WEEK 8 – IMMEDIATE CARE OF THE NEWBORN

Miss Caprecho || BSN || BATCH 2024 MOTHER AND

CHILD CARE

Unang Yakap: Essential Newborn Care Ø Use of bulb syringe

vNewborn deaths are due to stressful events / Ø Squeeze
conditions during labor, delivery, and immediate Ø Place in 1 nostril ¼ - ½ inch / inside of the cheek
postpartum period Ø Quickly release the bulb (pulls the mucus into
vSimple, cause effective bulb)
Ø Immediate and thorough drying (3o mins drying to
promote breathing; prevent hypothermia) Maintain Body Temperature
Ø Early skin-to-skin contact (est mother and child vNewborn temp is higher than mother’s but drops
bonding, minimizes the risk of sepsis and continuously
hypoglycemia) vWrap the newborn
Ø Properly timed cord clamping and cutting (1st vCover head with insulated fabric or knitted bonnet
clamp = 2cm from the umbilicus of fetus, 2nd vNewborn temp = stabilizes @ 8- 10hrs
clamp = 5cm; prevent anemia and hemorrhage) vHead loses a lot of heat
Ø Non-separation of the newborn and mother for vGooseneck lamp = place the newborn for added heat
early initiation of breastfeeding by radiation
§ carry out eyecare and immunization process v36.5-37.5 deg C per axilla
(HepB and Vit K) vHypothermia = a condition in which the newborns
§ Rooming in temp falls below 36.5 degrees C
vCheck initial temp = per rectum; also to check for
Principles of Immediate Newborn Care patency
vTaking rectal temp
Maintain Patent Airway Ø apply lubricating KY jelly into the tip of digital
vPriority goal thermometer
vClear the neonates airways = extension of fetal head Ø insert into the rectum about ½ - 1 inch
even before the chest is born
vCrying w/ mucus in mouth can cause aspiration of
mucus and meconium (meconium aspiration) Mechanism of Heat Loss
vNever stimulate crying b4 suctioning vConvection
vSuctioning =immediately when the head extends; Ø loss of heat to the cool air
mouth to nose (bulb syringe = shallow suctioning; Ø wrap baby and promote flexion
prevents stim of the vagus nerve) Ø avoid unnecessary exposure when doing
vSuction briefly 5-10 secs in full term, >5 seconds if procedures
preterm and high-risk newborns (prevents vRadiation
breathlessness) Ø heat loss due to cool surfaces not in contact with
vSlight Trendelenberg position = after suctioning; 10- the body (walls, floors, ceiling, etc.)
15 degrees angle head down (for the drainage of Ø Indirect contact
nasopharyngeal secretions; prevents abd contents Ø Most of newborn heat is loss this way
from compressing the diaphragm; contraindicated = Ø Wrap the infant
high risk of increased intracranial pressure) Ø Gooseneck lamp
vOxygenate between suctioning; may cause neonatal vConduction
blindness = O2 toxicity Ø loss of heat to cool surfaces in direct contact
vAsphyxia neonatorum = failure to initiate breathing Ø do not put the newborn in cold unlined surfaces
in the first 60s of life; clogged air passages; ensure (eg weighing scale)
patent airway Ø line the weighing scale w/ linen or weigh infant’s
vNewborn is OBLIGATE NASAL BREATHER = ensure clothes and weigh him with the clothes (subtract
nostril patency weight of the cloth from the newborns weight)
vGently stimulate cry and turn q2hrs =fully inflate Ø rest the infant on maternal abdomen / give him to
alveoli the mother or father to hold
vGently rub his back / slap soles = stimulate cry Ø maternal abd temp = same as temp in incubator
Page 81 Compiled by TEAM SHAWTIES
 WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024 MOTHER AND
CHILD CARE

vEvaporation vHR / pulse = most important APGAR score; w/o this

Ø loss of heat as water evaporates from the infant’s the other conditions will not be observed
body vColor = least important
Ø dry infant right away @ birth
§ Newborns don’t shiver = the burn heat through
BROWN FAT
vBrown Fat
Ø located around the scapula, sternum, kidneys,
and adrenals this is easily burned and produces a
lot of heat in the process
Ø major source of heat prod.
Ø excess causes metabolic acidosis
Ø requires more O2 and glucose = respiratory
distress / hypoglycemia
Ø nurse should keep the newborn warm and prevent
heat loss
vAcrocyanosis
Ø cold stress = metabolic acidosis, hypoglycemia,
Ø score of 9
and respi distress
Ø body pink, extremities blue
Ø sluggish peripheral circulation of the NB in the
Nursing Management in Thermoregulation
first 24hrs
vDry baby at once after delivery Ø gently stimulate cry to improve peripheral circ.
vPlace under radiant warmer (prewarm baby’s vReflex irritability
clothes) Ø should not be limited to the ability to illicit cry or
vWrap the baby accordingly sneezing upon stimulation
vProvide gooseneck lamp Ø the demo of reflexes in the NB like the moro reflex
vMonitor VS accordingly (reflex to lack of support; spreading of arms and
crying) means irritability and deserves perfect 2
Carry out APGAR Scoring score
vdetermines wellbeing Ø Good cry = breathing well; score of 2
vnumerical expression of the newborn’s adaptation to
extrauterine life performed @ 1min and 5 min after Prevention of Hemorrhage
birth vVit K or phytomenadione
v10 min scoring = when 5min score is under 7 Ø IM; to prevent hemorrhage
v1 min scoring = cardiorespiratory function of the Ø Vit K = 0.5 mg
newborn, general condition and the need for
Ø phytomenadione = 1.5 mg
resuscitation (resuscitation must be done Ø to prevent bleeding due to deficiency in the clotting
immediately and not delayed for the 1min score) factor vitamin K
vneed for resuscitation can be more accurately Ø 0.5mg (preterm)
assessed by = eval of NBs HR, respi activity, and
Ø 1.5mg (term)
color than by the APGAR score Ø the NBs GI tract is initially sterile = no bacteria
v5 min scoring = detects the NBs adjustment to the such as E. coli to stimulate the prod of vit K
new environment, detects prognosis’ Ø neonatal hemorrhage = lack of cofactor to blood
vin Nursing care planning we use 2nd APGAR score
clotting Vit K
(5 min) § Central nervous system hemorrhage = occurs
v0-3 = poor; need resuscitation in infants not given vit K
v4-6 = fair; may need suctioning and oxygenation; § given in the anterolateral aspect of the thigh or
newborn is condition guarded the vastus lateralis
v8-10 = good; no signs of distress; admission care § alternate sites: medial thigh / rectus femoris
only; no special care
Page 82 Compiled by TEAM SHAWTIES
 WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Ø ideal dose = 1mg Maternal-Infant Bonding

Ø stock dose for phytomenadione: 10mg/ml: 0.1 ml vUnang Yakap (ENC)
per IM Ø promoting bonding, encourage breastfeeding right
on the DR table
Prevention of Infection Ø delay prophylaxis / Crede’s prophylaxis for 1- 2hrs
vCrede’s prophylaxis (in order not to interfere with the bonding process
Ø eyecare by prophylaxis against ophthalmia due to blurred vision which does not promote eye
neonatorum / gonorrheal conjunctivitis = contact)
neonatal blindness Ø eye contact = most important prerequisite to early
Ø legal responsibility given to NBs whether or not the bonding
mother has gonorrhea vEarly Rooming in
vDrugs: Ø an infant delivered by normal spontaneous
Ø Silver nitrate = can cause black staining delivery (NSD) may be roomed in = 30mins after
Ø Tetracycline birth
Ø Erythromycin = most common Ø an infant delivered through c section = 4 hrs after
Ø all medications can cause chemical conjunctivitis birth varying any infant complications /
in the eyes within the first 24hrs after application contraindications
Ø rinse eyes before application, no rinsing after
application Continue Further Assessment
Ø eyecare may be delayed in 1-2 hrs after birth in vcommonly used technique of gestational age
order not to interfere w/ the bonding process assessment
vCord dressing and daily cord care vassigns a score to various criteria and the sum of all
Ø strict asepsis to prevent is extrapolated to the gestational age of the fetus
Ø tetanus neonatorum (Clostridium tetani) vPhysical Maturity
Ø Omphalitis (nonspecific bacterial infection of the
cord)
Ø Check the # cord’s blood vessels: one big vein and
2 small arteries = single cord artery requires
evaluation for genitourinary / kidney anomaly
Ø drying up = 70% alc application 1-2x a day or PRN
Ø cord stump drops off by 7-10 days (on its own)
Ø silver nitrate cauterization = If the cord did not
drop

Infant Identification
vID Band bracelets or Foot Tags
Ø mother’s name, mother’s hospital number, date of
delivery, time of delivery, and sex of the baby
Ø identify NB properly in the delivery room and not
in the nursery Ø allows for the estimation of age from 26wks44wks
Ø the identification of the NB is done before the NB Ø the scoring relies on the intrauterine changes that
is separated from the mother: the fetus undergoes during its maturation
§ Prevent switching Ø how well the fetus has matured
§ Misidentification Ø depends on anatomical changes
§ Abduction vNeurological Criteria
Ø the nurse must be familiar with the infant security Ø depend on muscle tones
system used in the area of practice Ø response of the newborn
Ø home birth = identified properly before being Ø Physiological Hypotonia = the neonate is in a
transported to a health facility state of physiological hypotonia
Page 83 Compiled by TEAM SHAWTIES
 WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Ø this tone increases throughout the fetal growth: a Taking of anthropometric measurement of the
more premature baby would have a lesser muscle newborn
tone vWeight
Ø avg: 300-400g ranging 2500g – 4000g (max)
Ø most raw data by weighing the infant naked /
subtracting the weight of the clothes from the total
length of the clothes of the baby
vBody Length
Ø full term NB varies from = 18-22 inches; avg of
50cm from heel to crown
Ø Straighten the legs of the newborn
Ø Measure till the highest point of the head
vHead Circumference
Ø The frontal-occipital measurement (FOC) is
measured in cm with a measuring tape placed
around the largest part of the occipital area and
gathered over the forehead on top of the eyebrows
Ø Tape measure should be clean
Ø 33-38cm / 34-35cm = normal head circumference
range for term measurement
Ø 3 measurements should be done, LARGEST of the
3 is recorded by the nurse
Ø Hydrocephalus = 0.5-1inch / month or greater
than 1 inch per month of increase in
circumference; water in the brain
Ø Head is the biggest part of the body; ¼ of the
Ø each of the criteria in physical and neurological body’s length
maturity is scored 0-5 in the original Ballard’s vChest circumference
score Ø Range: 32-33cm
Ø scores then range from 5-50 with corresponding Ø Equal to abd circumference
gestational ages in weeks Ø Nipple line = landmark for chest circumference
Ø ^in score by 5 = ^in age by 2 weeks vAbdominal Circumference
Ø Range: 31-33cm
Cont. Immediate Newborn Care
vThe newborn is a child from the time of compete Breastfeeding
delivery until 28 days old vMost important infant feeding
vNeonatal stage = neonate vMaintain rooming in to promote breastfeeding
vDemand feeding = best feeding sched; feeding the
infant according to his biologic need for food
whenever he is hungry and not whenever he cries
vCrying is the only means of communication
vOral / feeding needs = essential for the foundation
of the development of personality (Freud’s
psychosexual dev’t theory); sense of trust
vFirst 6 months
vColostrum
Ø Thin, light yellow fluid present in the breast from
pregnancy into early post-partum
Ø First breast milk
Page 84 Compiled by TEAM SHAWTIES
 WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Ø Rich in antibodies and proteins compared to Ø Children born to mothers with active Hep B or
mature breast milk carriers will be given Hep B Hepatitis
Ø Binds bilirubin and acts as laxative to promote the immunoglobulin (HBIG) after birth + dosage of
excretion of meconium human Hep B vaccine + 2nd dose a week later
vTransitional Milk vDrug Abuse / Narcotic Amdection
Ø Produced after colostrum and immediately before vMothers that are positive w/ HIV antibody to avoid
mature milk postnatal transmission
vForemilk vHIV infection – to avoid pre-natal transmission
Ø Thin, watery milk secreted at the beginning of a
feeding Infant Contraindications to Breastfeeding
Ø Low in calories but high in water soluble vitamins: vNewborn conditions that will not allow normal
§ Vit B sucking, swallowing, grasping of the nipple
§ Vit C vDiagnosed inborn errors of metabolism may
vHindmilk necessitate cessation of breastfeeding
Ø Thick, high fat breast milk secreted at the end of a
feeding Pharmacologic Indications to Breastfeeding Would
Ø Highest concentration of calories Include:
vMature Milk vDrugs that pass into breast milk
Ø Breast milk that contains 10% solids for energy Ø Cocaine
and growth Ø Most medications appear only in small amounts in
Ø Compared to cow’s milk, breast milk is higher in breast milk
carbs, fat, and water content but lower in proteins, vDrugs contraindicated in lactating women
vitamins, and minerals. Ø May suppress lactation
vLactalbumin Ø Toxic effects have been reported or predicted on
Ø protein in human milk theoretical grounds
Ø better protein Ø Analgesics, anti-inflammatory, antibiotics
Ø easy to digest (chloramphenicol, isoniazine, tetracycline)
Ø hypoallergenic Ø Hormones: estrogen
vAntibodies Ø Iodine salts
Ø most important part of breast milk Ø Anticoagulants: reserpine
Ø protect the infant from common diseases of Ø Anti-neoplastics
childhood which his mother has immunity Ø Atropins
vIdeal feeding sched: q2-3hrs regardless the time Ø Drugs acting on the CNS
of the day and even when the newborn is asleep Ø Lithium
vPrerequisite of Breastfeeding Ø Mephrodomate (?)
Ø Physiologic readiness § Not contraindicated if the mother has inverted
Ø Absence of emotional stress nipples = use nipple guard
Ø Sucking (stimulates first let down reflex) § Cytomegalovirus (CMV) – is not a
Ø Rest, exercise & diet contraindication because milk has the
Ø Absence of contraindications appropriate antibodies to protect the infant from
this infection
Maternal Contraindication to Breastfeeding § The negative effects of smoking on an infant may
vSevere Cardiac Diseases – life-threatening diseases be offset by breastfeeding due to the effects of
vCancer – breastfeeding is incompatible with hormones in breast milk. A study suggest that
chemotherapeutic agents children w/ smoking mothers who were
vSevere debilitating disease and conditions (surgery) breastfeeding scored better in tests of mental
vAcute contagious diseases – Hep C virus but not Hep dev’t that those whose mother’s smoked and did
B virus not breastfeed. If the mother cannot and would

