Mental health & crisis management 7 APRIL qui z

Jack Fowler

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Chapter 35

The Infant and Family

Promoting Optimal
Growth and Development

Biological development
Proportional changes
150–200 g weight is gained per week until age 5–6 months.
Birth weight doubles by age 6 months.
Birth weight triples by age 1 year.
Height increases by 2.5 cm per month for 6 months.
Growth occurs in “spurts” rather than following a gradual pattern.

Fine Motor Development

Grasp object: ages 2 to 3 months
Transfer object between hands: age 7 months
Use pincer grasp age: 8 months crude, 11 months refined
Remove objects from container: 11 months
Build tower of two blocks: 12 months

Fig. 36-1. Crude pincer grasp at 8 to 10 months.

Gross Motor Development

Head control: well established by 4–6 months
Rolling over: ages 5 to 6 months
Sitting: 7 months; 8 months unsupported
Moving from prone to sitting position: 10 months

Fig. 36-2. Head control while pulled to sitting position. A: Complete head lag at 1 month. B: Partial head lag at 2 months. C: Almost no head lag at 4 months.

Fig. 36-3. Head control while prone. A: Infant momentarily lifts head at 1 month. B::Infant lifts head and chest 90 degrees and bears weight on forearms at 4 months. C: Infant lifts head, chest, and upper abdomen and can bear weight on hands at 6 months. Note how this position facilitates turning from abdomen to back.

Fig. 36-4. Parachute reflex.

Fig. 36-5. Development of sitting. A: Back is completely rounded, and infant has no ability to sit upright at 1 month. B,:At 2 months, infant exhibits more control; back is still rounded, but infant can sit up momentarily with some head control. C: Back is rounded only in lumbar area, and infant is able to sit erect with good head control at 4 months. D: Infant can sit alone, leaning on hands for support, at 7 months. E: Infant sits without support at 8 months. Note the transferring of objects that occurs beginning at 7 months.

Gross Motor Development—cont.

MOBILITY

Cephalocaudal direction of development
Crawling age: 6 to 7 months
Creeping age: 9 months
Walk with assistance: 11 months
Walk alone: 12 months

Fig. 36-6. Development of locomotion. A: Infant bears full weight on feet by 7 months. B: Infant can maneuver from sitting to kneeling position. C: Infant can stand holding onto furniture at 9 months. D,:While standing, infant takes deliberate step at 10 months. E: Infant crawls with abdomen on floor and pulls self forward, and then, F, creeps on hands and knees at 9 months.

Pulls themselves into a standing position

Understand the word “No”

May sleep-in with parents in certain cultures

6 teeth (Age in months -6)
Can have water liberally

What else happens at 12 mos?

Psychosocial Development

Erikson phase I
Acquiring sense of trust while overcoming sense of mistrust
Birth to 1 year
Food intake most important social activity during first 3–4 months
Next modality reaching out through grasping
More active stage next, including biting

Erikson Interview 9:50

https://www.youtube.com/watch?v=FpOtpuBnjbo

Start at 9:50.

Cognitive Development

Piaget theory (1952)
Sensorimotor phase
Birth to 1 month: reflex stage
1 to 4 months: primary circular reactions

Reflex vs. Voluntary acts

4 to 8 months: secondary circular reactions

Deliberate movements for response reaction

Imitation
Play
Affect

Piaget Sensorimotor

https://www.youtube.com/watch?v=hqHhpj7g05o

Stage 1-4 only

Development of Body Image

Concept of object permanence
By end of first year recognize that they are distinct from parents

Fig. 36-7. Nine-month-old infant actively searches for object hidden behind pillow.

Fig. 36-8. Nine-month-old infant enjoying own image in mirror.

Social Development

Attachment
Reactive attachment disorder
Separation anxiety
Stranger fear
Language development
Play

Fig. 36-9. Behaviors related to fear of strangers include clinging to the parent and turning away from the stranger.

Coping With Concerns Related to Normal Growth and Development

Separation and stranger fear
Alternative child care arrangements
Limit-setting and discipline
Thumb-sucking and use of a pacifier
Teething
Infant shoes

Promoting Optimum Health During Infancy

First 6 months of life (0-6)
Breast milk should be only food.

