Promoting Optimum Health

Dr. Abdulmahdi .A.Hasan Page | 1



Pediatric Nursing


Promoting Optimum Health

During Infancy
Class objectives
Be familiar with feeding recommendations for infants.
Identify sleep problems and management during infancy.
Discuss infant’s dental care.
Be familiar with injury prevention based on infants developmental stage.
Nutrition
Breast milk is first choice only
for first 6 months of life. No supplements are needed.
The second acceptable diet is the commercial iron-fortified formula.
? (whole milk should not be introduced until after one year of age).
Number of feeds
During the first 6months, about 6 feeds /day, then decreased to 4-5 at the sixth month.
Total amount of milk to be given is 960ml /day.
If breast feeding is discontinued Iron-fortified formula is substituted.
Weaning from breast milk or bottle
It is the process of giving one method of feeding for another usually changing breast or bottle feeding to a cup feeding
Principles of weaning:
need to be done gradually.
The infant gives up a major source of oral pleasure and gratification.
There is no one best time for all infants but the infant will show signs for readiness.
The last feed to be discontinued is the night time one.
Introducing solid foods
? By 4-6 months the GI tract has matured sufficiently to handle more complex nutrients and is less sensitive to potentially allergic foods.
? Introduce solids when infant is hungry.
? Introduce foods at intervals of 4-7 days to allow for identification of food allergies
? As the amount of solid food increased the quantity of milk decreased.
? Do not introduce food by mixing it with formula in the bottle.
Solid food
? Infant cereals is introduced first since it is high in Iron (7mg of Iron/3 table spoons of cereal).
? Rice cereal is recommended to be introduced first it is easily digestible and low in allergic potential.
? After the first six months cereal is mixed with fruit juices. Vitamin C increases the absorption of Iron from the cereals and it is continued up to 18th month.
Solid food
? Fruit juice can be substituted for one milk feed/day and it has to be given by cup to prevent nursing tooth caries.
? Apple juice ,pear, prune, sweet cherry, peach, and grape should be avoided because they cause abdominal pain and diarrhea.
Solid food
? At 8-9 months family cooked vegetables, raw pieces of fruit (except grapes) or cheese and yogurt can be given.
? By one year well cooked table foods can be served, salt and sugar are not added.
? The Sequence is: strained fruits then vegetables and finally meat.
Sleep and Activity
Most children are naturally active and do not need stimulation.
Sleep:
By 3-4 months the infant develops nocturnal pattern; 9-11hrs.
Total daily sleep hrs: 13-15hrs, with one or two naps.
Breast fed infants sleep less periods especially at night than bottle fed infants.
Sleep problems
? Nighttime feeding
? A need for middle of night bottle
? Goes to sleep with bottle or breast feeding
? Frequent awakening
? Developmental night crying
? Between 6-12 months, changes in sleeping pattern
Sleep problems
? Refusal to go to bed
? Resist bedtime and comes out of room
? Might be frequent awakenings with refusal to go back to sleep
? Trained night crying
? Child falls asleep in a place other than his own bed
? Nighttime fears
? Fears going to bed because of nightmares
Sleep problems management
– Decrease activates around bedtime as much as possible, have rituals limited for bed time only.
– Put the child awake in the crib don’t allow to sleep in your arms, instead put to bed once felt sleepy.
– Do not use the bed for playing; it should be only for sleeping, so the baby will associate the bed with sleep and not with activity.
Sleep problems management
Increase daytime feeding intervals to 4 hours or more
Offer last feeding as late as possible at night
No bottles offered in bed
When child is crying, check at progressively longer intervals each night, reassure child but do not hold
Avoid rocking, taking to parent’s bed
DENTAL CARE
1. Begin care as soon as the primary teeth erupt
2. Cleaning teeth with a wet cloth by wiping them gently later can use soft brush
3. Avoid extra sugar and giving the bottle while asleep
4. Avoid pacifiers coated with honey or hard candy pacifiers
5. Water is preferred to paste
(Number of teeth in the first
year = age in months – 6)
Injury Prevention
Aspiration of foreign objects
Suffocation
Motor vehicle injuries
Falls
Rolls over
Poisoning
Burns
Drowning
Nurse’s role in injury prevention
Be aware of possible cause of injury for each age group.
Educate parents and family about these causes and ways to prevent it.
Thanks for listening
Have a great day