Page 85 Compiled by TEAM SHAWTIES

 WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024 MOTHER AND
CHILD CARE

not stop smoking, she should be encouraged to Different positions to assume while brea
breastfeed as long as she does not smoke while vMake her comfortable
vSafety of the newborn
Latch-on Position

vCradle position / cradle hold

Ø Traditional and most common hold when cradling
or cuddling the infant
Ø The mother cradles the newborn’s head in the
bend of the elbow of the non-dominant hand with
her forearm reaching around the outside of the
infant’s body to grasp outer leg -
Ø The mother’s dominant hand help support the
infant’s back and bottom
vCross- cradle position
Ø Similar or same to the cradle position however the
mother is using the dominant hand and the non-
dom hand supports the head and the breast
vFootball hold
Ø Safe and secure hold for shampooing NBs and
young infants and during breastfeeding as well
Ø Recommended if the mother is feeding twins
simultaneously
Ø Half the length of the NB’s body is supported by
the forearm while his head and neck rests on her
palm
Ø The buttocks and legs are firmly wedged between
the mother’s elbow and hip
Ø Leaves the mother with a free hand to shampoo
the hair, or grasps something, or other essentials
while carrying the NB
Page 86 Compiled by TEAM SHAWTIES
 WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024 MOTHER AND
CHILD CARE

vLaid back positions vCheck water temp

Ø Not ideal because mother might fall asleep in this Ø Fill basin w/ two inches of water that feels warm
position not hot to the inside of the wrist / elbow
Ø Mother must not fall asleep while breastfeeding Ø If filling the basin from tap = turn cold on then off
the baby = the baby might fall or the baby may not last to avoid scalding the child
be attended to Ø Keep the baby warm
vSide lying position Ø After undressing the NB place him in the water
Ø The baby is placed on the bed while the mother is immediately so that he doesn’t get chilled
feeding and is positioned in the lateral side facing Ø One of the hands to support the head, the other to
the baby guide in = feet first’
Ø Important to indicate = infant head has to be Ø Use soap sparingly = soap can dry baby’s skin
elevated to prevent aspiration during feeding Ø If a cleanser is needed for heavily soiled areas =
vShoulder Hold use mild, neutral ph soaps w/o additives
Ø After feeding burp the baby = shoulder hold. Ø Clean gently
Ø Burping or bubbling an infant Ø Soft cloth can be used carefully so as not to scrub
Ø Using two hands the mother holds up the infant or tug the skin
against one side of her chest and a shoulder Ø Massage the scalp gently even the areas over the
Ø One hand supports the infants buttocks while the fontanels or the soft spots
other hand supports the infants head and upper Ø After bathing:
back § Towel around the head and body to help him
Ø In burping: stay warm while he is still wet
§ The hand supporting the head and upper back Ø Ensure safety from trips or falls
may be momentarily withdrawn to pat the back vSleep
gently from the waist upward to the shoulders Ø The avg NB sleeps much of the day and night
§ Repeat until the infant burps waking up only q few hours
Ø May be hard for the new parents since there is no
Bathing set sched for the newborn at first
vWHO suggests delaying the baby’s first bath until Ø Many NB have their days and nights confused they
24hrs after birth or waiting at least 6hrs if whole day think that they are supposed to be awake at night
is not possible and asleep during the day
vTHINGS TO CONSIDER: Ø Generally a newborn sleeps a total of: 8-9hrs in the
vBody Temp and blood sugar of the NB day time, 8hrs at night
Ø Babies who takes bath right away may become Ø Small stomachs = awaken q 2-3hrs for feeding
cold and develop hypothermia Ø Most babies don’t start sleeping through the night
Ø The minor stress in the first bath = drop in blood until 3monthsof age (can vary, some can be up to
sugar / hypoglycemia one year)
vBonding and breastfeeding Ø Most cases: Baby will wake up ready to eat q 3hrs
Ø Taking the baby for a bath too soon can interrupt Ø How often to feed depends on what the baby is
skin to skin mother child bonding, and early being fed and his age
breastfeeding success Ø Watch the sleep pattern
vDry skin Ø Sleeping consistently waking up more often = may
Ø Vernix = white waxy substance that coats a baby’s be a problem
skin b4 birth acts as a natural moisturizer and Ø Growth spurt and needs to eat more often = sleep
anti-bacterial properties disturbances are caused by changes in dev’t or
Ø Best to leave vernix on the newborn skin for a overstimulation
while to help prevent their delicate skin from Ø SIDS =Sudden Infant Death Syndrome
drying out § Unexplained death usually during sleep
Ø Important for preterms (skin is highly prone to § Seemingly healthy baby less than a year old
injuries) § Aka “crib death” – infants die in their death
Page 87 Compiled by TEAM SHAWTIES
 WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024 MOTHER AND
CHILD CARE

§ Unknown but linked to a defect in a portion of § 10

the infant’s brain that controls breathing an § increase in response to dietary intake and
arousal from sleep bacterial colonization of the intestine
Ø NCM OF SIDS vAnticoagulant coumadin or warfarin - not given to
§ put baby to sleep on their backs, not prone pregnant women as it crosses the placental barrier
position or side position and accentuates existing vitamin K dependent
§ keep stuffed toys and fluffy blankets out of the factors deficiencies
crib (not overheating the baby) vHEPARIN - If there is a need for vit. K therapy in
§ no smoking during pregnancy pregnancy; safe drug to use is as it does not cross
§ no smoking around the baby the placental barrier

Cardiovascular System
vdecreased pulmonary artery pressure
vBV = 300ml
vAcrocyanosis
Ø Pink body, bluish limbs
Ø Normal in first 24hrs of life
vHigh RBC, HCT, & WBC (increased destruction)
Ø Hemolysis
Ø Umbilical vein, arteries, and ductus venosus close
with clamping of cord Respiratory System
Ø Foramen ovale and ductus arteriosis close vObligatory nose bleeders, meaning infants breathe
functionally with establishment of respirations through their nostrils
caused by increased pressure in the left side of the vInitiation of respiration is caused by different
heart as a result of increased pulmonary blood factors:
flow Ø Increased CO2
Ø Only becomes permanently anatomically closed Ø Decrease of oxygen, thus having low pH
after 3-4 months and explains why murmurs can Ø Decreased pulmonary vascular resistance
be observed at the first month of life Ø Increased pulmonary blood flow
vApical pulse - detected at the level of the third or Ø Decreased alveolar surface tension from adequate
fourth interspace to the left midclavicular line, and surfactant
normal rate would be 110-160bpm Ø Recoil of chest causing replacement of fluids
Ø Pulses reflect systemic circulation and easily Ø Change from weightlessness to gravity-controlled
palpable pulse can be found in the femoral and environment
brachial pulse sites vRespirations may be irregular with short periods of
Ø Difficult to palpate temporal and radial pulse for apnea
newborn infants vAt times shallow, abdominal, nasal, quiet, and rapid
Ø Initial sterility of infant’s GIT is absent which at 30-60 cycles per min
results to low levels of vit K = possibility of bleeding vMonitor rr = look into abdomen
Ø Cow’s milk - for bleeding; restores prothrombin vSURFACTANT - a requisite for mature long
time faster than breastmilk because breastmilk functioning
contains only a quarter of the amount of vit K per vRespiratory secretions may be abundant
deciliter of cow’s milk vRETRACTIONS - Look into for indications for high-
Ø Coagulation factors - synthesized in the liver and risk newborns; intercostal retractions and sternal
activated under the influence of vit. K retractions
Ø Vitamin k dependent factors such as factors: vBluish or cyanotic mucous membrane / central
§ 2 cyanosis- most reliable indication that inborn is
§ 7 having low O2 saturation which demands urgent
§ 9 attention due to hypoxia or congenital defects
Page 88 Compiled by TEAM SHAWTIES
 WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Gastrointestinal System usually after feeding while bottle fed stool is

more formed, light yellow, and foul-smelling
§ PHOTOTHERAPY STOOL: greenish due to the
evacuation of bilirubin
§ BILE-DUCT STOOL: grey due to decrease in
bile
§ LACTOSE-INTOLERANT STOOL: watery and
lose