Second 6 months of life (6-12)
Selection and preparation of solid foods
Introduction of solid foods
Weaning from breast or bottle

Sleep and Activity

Infants are naturally active.
Walkers, swings, and playpens are not necessary.
Sleep problems must be managed.
Concept of “graduated extinction” is of value in managing nighttime crying.
?Ferber method

Dental Health

Maternal dental health
Cleaning initiated at eruption of primary teeth
Fluoride at 6 months
Prevention of dental cavities

Fig. 36-10. Sequence of eruption of primary teeth. *Range represents ±1 standard deviation, or 67% of subjects studied.

Immunizations

Schedule for immunizations (Birth to 6 mos)
Recommendations for routine immunization
Hepatitis A and B viruses
Diphtheria (throat/ respiratory system)
Tetanus (motor neurons)
Pertussis (Whooping cough)
Polio (viral/ fecal-oral route/paralysis

Immunizations—cont.

Routine immunizations
Measles, mumps, rubella (Current outbreak in BC)

blindness
encephalitis, an infection that causes brain swelling
extreme dehydration
ear infections
pneumonia

Evidence-based research

The World Health Organization (WHO) reports that in 2017, there were 110,000 measles deaths globally, mostly among children under the age of five. However, measles vaccination resulted in an 80 per cent drop in measles deaths between 2000 and 2017 worldwide, which prevented an estimated 21.1 million deaths.

EBR cont’d

Despite the positive impacts vaccination has had in combatting one of the most highly contagious and serious diseases, the WHO has declared vaccine hesitancy one of the top 10 threats to global health in 2019. They wrote, “Vaccine hesitancy … threatens to reverse progress made in tackling vaccine-preventable diseases.”

Vaccinations cont’d

Pneumococcus
Haemophilus influenzae type B
Varicella (chickenpox)
Influenza
Meningococcus

Immunizations—cont.

Recommendations for selected immunizations
Selected groups of children
Rotavirus and human papillomavirus
Reactions
Contraindications and compliance
Administration

VAERS

Vaccine Adverse Event Reporting System
To report any adverse reactions after administration of any vaccine
Vaccine Information Statements
Information statements that must be given
to parents before administration of given vaccines
Provision of updated information for parent or guardian of child being vaccinated

Injury Prevention

Aspiration of foreign objects
Suffocation
Motor vehicle injuries
Falls
Poisoning
Burns
Drowning
Bodily damage
Shaken baby syndrome

Fig. 36-11. A rear-facing infant car restraint that is approved by Transport Canada and placed in the back seat provides the best protection.

Fig. 36-12. Safety demonstration board. Clockwise from lower left: Two types of cabinet latches, a shock guard for an electrical outlet in use, and two types of outlet covers (the one with the white cover has passive devices that automatically cover the outlet when a plug is removed).

Fig. 36-13. Infants can find hazardous electrical wires.

Feeding Difficulties

Regurgitation and “spitting up”
Colic (paroxysmal abdominal pain)
Therapeutic management
Growth failure
Terms organic failure to thrive (FTT) and nonorganic FTT no longer much used
FTT classified according to categories
Diagnostic evaluation
Prognosis

Fig. 36-14. The “colic carry” may be comforting to an infant with colic.

Fig. 36-15. Consistent nursing contact is important in developing trust in infants with failure to thrive.

Positional Plagiocephaly

“Back to Sleep” campaign since 1999
Front to play
Diagnostic evaluation
Therapeutic management
Nursing care management

Fig. 36-16. A, Plagiocephaly. B, Helmet used to correct plagiocephaly.

Disorders of Unknown Etiology

Sudden infant death syndrome (SIDS)
Etiology
Nursing care management
Finding the infant
Arriving at emergency department
Returning home

Apnea and Apparent
Life-Threatening Events

Apnea—unexplained respiratory pause of 20 seconds
Diagnostic evaluation of ALTEs
Therapeutic management
Theophylline or caffeine to stimulate respiration
Home apnea monitors
Family support
CPR training

Fig. 36-17. Electrode placement for apnea monitoring. In small infants, one fingerbreadth may be used.

Next Week: Toddler & the Family