utensils, shakes head no |
| What behavior will indicates a 10 to 12 month old has reached satiety | Shakes head no, sputters food, throws food to floor |
| What mealtime guidance can be given to the parents of a 0 – 3 month old | Burp frequently, avoid over or underfeeding, recognize signs of satiety |
| What mealtime guidance can be given to the parents of a 3 - 5 month old | Provide predictable routine, allow infant to gain experience with varied textures of fingers/toys |
| What mealtime guidance can be given to the parents of a 6 to 9 month old | Offer one new food at a time at spaced intervals to assess responses, include familiar favorites |
| What mealtime guidance can be given to the parents of a 10 – 12 month old | Allow infant to assist with feeding, introduce foods with varied textures, avoid foods that can be aspirated |
| When will a child reach for the spoon | 7 months |
| When will a child begin to use the spoon independently, though may not be able to keep food on it | 9 months |
| When will a child have the ability to both rotate the wrist and to elevate the elbow to keep food on the spoon | 2 years |
| Where should unopened bottles of baby food and juices be stored | In a cool, dry place |
| What should be heard when a jar of baby food is opened | A pop sound |
| Why should a parent not feed a child from the jar or return leftovers to the jar | Saliva may turn some foods to liquid by digesting them in the jar |
| How should unused baby food be stored | In the original container in the refrigerator |
| Why is it necessary to be careful when heating baby food in the microwave | It heats unevenly |
| What is weaning | Substituting a cup for a bottle or breastfeeding |
| What are the signs of readiness to wean | Eagerly looks forward to new tastes, not wanting to be held during feedings, starting to bite the nipple |
| What should weaning start with | Daytime feedings |
| When is weaning typically completed | 2 years |
| What should be used for all infants less than 1 year old and weighing less than 22 pounds when traveling in an automobile | Rear facing infant car seat located in the center rear seat |
| Why should an infant never be left alone on a flat surface | Crawl reflexes & infants under 4 have rounded backs, over 4 can voluntarily roll |
| What is the most important feature involved in toy selection | Safety |
| What will offer visual stimulation in a 0 – 2 month old | Black and white contrasting mobiles placed at midline of the infant’s vision |
| What will offer visual stimulation in a 3 to 5 month old | Unbreakable mirrors, infant seat positioned to view room |
| What will offer visual stimulation in a 6 to 9 month old | Peek – a – boo (teaches object permanence) & encourages imitation of facial expression |
| What will offer visual stimulation in 10 – 12 month old | Large picture books, shopping trips, soft blocks, nested boxes |
| What will offer auditory stimulation to a 0 – 2 month old | Talk, music, ticking clock |
| What will offer auditory stimulation to a 3 – 5 month old | Talk, rattles |
| What will offer auditory stimulation to a 6 – 9 month old | Using appropriate names for objects |
| What will offer auditory stimulation to a 10 – 12 month old | Reading, singing nursery rhymes, imitating animal sounds |
| What will offer sensorimotor stimulation to a 0 – 2 month old | Cuddling, rocking |
| What will offer sensorimotor stimulation to a 3 – 5 month old | Cradle gym, infant swing |
| What will offer sensorimotor stimulation to a 6 – 9 month old | Introducing various textures for infant to touch, using teething toys |
| What will offer sensorimotor stimulation to a 10 – 12 month old | Push/pull toys, activity boxes |
| What is the weight of a 6 month old | Double the birth weight |
| What is the weight of a 1 year old | Triple the birth weight |
| What is the average rate of height increase | 1 inch/month/1st 6 months to 29 inches by 1 year (growth is mainly in the trunk) |
| What is the rate of increase for head circumference | 0.6 in/month for 6 months to 18 inches by 1 year |
| What is the relation of head to chest circumference by 1 year | They are equal |
| When is the posterior fontanelle closed | 1 year (2 months by table 16-1) |
| When is the anterior fontanelle closed | 18 months |
| What replaces primitive reflexes | Voluntary movements |
| When do maternal iron stored decrease | 6 months |
| When does the digestive process increase functioning | 3 months |
| Until what age are amylase and lipase deficient | 4 to 6 months |
| What do amylase and lipase do | Digest fat in solid foods |
| When is binocular vision established | 4 months |
| When does depth perception begin to develop | 9 months |
| What is object permanence | Things exist even out of sight |
| What are major aspects of cognitive development in the first year of life | Separation of self from other, object permanence, and symbols (saying bye-bye) |
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