Urinary System
vNewborn often spits off mucus in the first 24 hours vMust void within 24hrs
regurgitation and is common in the first 3 months Ø Immature kidneys - Pale yellow due to lesser
vCalatia = immature or relaxed sphincter of the concentration
stomach would cause self-limiting or vomiting; Ø Cloudy - to high albumin content
Common in the first 3 months v15mL/void on the first day
Ø Nurses need to emphasize the importance of small v300mL/day first week
frequent feedings with infant in a semi-upright v6-10 times a day initially and 20/day on the second
position week
Ø Avoid overfeeding to avoid regurgitation and vIncreased uric acid in urine and red spots on diaper
vomiting are normal and occasional signs
vGastric capacitation of the stomach = 45-60mL
Ø Compute gastric capacitation through age of Immune System
newborn in months + 2 ounces vImmature
Ø Only simple carbohydrates and proteins can be vLacks competency of localizing infection
digested Ø Omphalitis (local infection of the cord) may readily
Ø Cannot digest fat due to insufficient lipase become systemic neonatal sepsis
vLiver vCapable of some body responses to immunizing
Ø Immature agents
vPHYSIOLOGIC JAUNDICE vFever
Ø decreased liver enzyme glucorenal transferase Ø may have infection not infection but dehydration
resulting to poor bilirubin conjugation, resulting vNeonatal sepsis
to Ø may have hyperthermia or hypothermia as
Ø Normal blood sugar: 30-50mg/dl manifestation
Ø Caloric requirement: 400cal/day vIgG
Ø Benefit from IgA, enzymes and lactobacilli from Ø offers passive natural immunity for major and
breastmilk communicable diseases provided mother is
§ 17.5 ounces of fluid per day immune; transferred through placenta
Ø Stomach empties around every 3hrs vIgM
Ø Secrete meconium, more solid consistency with Ø produced at 12 weeks
solid foods vIgA - secretory produced from breastmilk, protects
§ MECONIUM: black or dark green, passed during from some infection especially GI infections that
the first 24hrs – 48hrs or second period of cannot be destroyed by GI enzymes
reactivity which is 4-6hrs vEven if baby is breastfed, immunization is still
§ TRANSITIONAL STOOL: lose, greenish or yellow needed because available antibodies from placenta
or brown, passed within 2-4 days. Resembles and breastmilk is temporary
diarrhea but is normal vBCG and hepatitis B vaccine
§ MILK STOOL: from breastfed or bottle feeding, Ø immediately after birth
passed within 4-6 days, breastfeed stool is vthe rest are completed as scheduled before first
golden, yellow, mushy and sweet smelling and is birthday
Page 89 Compiled by TEAM SHAWTIES
 WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Ø Neonatal sepsis - undue lethargy, poor feeding,

unstable body temp, vomiting
Ø Breastfed infants have increased jaundice due to
pregnanediol = render glucorenal transferase as
ineffective
Ø Breastfeeding may be stopped for 12- 24hrs due to
severe breastfeeding jaundice, phototherapy may
be used
Ø Look into sclera, it would also turn yellow
vPallor
Ø Unlikely for newborn to be pale due to fetal
polycythemia
Ø May be due to anemia
§ identify by blanch the forehead or chest region
Physical Assessment to detect presence of jaundice -
vVital Signs Ø Anemia and hyperbilirubinemia - are
Ø Respiratory Rate characteristic signs of erythroblastosis fetalis
§ Observing the rise and fall of the abd counting to Ø Hypothermia, hypoglycemia, and newborn
a whole minute bleeding Reddish plethora or ruddy
§ 30-60 cycles/min Ø Plethora- hematocrit greater than 70%
vPulse Rate Ø Polycythemia -or elevated RBC give rice to ruddy
Ø Apical pulse = ideal way to take pulse; 3rd -4th or reddish color
intercostal space, left of the clavicular line Ø Red and wrinkled is common among pre-term
Ø 120-160bpm Ø Red and smooth is common among term babies
Ø Observe abdomen and count for 1 full minute vGreenish skin
vBlood Pressure Ø Stained by meconium due to chronic fetal hypoxia
Ø Rarely done, only if newborn has cardiac Ø Green, dry, parchment-like: postmature and
problems chronically hypoxic due to aged placenta
vTemperature
Ø Axillary
Ø 36.5-37.5 C
vSkin Assessment maybe darker if with more
pigmentation, and depends on
Ø Skin is usually pinkish the race of the newborn
Ø Cyanosis
§ look into mucous membranes, most reliable
indicator of central color in all babies
§ central cyanosis = occurs in tongue and mucous vPhototherapy
membrane, demands urgent attention; low O2 Ø Blue light and bili blanket
sat levels; hypoxia / congenital defects Ø transfers bilirubin from skin to blood then to the
Ø Jaundice bile then passed through stool
§ may be pathologic or psychological Ø 3-6 fluorescent light tubes with a total strength of
§ First action is to determine newborn’s age 200-500 candles
§ Pathologic: first 12-24 hours due to hemolytic Ø Photo discomposition = is an alternative route for
disease or erythroblastosis fetalis conversion - is a normal alternate route of bilirubin conversion
§ Physiologic: more than 24hrs or 2-7 days, due Ø Exposure to light increases rate of conversion
to immature liver. Prevent cold stress, provide Ø Place newborn 16 inches away except when we use the bili
early feeding to increase excretion blanket
Ø Preparation:
• Head chest first, it manifests in the head then progresses to § Undress newborn and cover eyes to prevent
the chest
• Blanche chest or and head region retinal damage
Page 90 Physiologic jaundice occurs after 24 hours Compiled by TEAM SHAWTIES
 WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024 MOTHER AND
CHILD CARE

§ Cover genitalia for possible painful penile Nevus Flammeus: Stork Bites
erection and sterility (PRIAPISM)
§ Eyes must be closed before putting cotton balls
and additional dressing to prevent corneal
damage
Ø Regular care during treatment
Ø Follow regular feeding (q2-3hrs)to prevent
metabolic acidosis
Ø Cuddle and remove eye dressing during feeding to vNape and behind the ears of the newborn
give ample sensory stimulation vLesions around nape and ears may fade
Ø Turn q 2hrs for max exposure to skin surfaces -
Increase sterile fluid intake in between feedings Strawberry Hemangiomas
Ø Monitor temp. every 2 hours
Ø Heat must be turned down when temp reading
Ø Hyperthermia - added heat from radiation of
phototherapy
Ø Assess for side effects and manage as necessary
Ø Explain to parents that having bronze skin is
temporary
Ø Dark colored urine is expected, thus, increase
fluids
Ø Bright green, loose stools - due to excess bilirubin
excretion
Ø Turn of lights when blood is extracted for serum vFormed by immature capillaries and immature
bilirubin determination and obtain darkened endothelial cells present at birth
container for blood specimen for accurate vMay be present up to 2 weeks after
determination. (Bilirubin is destroyed by light) vMay continue to enlarge up to 1 year
vHarlequin sign this is when the newborn is placed on the side; the lower
dependent portion of the body is darker in shade than the upper vShrinks or absorbs
Ø Lower body is darker than the upper due to vAt 5 years old, 50-75% would have disappeared
sluggish peripheral circulation vComplete absorption at 10 years old
vBirthmarks or hemangioma
Ø Vascular tumors of the skin
MONGOLIAN SPOTS

Nevus Flammeus: Port-Wine Stain

vBenign and self-limiting skin mark

vMacular purple or dark-red lesion vGreyish or blue patch in the buttock or sacrum
vPresent in birth and generally over the face /thigh vResults from the collection of pigments or
region melanocytes
vFades over the nose some does not fade overtime
Page 91 Compiled by TEAM SHAWTIES
 WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024 MOTHER AND
CHILD CARE

vDisappears within 1st-2nd year or as late as school Forceps Mark

age vMinor injury from forceps delivery due to pressure of
Lanugo forces
vTemporary weakness or facial palsy in one side
vMinor marks are normal and temporary
vRare complications

-> facial paralysis

on one side

vFine hair on the shoulders, back, forehead, upper

body, cheeks
vMore in the pre-term and gradually disappears close
to term
Milia
Desquamation vWhite/ yellow papules on the nose, cheek chin and
vDry peeling of the skin on the forehead
vpalms and soles of the feet vDue to the obstruction, immature, and blocked
vMore on post mature newborn sebaceous glands
vRequires no treatment vNeeds no treatment and disappears on its own

Head Assessment
Erythema Toxicum vRound and symmetrical with molding
vNewborn rash vMolding: reduction of 0.5-1cm in the fetal head size
vWhite or pink popular ras 24-48 hours after birth or the biparietal diameter is normal
vBenign and disappears within a few days vHead will return to normal in 2-3 days
vHarmless but must be differentiated from rashes in vNewborn may have head injuries and sutures and
infection fontanels must be patent
vTo confirm diagnosis, a smear of aspirate will show vHead moves from right to left, up to down
numerous eosinophils which indicates an infection vWith silky hair
vCaput succedaneum and cephalhematoma = are
common variations
vMacrocephaly: frontal occipital circumference
greater than 90% -
vMicrocephaly: less than 31.7cm, head is smaller
than chest, small brain
vHydrocephaly: head is excessively large due to
increased amount of CSF
vAnencephaly: absence of cranial bones usually
incomplete
Page 92 Compiled by TEAM SHAWTIES
 WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024 MOTHER AND
CHILD CARE
FONTANELLES
vVision is focused on human face
vCan see clearest at 8-10 inches distance
vGross vision may be examined by holding examiner’s
face 8-10 inches from the newborn’s face and
determine infant’s ability to direct his gaze to the
nurse’s face
vNewborn can fixate and track for short distance to
midline with some degree of color and pattern
discrimination

v Posterior fontanel closes at 2-3 months of life Subconjunctional Hemorrhage

vAnterior fontanel closes at 12-18 months vRed spot on the sclera due to the rupture of small
vFontanels give an idea of hydration status of capillaries during delivery and is absorbed in about
newborn 2 weeks
vSunken: dehydration
vBulging: high ICP (intracranial pressure)

Craniotabes
vDemineralized skull or softening of skull
vindented with gentle pressure like a table tennis
ball
vmild degree near the suture line: normal
Strabismus
vover most of the skull: calcification deficiency such
vPoor neuromuscular control or coordination
as osteogenesis imperfecta or syphilis
vCondition where there is an occasional crossing of
eyes due to the normal immaturity of eyes muscles
vControl is obtained in about 3-4 months

Eye Assessment
vEyes evenly placed on the face with outer canthus in
line with the upper border of the ears
Doll’s eyes
vBest way to inspect eyes is to hold the infant up and
vMoving of the eyes to the opposite direction as the
tip the head gently forward and backward better
position of the head is changed to the left and then
than forcing the eyelids open
to the right
vBright and clear blue or greyish true color appears
vPresent for about 10 days after birth Mouth
in 2-3 months
assessment
vPupils should be equal in size
vSclera should be white
Ø blue may mean osteogenesis imperfecta which
affects bone structure integrity and cause rupture
there is increased bilirubin, and prompt
Ø yellow may mean jaundice intervention would be to perform phototherapy
vCrying is tearless because of immature lacrimal
structures; fully functional at 2 months
vVision of newborn (pupillary and blink reflexes –
response to bright light) are present after 28 weeks
gestation
Page 93 Compiled by TEAM SHAWTIES
 WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Mouth Assessment vMild but uncomfortable or painful

vShould be closed and opens only when crying vProbably started in the birth infection as a yeast
in the birth canal
vLips should be equal, complete with symmetrical infection
movement
vTongue should be midline and free moving and not
tongue tied
vLingual frenulum protrudes forward
vTaste is present at birth but prefers sweet over bitter
taste
vPalates should be intact; variation would be cleft
palate
vSaliva is scanty and increases with the development Chest to genitalia assessment
of salivary glands at about 3 months wherein vChest should be symmetrical and should have
drooling starts uniform movements
vEpstein pearls - Small epithelial cyst pearls vBreath sounds are clear and equal at both sides
disappear at 1-2 weeks vHR should be 120-160 bpm
vdown syndrome - Open mouth with a tongue vMay have functional low-pitched musical murmurs
protruding in states may mean heard just to the right of the apex of the heart,
vesophageal atresia - Frequent or excessive drooling common in the first month of life
despite of frequent feeding. vForamen ovale and ductus arteriosis take 2-3mos to
voral thrush - White, cheese-like substance on the permanently and anatomically close
tongue. vACYANOTIC HEART DEFECT = Increased
murmurs and fatigue manifested by brow sweat
Epstein Pearls when sucking / feeding should be referred for
vSmall epithelial cells on the hard palate that further investigation
disappears after 1-2 weeks vCough reflex is not present at birth and appears 2-3
days
vWITCH’S MILK = Breasts enlarge with milky
secretions, resulting from maternal hormones;
common in both sexes, part of self-limiting genital
crisis in newborn; occurs on the 3rd day and may
last up to 7 days after delivery
vLabia majora of female infants should be
symmetrical, slight edema to cover the labia minora
Natal Teeth and may have vernix caseosa between folds; must be
vRarely are supernumerary teeth cleansed to avoid bacterial growth
vAlmost always genuine primary lower incisors vPSEUDOMENSTRUATION = normal, occasional,
vMinimal length of root development, greyish and blood-tinged blood vaginal discharge due to
hypermobile maternal hormones part of female genitalia crisis;
vMay irritate the baby’s tongue during sucking or clitoris may be enlarged
irritate the mother’s nipple during breastfeeding
vRisk for aspiration - Usually extracted Cremasteric Reflex
vCremaster muscles = contract and draw the testes
Oral Thrush out of the scrotum temporarily = retractile testicle
vType of yeast infection that typically appears as vCommon for young boys or newborns, especially
white or yellow irregular patches or sores that coat during physical examinations which triggers reflex
the baby’s gums and tongue along with the sides and vCREMASTERIC REFLEX = Elicited by gently
root of the mouth stroking a finger on the inner thigh and the muscles
vCaused by yeast or fungi called candida albicans will pull the testicles upward
Page 94 Compiled by TEAM SHAWTIES
 WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024 MOTHER AND
CHILD CARE

vBARLOW TEST = identifies loose hip that can be

pushed out of the socket with gentle pressure
vApprox. 80% of barlow positive test will resolve
spontaneously in the first few weeks of life
vMinor degrees of instability can be treated my
multiple diapers followed by an UTZ study at 6
weeks of age

