DQ

Professor’s comments:

Responses such as “I agree”, “thanks for that information – I didn't know that”, “I experienced that also”, etc. will not receive participation credit. Please do not repeat what is already mentioned in the post. Responses should be a minimum of 150 words and minimum of 2 peer reviewed or scholarly sources with 5 years

Please do not to "cut and paste" answers from your references such as lists, bullet points, etc. This will not receive points for responses that are "cut and paste" even if you provide a citation. Please do not repeat what is already mentioned.

Post 5.

When assessing a 9-month-old female infant, the nurse must identify whether the child meets the motor, sensory, and cognitive skills appropriate for this age. Regarding motor skills: by 9 months, a child should be able to sit up, crawl, and pull herself up to stand. She should be able to perform a pincer grasp and be able to feed herself with her fingers. Sensory skills at this age include imitating speech sounds, babbling, developing depth perception, and responding to her name. Developed cognitive skills may manifest in separation anxiety and clinging to a familiar adult, waving goodbye, playing peekaboo, and responding to simple commands (MedlinePlus, 2021).

The nurse can encourage the parents in their interactions with their 9-month-old by suggesting the following age-appropriate activities: narrating what their baby is observing (such as saying, “that cup is blue,” or “your dress is red”); acknowledging the emotions their baby may be conveying; copy their baby’s words and sounds; continue with routines; play peekaboo; teach cause-and-effect using her toys, such as gently bouncing a ball, or rolling toy cars (Centers for Disease Control and Prevention, 2021). These suggestions can be found on a checklist from the Centers for Disease Control and Prevention website, but information was sourced from the American Academy of Pediatrics. The nurse should also gently remind the parents to try to view their homes from the perspective of their baby, and to “baby proof” any electrical outlets within reach, and securing any furniture that may tip over should the baby use it to pull herself up to stand.

With regard to the infant’s placement on the growth chart, the large difference between the 25th percentile of the length and head circumference with the 5th percentile of weight is concerning. This means that while she is longer than 25% of children of comparable age, she is heavier than only 5% of that same population. This would indicate the infant being underweight. The nurse can assess the child’s eating patterns, such as the amount of breastmilk or formula she is taking in, as well as the solid foods she is consuming. The nurse can then provide a sample menu that includes both measured volumes of milk or formula and suggested types of solid food and at what amounts. For example: a 9-month-old’s lunch can include 2 to 4 ounces of yogurt or cottage cheese, 2 to 4 ounces of pureed orange vegetables, then breastmilk or 4-6 ounces of formula (HealthyChildren.org, 2021)

References:

Centers of Disease Control and Prevention. (2021). Your Baby at 9 Months. https://www.cdc.gov/ncbddd/actearly/pdf/checklists/CDC_-LTSAE-Checklists-with-Tips-9month-P.pdf

HealthyChildren.org. (2021, March 17). Sample Menu for a Baby 8 to 12 Months Old. https://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/sample-one-day-menu-for-an-8-to-12-month-old.aspx

MedlinePlus. (2021). Developmental milestones record - 9 months. https://medlineplus.gov/ency/article/002009.htm

Post 6:

A nine-month-old baby with these measurements lands in the 25th percentile for height and head circumference, but is only in the 5th percentile for weight. This would be a strong indicator that she's underweight as her weight is not proportional (Mares, S 2012).

Developmental markers that should be present when doing an assessment on a nine-month old baby would be crawls, feeds self finger foods, being able to pull self to standing position and sits without support. Other development markers that are for 9-12 month range include able to drink from a cup with help, stand alone, walk along the furniture, points at objects and get into sitting position by self. The nurse will also measure the capacity of the baby to interact with caregiver and strangers, babble, chuckle and mimmick (Mares, S 2012). The nurse would evaluate the general appearance as well as caregiver interactions in order to be able to give recommendations, much of the data collected would be objective, questions answered by the caregiver which can provide information on nutrition habits, daily routine, hygiene habits, interactions with others. Subjective assessment is also very important; the child's mental alertness and movements.

As the nurse, I would give suggestions about the baby's nutritional needs and offer education with strong emphasis, in this case I would talk about the diet of the child in detail with the mother and get verbalized understanding of continued breastfeeding or taking formula along with supplementation of nutritious snacks. It will be important for the mother to realize that for the first 12 months, the baby should continue to breastfeed and use formula and not use cow's milk during this first year. Solid food should also be introduced around six months. Providing the mother with educational material and handouts as to what a child should eat & important milestones the child should be reaching at nine months of age would be important in addition to the verbal understanding (Flowers, et al 2020). I would offer recommendations for healthy food choices and iron-fortified baby cereals.

These recommendations are based on evidence-based practice for they followed the five steps of EBP; forming a clinical question to identify a problem, Gathering the best evidence, Analyzing the evidence, Applying the evidence to clinical practice, and scheduling follow up visits to asses / monitor the results.

Mares, S., & Graeff-Martins, A.S. (2012). The clinical assessment of infants, preschoolers and their families. In Rey JM (ed), IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions. Available: http://iacapap.org/wp-content/uploads/A.4.-INFANT-ASSESSMENT-072012.pdf

Flower, K. B., Massie, S., Janies, K., Bassewitz, J. B., Coker, T. R., Gillespie, R. J., ... & Earls, M. F. (2020). Increasing early childhood screening in primary care through a quality improvement collaborative. Pediatrics, 146(3).