Assessment of extremities
vGood muscle tone, flexed and should resist having
extremities extended
vArms and legs should be equal in length
vLegs should be shorter than arms
Neuromuscular Assessment
vDigits should be complete, 5 on each hand and foot
vReflexes = are involuntary movements or actions
with nails
vPOLYDACTYLY - Excess fingers or toes vSome are spontaneous, others are responses to
vSYNDACTYLY - Webbed fingers or toes certain actions
vSome reflexes occur only during specific
developmental stages -
vTo check if the brain and NS is working well
vAbsence of newborn reflex at birth or persistence of
a reflex past a certain age may indicate a problem
with the CNS function
v TALIPES EQINOVARUS/“CLUBFOOT”
vPositional =can easily be returned to midline, no
Classification of Newborn
treatment needed
vTrue

Barlow and Ortolani Test

vDetects presents of hip displacement
vORTOLANI TEST = identifies dislocated hips that
can be reduced in the socket or acetabulum, vAGA
describes feeling of reduction as a hip click and Ø Appropriate for Gestational Age
translation is interpreted as sound instead of Ø Weighs 10th-90th percentile
sensation of the hip moving to the socket when it vSGA
relocated, rarely detectable sensation after 6 weeks Ø Small for Gestational Age
and should not confused with snapping Ø Weighs below 10th percentile
vPositive ortolani test (hip is dislocated) should be Ø Dysmaturity, fetal growth restriction, or
treated to keep hip in socket until stability is intrauterine restriction (infants who @ measure
established less than the 10th percentile)
Page 95 Compiled by TEAM SHAWTIES
 WEEK 8 – IMMEDIATE CARE OF THE NEWBORN
Miss Caprecho || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Ø Risk for stilled birth, perinatal morbidity, adverse Ø Send specimen to newborn screening laboratory
effects in adulthood, disruption of parent infant Ø For home deliveries baby may be brought to
bonding nearest NBS
vLGA Ø Follow up results are available within 7-14 weeks
7-14 working days
Ø Large for Gestational Age after submission of specimen (not weeks)
Ø above 90th percentile Ø Negative screen: extremely low risk of having any
vLBW disorders being screened screen
Ø Low birth weight Ø Positive screen: high risk for having one of the
Ø Birth weight less than 2,500 grams disorders screened and must be brought to
Ø Independent of gestational age assessment hospital for confirmatory test

Newborn Screening Hearing Screening

vEssential for early detection and management of vRepublic Act no. 9288 otherwise known as
congenital disorders which may lead to mental Newborn Screening Act of 2004
retardation or death if untreated Ø to ensure that all infants born are screened before
vEarly diagnosis and long-term care is essential for discharge
normal growth vInfants who do not pass the initial screening test will
vAvailable in PH for 1996: be referred to proper treatment
Ø Phenylketonuria (PKU) vSupport is provided for families
Ø Methylmalonic acidemia vHeel prick method and hearing screening using
Ø Maple syrup urine disease (MSUD) otoacoustic emissions (OAEs)
Ø Tyrosinemia
Ø Citrullinema
Ø Medium chain acyl CoA dehydrogenase (MCAD)
deficiency
vExpanded screening includes 22 more disorders
such as hemoglobinopathies, and additional
metabolic disorders namely organic acids, fatty
acids oxidation, and amino acid disorders
vNewborn screening = should be done after 24 hours
of life but not later than 3 days from complete
delivery
vIdeally done on the 48th hour
v If done earlier than 24th hour, baby must be
screened again after 2 weeks for more accurate
results
vHigh-risk babies in the NICU may be exempted from
3 day requirement but must be tested within 7 days
vHow it is done:
Ø Explain procedure to parents and collect the blood
specimen
Ø Done by a physician, medtech, or after training—
nurse or midwife.
Ø Heel prick method: to obtain few products of
capillary blood from baby’s heel and blot on a
special absorbant filter paper
Ø Drying time of blood is 4 hours
Ø NBS fee is P550 for regular NBS, maximum fee for
specimen collection is P50
Page 96 Compiled by TEAM SHAWTIES
 WEEK 11 – POSTPARTUM CARE
Mrs. Emma Dotillos || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Care of a PostPartum Mother § Post-partum depression may set in

vPUERPERIUM - Latin word puer “child”, parere “to § Readjustment of relationship = for easy
bring forth” transition
Ø Refers to 6 week period after birth
Ø 2 types of changes: Rooming In
§ Retrogressive = involves the returning of the vThe more time a woman has to spend with her baby
uterus and vagina to its non pregnant state = the sooner she will feel competent in childcare
§ Progressive = production of milk, restoration of vSound mother-child relationship
normal mens cycle, beginning of parenting role vInfant stays in the room with her mother rather than
vPOSTPARTUM = 4th stage of labor also known as the
FOURTH TRIMESTER
in a central nursery
Ø 3 stages: vMother can become better acquainted w/ her child
§ Immediate postpartum = 1st 24 hours after vCan give confidence when taking care of her child
delivery vAllows the father and siblings can hold and feed the
§ Early postpartum = 1st week after delivery infant when they visit this is for both complete and partial rooming-in
§ Late postpartum = 2-6 weeks after delivery vHelp a couple retain instructions and anticipatory
guidance in the care of the newborn = nurses
Psychological Changes during the Post-Partum demonstrate bathing, feeding, and changing
vChanges are crucial within the first 24 hours of v2 Types:
These changes might affect the woman permanently Ø Complete rooming - in
postpartum if not given appropriate attention and care.
vMay become permanent if not give appropriate § Mother and child is together 24hrs a day
attention and care Ø Partial rooming-in
v3 Phases: § Infant remains in the room of the mother most
Ø Taking in Phase This is the time for reflection of the woman of the time (daytime)
§ 2-3 days after delivery § She will then be taken to a nursery near the
§ The woman is passive mother’s room/central nursery at night.
§ Dependent on the caregiver w/ daily task and
decision making (after pains, extreme Sibling Visitation
exhaustion and fatigue of childbirth) vPreparation is as painful to the mother as it is for
§ Self-centered her children SEPARATION, not preparation
§ Reliving birth experiences vWaiting at home for their mother and telephone
§ Regaining physical strength and organize reports of what their new brother / sister looks like
thoughts on roles = very difficult for older children
§ Encouraging women to talk about labor and vAllowing visits reduces the feeling that their mother
birth will help them adjust and incorporate it in her new cares more about the new baby than about them
life
Ø Taking - hold Phase vRelieves the impact of separation
§ 3-10 days after delivery vHelp make the baby part of the family
§ Regaining autonomy (take action on their own vMake sure of the ff:
and make decisions) -> without relying on others Ø URT illnesses
§ Open to health teachings Ø Contagious diseases
§ Women on anesthesia gets to this phase only Ø Recent exposure to chickenpox
hours after birth vMake them wash their hands if they want to hold
§ Actively learn newborn care and touch the newborn w/ parental assistance
§ Demonstrate to the mother, and watch her do a vSome hospitals may require covered gown this is worn by
the older siblings
return demo vCaution women that opinions of a new brother or
§ Needs positive reinforcement = may feel insecure sister expressed by her children may not be
about the care for her child complementary
§ Let the women settle in gradually on her own vappearance of the baby is not what the older child
Ø Letting-go Phase expected = establishing strong relationships, should
§ Recognition and adjustment to new role be encouraged
Page 97 finally, accepts her new role and gives Compiled by TEAM SHAWTIES
up her old roles
 WEEK 11 – POSTPARTUM CARE
Mrs. Emma Dotillos || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Postpartum: Maternal Concerns Ø cause of hormonal changes = decrease in estrogen

vAbandonment and progesterone that occurs in the delivery of the
Ø many mothers feel abandoned and less important placenta
after giving birth Ø it may be a response to dependence and low self-
Ø an hour before they were the center of attention; esteem:
during the birth of the baby the baby becomes Ø exhaustion
chief interest Ø being away from home
Ø make a woman confused; sensation close to Ø physical discomfort and tension due to assumed
jealousy new role
Ø help by verbalizing the problem: “how does it make Ø no support from partner
you feel?” Ø tearfulness, feeling of inadequacy, mood liability,
Ø the sensation is normal although, uncomfortable anorexia, and sleep disturbance
Ø For the father: may also feel what the mother feels Ø sudden crying episodes = normal
Ø when a NB comes home, father may become Ø 30% of women experience a more serious sadness
resentful of the time the mother spends with the at birth; requires formal counseling or psychiatric
infant (e.g. sitting at the table to talk about their care= POSTPARTAL DEPRESSION
day mother is hurrying to feed the baby) Ø Nursing Care Management
Ø Nursing Care Management § support from health care professionals help the
§ help them accept and understand that parents understand that this response is
parenthood is compromise in favor of the interest normal
of the baby § verbalize feelings
§ teachings start during the pregnancy or in the § make as many decisions as possible = sense of
early post-partum period confidence
§ making infant care and shared responsibility can § not all postpartal women cry because of baby
help alleviate these feelings and makes both blues = may have other reasons:
partners feel equally involved • overwhelming problem at home
vDisappointment • financial problem
Ø disappointment in their baby § keep lines of communication open = differentiate
Ø couple imagined a cute, chubby-cheek, curly problems that can be handles well with
haired, smiling baby girl/boy instead they have a discussion, concerned understanding, and those
skinny baby, no hair, cries constantly that should be referred to the social service dept.
Ø diff. for parents to feel positive immediately about
the baby who does not meet their expectations. Postpartum: Psychological Changes
Ø Nursing Care Management vUterus
§ accept that they can never change the sex, the Ø involution completes in 6wks = reproductive
size or the look of their child organs return to nonpregnant state
§ change the feeling of the parents by handling the Ø 1 finger breadth per day; non-palpable on 10th day
child warmly = you find the infant satisfactory / Ø AFTERPAINS contraction of the uterus - the areas
special where the placenta implanted is sealed off to avoid
§ comment good points on the child: long fingers, bleeding.
lovely eyes, good appetite Ø The areas where the placenta implanted is sealed
§ have a key person offer support and help them off to avoid bleeding
towards acceptance / take a clearer look into Ø Contractions = allow the uterus to go to its normal
their situation and begin to cope size quickly; prevent hemorrhage
vPostpartal Blues as many as 50% of women
experience overwhelming sadness Ø Nursing Consideration
Ø overwhelming feeling of sadness = may burst into § Monitor for Postpartum hemorrhage
tears easily or feel let down, irritable § Involution occurs more quickly in women who
Ø temporary feeling are more nourished and ambulate early after
birth.
Page 98 Compiled by TEAM SHAWTIES
 WEEK 11 – POSTPARTUM CARE
Mrs. Emma Dotillos || BSN || BATCH 2024 MOTHER AND
CHILD CARE

vLochia vAbd must be assessed to prevent damage of the

Ø Vaginal discharge after giving birth: bladder = over distension -> back to
§ Blood vDecrease blood vol = 1st – 2nd week of birth normal level
§ Mucus vHematocrit levels go to pre-pregnancy = 6 weeks
§ WBC after birth
§ Fragments v^Leukocytes and plasma fibrinogen = 1st
§ Bacteria postpartum week; defense mechanism against
Ø Vaginal discharge after giving birth: infection and hemorrhage
Ø Typically continues from 4-6weeks after birth vPain upon bowel evacuation: passage of stool may still be slow
Ø Lochia Rubra =3-4days postpartum; red; blood Ø relaxin present in the bowels;
discharge - Ø Pain in episiotomy difficulty in sleeping-> for several
months of pregnancy due to
Ø Lochia serosa = brownish, pinkish discharge; 4th vStriae gravidarum lightens unable to find a comfortable
day; amount of blood and tissues decreases vExhaustion position in bed because of fetal
activity and presence of back
Ø Lochia Alba = 10th day; discharge decreases; looks Ø As soon as birth is completed ache or leg pain
colorless, whitish, or yellowish; may last until the Ø Difficulty in sleeping while pregnant
3rd week after birth Ø During labor she has worked very hard
Ø Nursing Considerations: Ø SLEEP HUNGER = makes it difficult for the mother
§ Lochial Flow: to cope w/ the new experiences and stressful
• Scant – less than 2 inches stain on the pad situations
• Light – 4 inches stain on the pad vWeight loss – losing 19lbs
• Moderate – more than 6 inches stain on the Ø At birth = 12lbs weight loss -
pad Ø 2nd – 5th day after birth = diuresis and
• Heavy –large; appear more than 6 inches and diaphoresis = 5lbs weight loss
saturated in an hour Ø Lochial flow = 2-3lbs weight loss
• If with offensive odor = retained placental Ø TOTAL: about 19lbs vital signs changes in the postpartum
fragments v^clotting factors period reflects internal adjustments that
occur as the woman's body returns to its
• PUERPERAL SEPSIS = scanty with putrid odor vTemperature pre-pregnancy state
accompanied w/ fever and pyrexia Ø Never get rectal temp during puerperium = risk for
• Normal blood loss for Spontaneous Vag vaginal infections and rectal intrusion
Delivery = 300-500 ml Ø Dehydration – slight increase in temp after birth;
fluids for 24hrs = elevated temp will return to
• C section = 800-1000 ml
normal
§ Cervix
Ø Breast engorgement – breast fill with milk on 3rd
• Internal and external os
or 4th postpartum day = temp rises for a period of
• Soft and malleable immediately after birth
hours due to increased vascularity in the breast If
• Contraction of the cervix = return to
high temp lasts for more than a few hours =
nonpregnant state
infection
• At the end of the 7 days = external os is
Ø Puerperial infection – fibril episode after the 1st
narrowed to the size of a pencil opening; slit-
temp = infection -> postpartum infection
like or star-shaped
vPulse
vEstrogen and progesterone drops (when placenta is
Ø Slightly slower than normal
no longer present) = ^FSH
Ø Increased BV returning to the heart = stroke vol
vFSH remains low for 12 days then starts to increase
increases = reduce pulse rate
to signal the start of new mens cycle
Ø 60-70bpm
vEstrogen and progesterone levels return to pre-
Ø Diuresis diminishes = BV falls = pulse rate rises
pregnancy = a week after birth
Ø By the end of the 1st week the pulse rate will have
vHPL an d HCG are insignificant in 24hrs
returned to normal
vDiuresis (ridding the body of excess fluid)=
Ø NOTE: monitor the pulse closely
3000ml/day to get rid of the accumulated excess fluid
during pregnancy § Rapid, 3D pulse = hemorrhage
Page 99 Compiled by TEAM SHAWTIES
 WEEK 11 – POSTPARTUM CARE
Mrs. Emma Dotillos || BSN || BATCH 2024 MOTHER AND
CHILD CARE

vBP precaution on medications § III – day 10 to weaning PP; mature milk supply
Ø Decrease in BP = bleeding is driven by oxytocin and progesterone
Ø Elevation above 140 mmHg systolic, 90 mmHg § IV – after complete weaning PP until breasts
diastolic = development post-partal pregnancy involute
induced hypertension vEndorphins and oxytocin - help mitigate and reduce
Ø Unusual but serious complication of the the risk oof developing PP depression
puerperium vMaternal Reflex in Breastfeeding
-> drug frequently administered during postpartum period
vOxytocin to attribute uterine contraction Ø Prolactin reflex (milk secretion reflex)
Ø Can cause contraction in all smooth muscle § ^prolactin stimulates the alveoli, specifically the
including blood vessels acinae cells and milk is produced in the milk
Ø Can increase BP tubules
Ø Measure BP before administering § ^levels of estrogen and progesterone = induce
Ø If above 140 mmHg = hold the drug; notify the alveolar and duct growth
physician = prevent hypertension / § In pregnancy, milk sec is not stimulated because
cerebrovascular accidents of low prolactin and ^estrogen secretion by the
Ø Orthostatic hypotension placenta
§ Women who loss a lot of blood Ø Letdown reflex (drought reflex)
§ Dizziness due to lack of adequate BV to maintain § Oxytocin induced
nourishment to the brain cells § The act of sucking a lactating breast stimulates
Ø Advice: for example, from lying down the flow of milk
to sitting down -> she has to
§ Change position gradually move slowly § Free flowing of milk
§ Dangle legs before attempting to walk § Affected by maternal emotions
Ø Milk ejection reflex
Progressive Changes § Controls the ejection of milk from the breast
vLactogenesis – human milk production tubules
Ø The arterial venus and lymphatic venus § Under the influence of oxytocin
communicate medially with the internal mammary vReturn of Menstrual Flow
vessels; laterally with axillary vessels Ø Decrease in estrogen and progesterone (delivery of
Ø In cancer of the breast = metastasis follows the placenta) = ^FSH = delay of ovulation = normal
vascular supply both medially and laterally menstrual cycle -> decrease in hormone secretion
Ø PROLACTIN = milk production hormone - Ø Non BF = 6-10 wks; BF = 3-4 mos.
Ø OXYTOCIN = let-down reflex arc Ø Absence in menstrual flow will not guarantee no
Ø Retained placenta can disrupt this process = conception = may ovulate before menstruation
continuation of progesterone = inhibits prolactin = returns
inhibit milk production vLactation Amenorrhea – 3-4mos. w/o menstruation
Ø PHASES: vBreast care
§ I – 16 wks of gestation; milk synthesis; glandular Ø cold compress – non-lactating; minimize pain and
luminal cells in the breast begin secreting discomfort with engorgement; minimize swelling
colostrum and pain
§ II – birth to 10 days PP; triggered at birth by the Ø warm compress / warm showers or baths –
delivery of the placenta; progesterone and other lactating; vasodilation = facilitating letdown reflex
circulating pregnancy hormones decrease +
oxytocin sharply increase = infant suckling Post Complications
• Oxytocin = helps the uterus shrink to pre- vPostpartum Hemorrhage
pregnancy size; mothers will feel uterine Ø Most common cause of maternal deaths assoc. w/
cramps when breastfeeding until the uterus childbirth
fully involutes Ø Any blood loss in the uterus greater than 500ml
• milk has come and breast engorgement within a 24hr period
• Transitional milk Ø Hemorrhage that reaches 1000ml of blood loss
Page 100 The breast functions for lactation or milk section for nourishment and Compiled by TEAM SHAWTIES
maternal antibodies which is IgA and the source of pleasurable sexual
sensation.
 WEEK 11 – POSTPARTUM CARE
Mrs. Emma Dotillos || BSN || BATCH 2024 MOTHER AND
The uterus must remain in a contractive state after CHILD CARE
childbirth to allow the open vessels of the placental site to
seal off
Ø Etiology: Uterine atony = relaxation of the uterus Ø Nursing Management
Ø Risk factors: § Stay with the client
§ Polyhydramnios, macrosomia, multiple § Fundal check – q 5-15mins (massage fundus
gestation and grand multiparity until firm = 1st NCM for uterine atony = expel
§ Placental complications (placenta acreta, clots) avoid over massaging since this can tire the muscles
causing relaxation
placenta increta, and placenta percreta) § Lochia check / pad count q hour (assessing for
§ Blood clotting problems blood loss)
§ Lacerations § Bladder check (distended bladder can displace
§ Medications the uterus to the side = uterine atony and
§ Hematoma bleeding)and vital signs (q 5- 15mins)
§ Subinvolution monitoring
§ Encourage voiding – to void 4-6 hours after
POST-PARTUM birth
HEMORRHAGE -> § Ice pack application (on fundus) Breastfeeding
(or nipple stim = secretion of oxytocin)
§ Check lacerations for DNC
§ Maintain Asespsis
Ø Nursing Care Management § INO fluid and blood replacement and O2 admin
§ Monitor for any placental fragments § Fluids up to 4000-3000ml if not
§ Facilitate ambulation = accurately identify post- contraindicated
partum hemorrhage § Provide psych support
§ Frequent lying down of the mother may cause § Look out for blood Admin of oxytocics
pooling of blood in the uterus § Antibiotics – broad spectrum antibiotics
§ Ambulation = facilitates drainage of blood via administered prophylactily for c-section
gravity § Proper positioning: Fowler’s / Semi
Retained placental fragments: fowlers Perineal hygiene
§ High CHO, Pro, and Iron diet
vNCM for mother with episiotomy

vAccreta
Ø Unusually deep attachment of the placenta to the
uterine myometrium; so deep that the placenta
will not loosen and deliver Ø Take note of:
vIncreta § Check appearance
Ø Implantation of the placenta deep into the § Monitor for tearing or lacerations
myometrium and into the perimetrium § Hematoma formation and hemorrhoids
vPercreta - Ø Use REEDA for assessment if the mother has any
Ø Reaches towards the perimetrium of these
Ø associated with prev cesarean birth and in vitro Ø ECCHYMOSIS
fertilization § pinpoint blanching of the skin due to bleeding
Ø detected through UTZ during pregnancy Ø note infection of the site to prevent maternal
Ø removing these complications manually can cause sepsis
hemorrhage Ø Nursing Management
Ø HYSTERECTOMY = surgical removal of the uterus § the vagina may be edematous, bruised, thin-
*treatment of method using walled due to estrogen levels
Ø METHOTREXATE = to destroy the still attached § few rugae, small lacerations
tissue may be necessary § smooth @ 3-4wks – rugae may reappear @ 4wks
Page 101 Compiled by TEAM SHAWTIES
 WEEK 11 – POSTPARTUM CARE
Mrs. Emma Dotillos || BSN || BATCH 2024 MOTHER AND
CHILD CARE

§ return to pre-pregnancy state by 68- wks Ø Handwashing - prior to breastfeeding; most

§ perineal care 6-8 WEEKS, not 68 !!! important practice to help prevent the spread of
• infection should not occur infection
§ perilite treatment Ø Resumption of intercourse – would depend on the
• dry heating to promote early drying and couple; no prescribed time; factors in deciding
healing of the round; 20mins @ 20 inch when
distance 3x/day § Maternal comfort
§ hot sitz bath § Perineal swelling
• for hemorrhoids § Desire to have sex
§ kegel exercise Ø Regular visit – for health maintenance
• exercise the pubococcygeal muscle after Ø RhoGam & Rubella vaccine
delivery § RhoGam – prophylaxis for unsensitized mothers
who are Rh negative and has given birth to and
Postpartum Care infant who is Rh negative; immunoglobulin w/in
vNursing Management Diet 72hrs after delivery -
Ø high in protein and carbohydrates; 2500kcal (non- § Administered even after the mother has received
lactating), 3000kcal (lactating) RhoGam after prev deliveries; or even when she
Ø Vitamin C and Iron receives RhoGam in the antenatal period o
Ø Monitor vital signs and fundus for firmness and § Rubella vaccine –if the mother is not immune to
descent rubella or german measles, she must receive
§ fundus is palpable until the 10th day and no vaccine b4 discharge from the hospital bc of
longer palpable as it descends behind the potential teratogenicity of rubella virus = mother
symphysis pubis signs informed consent before receiving the
Ø Monitor color, amnt of lochia vaccine and a written in: NOT TO GET
Ø Expect diuresis PREGNANT FOR 28 DAYS – 3 MONTHS
Ø note for postpartal blues vEssential objectives during the puerperium Promote
§ drop of maternal hormones on the 4th-5th day uterine involution
Ø Bowel & bladder function – Kegel exercise Ø promote breastfeeding; oxytocin, knee-chest /
§ Constipation prone position; promote normal anteflexion;
• Increase fluid and roughage intake Ø early ambulation = prevents bed rest
complications prevent common discomfort of
• Promote fresh fruits puerperium, provide psychological
§ Thrombophlebitis
• Promote regular bowl habits support, and initiate contraception,
§ Pneumonia and prevent complications
• Glycerine / bisacodyl dulcolax as ordered =
§ Subinvolution of the uterus
bowels do not move after the 3rd morning of
Ø Regular voiding = bladder displaces uterus
delivery
Ø Note fundic height = pos. of the uterus is expressed
Ø Provide psychological and physical support
in finger breadth above and below the umbilicus to
Ø Meet the mothers needs so she can meet the NB’s
promote accurate results; empty the bladder
needs
before assessing
Ø Assist with self-care and baby care
§ Positive sign – fundus above umbilicus
Ø Promote bonding
§ Negative sign – fundus above the umbilicus (ex.
Ø Promote breastfeeding
1 finger breadth below the umbilicus = -1, 2
Ø Start rooming in
finger breadths above the umbilicus = Positive 2,
Ø Verbalize positive neonatal traits and similarities
level of umbilicus = 0)
w/ the mother and father’s features
vRecord fundus as firm, -3 central
Ø Oxytocic drugs = uterine involution
Ø Lochial discharge
Ø Strict asepsis = maternal teaching; pericare; front
Ø Afterpains
to back technique of flushing and removal of
Ø Normal involution of the uterus = after delivery
peripads
fundus is firm, midline, level of umbilicus
Page 102 Compiled by TEAM SHAWTIES
 WEEK 11 – POSTPARTUM CARE
Mrs. Emma Dotillos || BSN || BATCH 2024 MOTHER AND
CHILD CARE

§ Day 1 – 1 finger breadth above umbilicus § 20 mins, position lamp 20 inches away from
§ Descends by one finger breadth/day perineum, 3x a day
§ Day 10 – behind symphysis pubis, no longer § 40 watt desk bulb – can be effective heat bath
palpated Ø Moist heat: hot sitz bath 2x / day or more
§ Easily displaced above the umbilicus, to the Ø Anesthetic spray ointment / Analgesics
right side by distended bladder = broad and § Given as ordered
round ligament were greatly stretched during
pregnancy = MARKED LAXITY after delivery PP Phases of Maternal Role Taking
vPromote successful breastfeeding vTaking-in Phase
vPrevent common discomfort of puerperium Ø 1-3 days after delivery -
Ø Breast engorgement - wet compress application Ø Dependent phase
§ Warm for lactating Ø Mother is talkative; verbalizes delivery experience;
§ Cold for non-lactating dependent; concerned w/ own needs; self-
Ø Afterpains – explains possible causes, signs of the centered; passive
uterus involuting Ø Nursing Care Management
§ Ice pack on the fundus (never hot water to § Meeting mothers’ physical needs
prevent bleeding) give analgesic as ordered § Verbalization
vUrinary retention § Listening = not the best time to focus on baby
Ø Early ambulation 4-8 hrs after delivery can help care
prevent urinary retention vTaking-hold Phase
Ø Increase fluid intake Ø 3 days-2wks after delivery
Ø Straight catheterization = last resort Ø Striving for independence -
vHemorrhoids to prevent hemorrhoids Ø Impatient to have control over bodily functions and
Ø Promote ambulation to learn mothering tasks
Ø Cold packs on affected areas after delivery leave on Ø Mood swings
same position for 20 mins, repeat q 4 hrs Ø Strong anxiety element
Ø Provide moist heat = sitz bath w/ water @ 38 Ø Responds to positive reinforcement
degrees C for 20min (observe for signs of fainting) Ø More in control
Ø Small hemorrhoids – mother can be shown how to Ø Nursing Care Management
place the hemorrhoid back into the anorectal canal § Provide teaching abt Baby care
using a lubricated finger § Stay during care for positive reinforcement
Ø Avoid oily food § Guard against fatigue
Ø Local heat § Complement generously
Ø Occasional analgesics vLetting-go Phase
vProvide psych support Ø 10 days- 2wks after delivery
Ø Assurance that the condition will correct itself Ø Independent phase
once the increase blood supply and pressure of Ø Women gives up former roles and self-concept and
pregnancy are diminished and the reg movement integrate formal role and self-concepts as a
of bowel is est. mother
Ø Understanding of the normal maternal psychologic Ø Achieves independent - Accepts the baby as a
adaptations and reactions separate being
vInitiate contraceptions Ø May have feelings of insecurity, inadequacy, and
vPrevent complications deep loss over separation of baby from her -
vFor Episiotomy Ø Nursing Care Management
Ø Ice /cold pack = vasoconstriction effect, reduce § Verbalization of new roles
edema and discomfort, anesthetic effect reducing § Provide positive reinforcement as she defines her
pain roles w/ her support system
Ø Dry heat / Perilite § Be understanding and supportive

Page 103 Compiled by TEAM SHAWTIES

 WEEK 11 – POSTPARTUM CARE
Mrs. Emma Dotillos || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Page 104 Compiled by TEAM SHAWTIES

 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Growth and Development Ø Structural theory of personality gives great

vGrowth importance on how conflicts among the parts of
Ø increase in physical size (quantitative) the mind shape behavior and personality =
Ø Growth in weight is measured in pounds ( lbs) or conflicts are mostly unconscious
kg Ø Psychosexual theory of development = According
Ø Growth and height is measured in inches or cm to Freud personality develops during childhood
vDevelopment and is critically developed through five
Ø progressive towards maturity ( qualitative) psychosexual stages:
Ø Increase in skill or function - Can be measured by: § Oral
§ observing a child perform specific tasks such as § Anal
how well a child picks up small objects E.g. § Phallic
raisins § Latent
§ recording the parents description of the child's § genital
progress Ø During each stage a child is presented with a
§ standardized tests: conflict between biological drives and social
• MMDST expectations
Ø Maturation Ø Successful navigation of these internal conflicts
vDevelopmental milestones will lead to mastery of each developmental stage =
Ø major markers of normal development Fully mature personality
Ø Are behaviors and physical skills seen in infants vErickson’s stages of Personality development
or children as they grow and develop Ø Psychosocial development
§ Rolling over Ø Personality develops in a predetermined order
§ walking through 8 stages of psychosocial development
§ Talking from infancy to adulthood
Ø Milestones are different in each range Ø During each stage, the person experiences a
vDevelopmental tasks psychosocial crisis which could have a positive or
Ø skill or growth responsibility arising at a particular negative outcomes depending on the person
time and an individual's life Ø Successful completion of each stage results in a
healthy personality and the acquisition of basic
Division of Childhood virtues
Neonate - first 28 days of life Infant - 1mos - 1yr Ø Basic virtues = Are characteristics strengths which
Toddler - 1-3 yrs. Preschooler - 3-5yrs the ego can use to resolve subsequent crisis
School-age child - 6-12 yrs Adolescent - 13-17 yrs Ø Failure to successfully complete a stage = reduced
Late adolescent - 18-21 yrs ability to complete further stages → unhealthy
personality and sense of self
Theoretical Foundation Ø Can be resolved at a later time
vFreudian Theory
Ø Psychosexual development

Ø Human behavior is the result of the interactions

among three components of the mind: id, ego and
superego
Page 104 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

vKohlberg's theory of moral development

Ø Identify how children may feel about an illness
Ø Approximates the cognitive stages of development
Ø 3 stages of moral reasoning, each level has 2
substages
§ Post-conventional
§ Conventional
§ Preconventional
Ø People can only pass through these levels in the
order listed
Ø Each new stage replaces to reasoning typical of the Ø Each child goes through the stages in the same
previous stage order and child development is determined by
Ø not everyone achieves all the stages biological maturation and interaction with the
environment
Ø No stage can be missed out = Individual differences
at which children progress through the stages
Ø Some individuals may never attain the later stages

Principles of Growth and Development

vGrowth and development are continuous processes
from conception till death.
Ø Rate of growth changes: growth during the first
year of life and the later years of life
Ø Increase of 50% in the growth rate in the first year
Ø If growth rate of the first year continues = a five
year old child will weigh 1000 lb and be12 feet and
6 inches tall
vGrowth and development proceed in an orderly
sequence.
vPiaget’s Theory of cognitive development Ø Growth in height is only one sequence = smaller →
Ø Explain how a child constructs a mental model of larger
the world vChildren pass through the predictable stages at
Ø Disagreed with the idea that intelligence is a fixed different rates
trait Ø Sit → creep → stand → walk → run
Ø regarded cognitive dev’t as a process which occurs Ø A child may skip a stage or passed through its so
due to biological maturation and interaction with quickly that the parents will not observe the stage
the environment - -
Ø Suggest that children move through four different Ø Different children = different rates
stages of intellectual development which reflect the Ø Range of time rather than certain point at which
increasing sophistication of children’s thoughts they are accomplished
Ø focuses on understanding how children acquire vAll body systems do not develop at the same rate
knowledge Regarding fundamental concepts such Ø Neurologic tissues experienced their peak growth
as object permanence, number categorisation, at the first year of life
casualty, and justice vDevelopment is cephalocaudal.
Ø Four stages: Ø Proceeds from head to tail -
§ Sensorimotor Ø Newborns can lift only their head off the bed when
§ Preoperational concrete operational they lie in a prone position
§ formal operational Ø By age 2 months, infants can lift both head and
chest up
Page 105 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Ø By 4 months, the head, chest and part of the Ø Taking a first step before they can accomplish this
abdomen securely
Ø By 5 months, infants have enough control to turn Ø If children fall behind G&D because of illness, they
over are capable of catch up growth to bring them equal
Ø By 9 months, they can control legs enough to again to their age group
crawl
Ø By 1 year, children can stand upright and perhaps Factors Affecting Growth and Development
walk vGenetics
Ø Motor development proceeds in cephalocaudal Ø From the moment of conception, when the sperm
order from head to lower extremities and ovum fuse, the basic genetic makeup of an
vDevelopment proceeds from proximal to distal body individual is cast
parts Ø In addition to physical characteristics (eye color,
Ø Illustrated by tracing the progress of upper height potential), the inheritance determines other
extremity development characteristics such as learning style and
Ø Newborn makes little use of arms and hands temperament
Ø Any movement except to put a thumb in the mouth Ø Individual may also inherit genetic abnormalities
is a flailing motion which could result in disability or illness at birth
Ø By age 3-4 months, the infant has enough arm or later in life
control to support the upper body, weight on the vGender
forearms and the infant can coordinate the hand Ø On average, girls are born lighter by an 1-2 ounces
to scoop up objects and shorter by 1-2 inches than boys
Ø By 10 months, the infant can coordinate the arm Ø Boys tend to keep this height and weight
and thumb and index fingers to sufficiently well to advantage until prepuberty, at which girls surge
use a pincer like grasp to pick up objects as fine ahead because they begin their puberty growth 6-
as breakfast cereal on a high chair tray 12 months earlier than boys
vDevelopment proceeds from gross to refined skills Ø By the end of puberty (14-16 years old), boys tend
Ø Once the children are able to control distal body to be taller and heavier
parts, they are able to perform fine motor skills Ø Difference in growth patterns is reflected in
Ø Ex. 3 year old colors best with a large crayon. 12 different growth charts used for boys and girls
year old can write with a fine pen vHealth
vThere is an optimum time for initiation of Ø A child who inherits a genetically transmitted
experiences or learning disease may not grow as rapidly or develop as fully
Ø Children cannot learn tasks until their nervous as a healthy child depending on the type of illness
system is mature enough to allow that particular and the therapy or care available for the disease
learning Ø Ex. Insulin was discovered in 1922, many children
Ø A child cannot learn to sit no matter how much the with type I diabetes died in early childhood during
child’s parents have them practice until the those times and those who lived were left
nervous system has matured enough to allow back physically challenged. Currently with good health
control supervision and advanced medicine, the effects of
vNeonatal reflexes must be lost before development type I diabetes can be minimized that children with
can proceed diabetes will thrive and grow.
Ø An infant can not grasp with skill until the grasp Ø Diabetes is still a major factor in children as more
reflex has faded nor stand steadily until the and more children become obese, type II diabetes
walking reflex has faded has now begun to occur in children beyond school
Ø Neonatal reflexes are replaced by purposeful age
movements vIntelligence
vA great deal of skill and behavior is learned by Ø children with high intelligence do not generally
practice grow faster physically than other children but tend
Ø Infants practice over and over to advance faster in skills
Page 106 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Ø occasionally, children of high intelligence fall § Adaptability/adaptability:

behind in physical skills because they spend their • the degree of ease or difficulty with which a
time with books or mental games rather than child adjust or change to a new situation and
games that develop motor skills so they don’t how well they can modify the reaction
receive practice in this area § Intensity of reaction:
vTemperament • energy level with which a child responds to a
Ø Usual reaction pattern of an individual or an situation whether positive or negative
individual’s characteristic manner of thinking, § Distractibility:
behaving or reacting to stimuli in the environment • ease which a child can be distracted from a
Ø Unlike cognitive/moral development, task by the environmental stimuli
temperament is not developed by stages but is an § Attention span and persistence:
inborn characteristic set at birth • ability to concentrate and stay with a task with
Ø Understanding that not all children are alike, some or without distractions
adapt quickly to new situations while others adapt § Threshold of response:
slowly or react intensely or passively • the amount of stimulation required for a child
Ø Parents it’s good for them to better understand to respond. Some children respond to the
why their children are different from each other slightest stimulation and others require
and help them care for each child constructively intense amount
Ø Although individual children show characteristics § Mood quality:
from all group, most children can be categorized • positive or negative mood or degree of
Ø Categories: pleasantness and unfriendliness in a child’s
§ The easy child words or behaviors
• Child who is rhythmic, approaching, vEnvironment
adaptable, mild and positive in mood Ø Although children cannot grow taller than their
§ The intermediate child genetically programmed height potential allows
• Having some characteristics coming from both their height to be considerably less than genetic
groups are to follow potential if their environment hinders their growth
§ The difficult child in some way
• Child that is arrhythmic with growing, low in Ø Ex. A child could receive inadequate nutrition
adaptability, intense and negative in mood because of a family’s low socioeconomic status. A
§ The slow-to-warm up child parent could lack child care skills and are not able
• Inactive, low in approach and adaptability and to give attention or a child could have a chronic
negative in mood illness
Ø Characteristics of Temperament: Ø Many illnesses lowers the child’s appetite
§ Activity level Ø Endocrine disorders directly alter the growth rate
• level of physical activity, motion or Ø Having a parent who abuses alcohol or other
restlessness or fidgety behavior that a child substances can cause inconsistency in care and
demonstrates in daily activities affects mental health
§ Rhythmicity Ø Environmental influences are not always
• presence or absence of a regular pattern for detrimental.
basic physical function such as appetite, sleep Ø Ex. People with phenylketonuria, an inherited
and bowel habits Ø metabolic disease can achieve normal growth and
§ Approach development in spite of their genetic make up if
• (and withdrawal) their diet is properly regulated
• the way a child initially responds to a new Ø Environmental influences most likely to affect
stimulus, whether it may be people, situation, growth and development:
places, food, changes in routine and other Ø Socioeconomic level
transitions § The parent-child relationship
§ Ordinal position in the family
Page 107 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

§ Health § Skill play

§ Nutrition • After infant develops the ability to grasp and
manipulate, they persistently demonstrate and
exercise their newly acquired abilities through
Needs for Growth and Development skill play or repeating an action over and over
vPhysical and biologic needs again
Ø in order for a child to fully grow and develop • Ex. Building a tower using cups. Picking up
physiologically, there must be enough sunlight, cubes.
food, water, air ventilation and all physical needs § Unoccupied behavior
should be attended • Activity when a child actually isn’t playing at
vLove and affection all
vSecurity • They maybe engaged in seemingly random
Ø Must be able to provide the child may grow movements with no objective
psychologically and emotionally • despite appearances, this is play and sets
vDiscipline and authority stage for future play exploration
Ø Balance between the sense of freedom and • may not be playful but focusing their attention
discipline momentarily on anything that strikes their
Ø To morally and intellectually grow and have a interest and stay focused on
sense of discipline • ex. Daydreaming. Fiddle with clothes or other
vDependence and independence objects. Walk aimlessly
Ø Promote autonomy towards them § Dramatic or pretend play
Ø Balance by making them feel secured and making • Symbolic play
sure that their independence is within the control • Predominant amongst preschool
while promoting growth
• After children begin invest situations and
vSelf esteem
people with meaning and to attribute affective
Ø Psychologically grow
significance to the world, they pretend and
Ø Be able to boost and push themselves to grow and
fantasize almost anything
develop
• Acting out daily events, children learn and
vCommunication
practice the roles and identities modeled by
Ø Promote social growth or social development
members of family and society
vPlay
• Ex. Using the telephone, rocking a doll, driving
Ø Good avenue for children to practice their skills,
a car, pretending to be a doctor or superhero
thinking and socialization with others
or policeman
Ø Classifications of play
§ Games
§ Social-affective play
• Competitive play
• Infants take pleasure in relationships with
• Apparent in cases wherein sibling may beat his
people
sibling
• As adults talk, touch nozzle and various ways
• Rules, turn taking and functioning as part of a
elicit a response from an infant, the infants will
team are big lessons taken from this type of
learn to provoke parental emotion and
play
response for such behaviors (smiling, cooing or
• Important to guide children in dealing with
initiating games or activities)
winning and losing
§ Sense-pleasure play
§ Onlooker play
• Nonsocial stimulating experience that
• A child in play observes other children playing
originate from without
and doesn’t participate in the action
• Objects and environments such as light, color,
• Common in younger children who are working
taste, odors, textures and consistencies
on their developing vocabulary
attracts children’s attention to stimulate their
senses and give pleasure
Page 108 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

• Children watch what other children are doing • Ex. Children building a tower of blocks. As they
but make no attempt to enter into the play are building their own building they are talking
activity to each other and engaging in each other
• There is an active interest in observing the • Helps little ones to develop skills like
interaction of others but no movement towards socialization, problem solving, cooperation and
participating language development
• Should not worry because it could be a child • How children begin to make real friendships
feels shy, needs to learn the rules, or is the § Cooperative play
youngest and wants to take a step back for a • All stages come together
while • Children start playing together
§ Solitary play • Common in older preschoolers or in younger
• Child plays alone preschoolers who have older siblings or have
• Teaches the child to keep himself entertained been around a lot of children
and eventually setting the path to being self • Uses all of social skills that the children has
sufficient been working on and puts them into action
• any child can play independently • Sets the stage for future interactions as a child
• most common in younger children around 2-3 matures into an adult
years old or toddlerhood. At that age they are Ø Functions of play
still pretty self centered and lack good § Sensorimotor development
communication skills • major components of play at all ages and its
• if the child is shy, and don’t know playmates predominant form of play in infancy
well he may prefer this type of play • active play is essential for muscle development
§ Parallel play and serves a useful purpose in the release of
• No group association surplus of energy
• Play independently but among other children § Intellectual development
• Put 2 3 year olds in a room together • Through exploration or manipulation, children
• Having fun side by side in their own little learn colors, shapes, sizes and textures and
world significance of objects
• doesn’t mean they don’t like each other but are • Books, stories, films and collections extend
just engaging in parallel play knowledge and provide enjoyment
• despite little social contact, children who • Puzzles help with problem solving abilities
parallel play learn from one another like taking § Socialization
turns and other social necessities • Learn to establish relationships - Initial social
• even though it appears that they are not paying contact
attention to each other, they are and are • Establish social relationships and solve
mimicking the other’s behavior problems associated with relationships
• important bridge to the other stages of play • Learn to give and take, roles that the society
§ Associative play expects to fulfill and approved patterns of
• Children play together and are engaged in a behavior and deportment
similar or identical activity but there is no § Creativity
organization, division of labor, leadership • Children experiment and try out their ideas in
assignment or mutual goal play through every medium at their
• Each child acts according to their own wishes disposable
and no group goal • Product of solitary activity
• Features children playing separately from one • Creative thinking is often enhanced in group
another but are involved in what the others are settings
doing • listening to others ideas stimulates further
exploration of one’s own ideas
Page 109 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

• experiment and try out new ideas § They become fearful or suspicious of people and
§ Self-awareness then the world
• Children learn who they are and their place in Ø Not all children achieve developmental tasks
the world readily; each task need not be resolved each time
• The process of developing a self identity is it arises
facilitated through play activities Ø The developmental issue of TRUST vs MISTRUST
• They become increasingly able to regulate their arises again at such successive stage of dev’t
own behavior to learn what their abilities are Ø NURSING RESPONSIBILITY:
and to compare their abilities to those of § Constant caregiver / the mother must always be
others there most of the time to promote trust of the
• Test ability to assume and try out various roles infant
and to learn the effect of their behavior on § Accdg to Freud; infant belongs to the oral stage
others = child explores the world using the mouth
§ Therapeutic value § Oral stimulation using pacifiers
• Important at any age § Do not discourage thumbsucking
• Can express emotion and relieve unacceptable § health care visits: 2 weeks, 2 months, 4 months,
impulses in a socially acceptable fashion six months, 9 months, 12 months
§ Provide time for immunizations and health
• Learn to express emotion and intention
assessments
• Moral value
§ Provide opportunity for parents to ask questions
• Enforcement of moral standards of right and
about the child’s growth patterns and
wrong in the culture, interaction with peers
developmental progress
• If they are to be acceptable members of a
§ Opportunity for healthcare providers to asses for
group, children must adhere to accepted codes
potential problems as they first appear
of behavior of the culture
§ aspiration prevention
§ Chief injury threat to infants in the first year
Infancy
§ Round cylindrical objects are more dangerous
vFor the first year after birth a baby is called an
than square or flexible objects in this regard. -
infant
§ 1 inch or 3.2 cm cylinder such as a carrot or a
vInfancy = the first year of life after birth
hotdog is particularly dangerous because it can
vThe infant is born with certain abilities already
totally obstruct an infant's airways.
developed
§ A deflated balloon can be sucked into the mouth
Ø e.g. they have a well-developed sense of smell, they
and obstruct the airway in the same way
can also communicate their needs by crying when
§ Educate the parents who need infant formula
they are hungry, uncomfortable, bored, or lonely.
not to prop bottles (milk may overflow fast) =
vDuring the first year they develop many abilities
They are overestimating is there infants' ability
Ø Ability to smile, make vocal sounds, spend time
to push the bottle away
bubbling, sit, and crawl until they are able to
stand and walk.
v“Trust vs mistrust”, “oral stage”
Ø TRUST: When an infant is hungry the parent feeds
and makes the infant comfortable again, when the
infant is wet a parent changes his or her diaper
and infant is dry again, When an infant is called
the parent holds the baby closely = The infant will
trust that when he or she has needs or distress a
parent will come and meet that need
Ø MISTRUST: If care is inconsistent, inadequate, or
rejecting → Infants learn mistrust
Page 110 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

§ Sit up, turn the head to the side, cough and clear back support many parents begin to babe them in
the airway if milk flows through rapidly in the an adult tub:
mouth to aspirate vNever leave and infant unattended even when
vfall prevention propped up ou of the water or sitting in a bath ring
Ø NURSING RESPONSIBILITY or bath seat
§ Instruct the parent to never leave an infant in an vNormal wiggling can cause the baby to slip down
unprotected surface such as bed or couch even under the water = applies to the hospital setting as
if the infant is in an infant seat well
§ Place a gate at the top and bottom of stairways vBeing able to swim momentarily may cause children
§ Do not allow the infant to walk around with a to lose their instinctive fear of water = be in more
sharp objects in the hands or mouth danger that children more cautious of water
§ Raise crib rails and lock before walking away vHypothermia
§ Never leave an infant unattended in a high-chair vMicroorganisms = infants at this age are nt=ot yet
§ Avoid using infant walker near a stairway toilet trained
vsafety with siblings vExposure to chlorinated water = damages lung
Ø Infants become fun to play with @ 3mos of age, epithelium → precursor to asthma
older brother/sister grow more interested in vInfant does not need a bath everyday = face, hands,
interacting with them and diaper area washed
Ø Important to remind parents that children >5 yrs vSome infants need their head and scalp washed
of age are not responsible or knowledgeable frequently everyday or every other day to prevent
enough about infants to be left unattended w/ SEBORRHEA = Scaly scalp condition often called
them: may introduce unsafe toys or engage in play cradle cap; Adhere to the scalp in yellow crusty
that is too rough for an infant patches; skin beneath the lesions may be
Ø Preschoolers = may be jealous of a new baby and erythematous ; Touches can be softened with
may physically harm if left alone mineral oil or petroleum jelly and leaving it on
vChildproofing overnight → Crust can be removed by shampooing
Ø Preparing the infant arrival towards the end of the the hair the next morning (Soft toothbrush or fine
pregnancy tooth comb can be used to help remove the crusts)
Ø Use of diff gadgets / tools to prevent any injury to vbathtime should be fun for an infant and can serve
the child may occur many functions other than just the obvious one of
Ø Bassinet = used in the hospital; used until 2 mos cleanliness especially during the second half of the
only first year:
Ø Rear facing seat = in the car; until they reach the Ø infant enjoys poking at soap bubbles on the
height allowed by care safety seat manufacturer; surface of the water
children ride rear-facing for 2yrs or more Ø playing with bath toys
Ø The first year caring for an infant as feeding, Ø helps an infant learn different textures and
bathing, dressing ,and so forth occupies what may sensations
seem like nearly all of the parents' waking hours. Ø provides an opportunity to exercise and kick
All of these basic care-related activities provide Ø good opportunity for parents to touch and
important opportunity for parents and infants to communicate with a child
get to know one another and to be coming into vteach parent to not leave the infant alone in tubs as
each other's unique personalities and patterns they could easily slipped under the water
vPotential Sources of Injury
Bathing Ø Accdg. To the CDC
vit is very important to never leave the baby Ø WATER: such as in the bathroom, kitchen,
unattended on bath seats swimming pools, hot tubs
vCheck the temperature of bath water for comfort and Ø HEAT: in the kitchen, in a fireplace, or at a bbq
to prevent chilling as babies begin to develop good grill

Page 111 Compiled by TEAM SHAWTIES

 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Ø TOXIC SUBSTANCES: like under the kitchen sink, vAbnormal signs (not signs of teething)
in the medicine cabinet, in a garage or garden Ø high fever
shed, in a purse or where medications are stored Ø seizures
Ø POTENTIAL FALLS: on stairs, the slippery falls, Ø vomiting or diarrhea
from high windows, from tipping furniture that is Ø earache
why childproofing is very important infant with any of these symptoms has an underlying
infection or disease process requiring further
evaluation
Teething vmany otc medications are sold for teething pain, use
vBegins at 5-6 mos should be discouraged if they contain BENZOCAINE
vInfants chew on any object within reach to lessen (topical anesthetic) → because if applied to far back
gum line pain in the throat interferes with the gag reflex
vRemind parents to check for possible sources of lead vTeething rings that can be placed in the refrigerator
paint = provides soothing coolness against tender gums
vWander into elevators, out of the hospital, into vAn infant who is teething will place almost any object
laboratory area, down a flight of stairs if not in the mouth
supervised Ø parents must screen articles within the babies
vInstruct parents to keep guns out of reach reach to be certain they are edible or safe to chew
vKeep coin lithium batteries/ coin batteries and any
devices that contain them out of reach of children = Nutrition
fat if swallowed vWeaning at 6 mos
vKeep choking hazards (toxic substances, hot/sharp Ø WEANING = transition from breastmilk /
items) out of reach commercial iron fortified formula → solid food
vHave your child use safety glasses if involved in vOffer new foods one at a time and let the child eat
activities = woodworking, science projects, involving the item for about 1 wk before introducing another
chemicals, racquetball, paintball, enterprises w/ new food
flying debris vDetect possible food allergies
vNever leave young kids unattended in a bath vEstablish sense of trust in infants = minimizes
vSafety latches and locks for cabinets and drawers = experiences in any one day
Prevent poisoning or other injuries vTake note of the important nutrients taken by the
vOutlet covers could also be used in areas in the wall infants
vAnchors to prevent furniture such as tv or gas vFeed the first solid food in the parent’s arms such as
ranges from tipping over and crushing children breastfeeding / bottle feeding = reduces the newness
vCorner and edge bumpers to help prevent injuries of experience; reduces the amnt. Of stress
from falls against sharp edges on walls, furniture, associated w/ it
and fireplaces vcow's milk needs vitamin c, iron and fluoride
vKnob covers which snap over door knobs to prevent supplementation
young children from turning them vNormal infant can survive on breastmilk /
vCordless window coverings to prevent strangulation commercial iron-fortified formula w/o the addition
could also be of use of any other solid food until 4-6mos
vInfant have little difficulty with teething but some vDelaying solid food at this time:
appear very distressed Ø prevent overwhelming infant kidneys w/ heavy
vgenerally the gums are sore and tender before a new solute load (occurs when protein is ingested)
tooth breaks the surface, as soon as a tooth is Ø May delay food allergies in susceptible infants
through the tenderness passes Ø May prevent obesity
vTooth and gum pain = infants can be resistant to vhigh-protein and high -calorie
chewing for a day or two and differently cranky vRapid growth of the 1st yr
(possibly because they are a little hungry from not vCommercial Formula and breastmilk
eating as much as usual) Ø 20cal/oz
Page 112 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

vCalorie levels can be reduced Ø changing the brand or type of diaper or washing
Ø 120/kg body weight @ birth → 100/kg body weight solution usually alleviate this problem
@ end of 1st yr to prevent babies from being vFUNGAL / CANDIDA INFECTION = if a diaper area
overweight is covered with lesions that are bright red with or
vbreastfeeding every 2-3 hours per demand, cup without oozing; last longer than 3 days and appear
feeding as red pinpoint lesions → suspect a fungal or
Ø Should still be encouraged - CUP-FEEDING = candida infection
prevent nipple confusion
vallergy-precaution Dental Care
vexposing developing his to fluoride = is one of the
Diaper Area Care most effective ways to promote healthy tooth
vMost effective means of promoting good diaper formation and prevent tooth decay
hygiene is to change diapers frequently about every vMost important time for children to receive fluoride:
to 2-4 hours between 6mos and 12 years of age
vhowever it is rarely good practice to interrupt childs vwater level of 0.6 ppm fluoride is recommended =
sleep to change diapers because this is the level that protects tooth enamel
vif an infant develops a rash from sleeping in wet yet does not need to staining of teeth
diapers = air drying or sleeping without in diaper vcommunities where the water supply does not
may be as solution provide enough fluoride:
vAt each diaper change the parents should wash the Ø the use of oral fluoride supplements beginning at
skin with clear water or with a commercial alcohol- 6 months
free diaper wipe then pat or allowed to air dry Ø the use of fluoride toothpaste
vroutinely use and ointments such as Desitin or A Ø rinses after tooth eruption is recommended
and D ointment to keep urine and feces away from Ø teach parent to ask about the presence of fluoride
an infant skin is a good prophylaxis in the drinking water in the community to help
vparents do not need to use baby powder, if they them determine if supplementation is necessary
choose to advise them to sprinkle the powder on Ø breastfed infants do not receive a great deal of
their hands first and then apply it to the infant skin fluoride from breast milk so it may be
vcaution them not to shake the powder on an infant recommended by be given for fluoride drops once
to reduce the possibility of aspiration a day
vthey should place the container out of the infants Ø teach parents to begin brushing even before teeth
reach after applying it erupt by rubbing off a washcloth a soft wash cloth
vparent should always watch carefully while infants over the gum pads = this eliminates plaque and
and toddlers are in the tub as well reduces the presence of bacteria creating a clean
vsome infants have such sensitive skin that environment for the arrival of the first tooth
vDIAPER DERMATITIS OR DIAPER RASH is a vOnce teeth erupt all surfaces should be brushed
problem from the first few days of life that occurs for with a soft brush or washcloth once or twice a day
several reasons: vchildren lack the coordination to brush effectively
Ø frequent diaper changing until they are school age = parents must be
Ø applying A and D or Desitin ointment and exposing responsible for this activity past infancy
the diaper area to air may relieve the problem vtoothpaste is not necessary for an infant because it
Ø some infants may have to sleep without diapers at is the scrubbing that removes the plaque
night to control the problem vinitial dental check up = 1year of age should
vWhenever the entire diaper area is erythematous continue a 6-month intervals until adulthood
and irritated so that the outline of diaper on the skin
can be identified = one must suspect and allergy to Dressing
the material in the diaper or to laundry products if a vClothing for infants should be:
commercial washed or home wash diaper is being Ø easy to launder
used
Page 113 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Ø simply constructed so dressing and undressing is Ø does not deform the jaw in infancy
not a struggle Ø it does not cause baby talk or any of the other
Ø clothing should not be Binding = infants enjoy speech concerns commonly attributed to it
kicking and making gross body movements Ø children you continue the habit into school age
Ø when they begin to creep = they need long pants to = however can have changes in their dental arc that
protect their knees leads to asymmetric concern such as crossbite
Ø soft-soled shoes = until they begin to walk merely vthe best approach for parents is to be certain and
socks or booties to keep their feet warm infant has adequate sucking pleasure and then to
Ø when they begin walking = the soles of their shoes ignore thumbsucking
need only be firm enough to protect their feet Ø making an issue of it really has a child to stop = it
against rough surfaces may intensify and prolong it
vextremely hard soles and high ankle sides are vwhether to use pacifiers is a question that parents
unnecessary must settle for themselves depending on how they
feel about them and their infants needs benefits of
Sleep pacifiers include the following:
v10-12hrs Ø they appear to be comforting to an infant
vSleep need and habits vary greatly among infants Ø may may aid in pain relief
vMost require 10- 12 hours of sleep at night Ø decrease the risk of SIDS -
v1 or several laps during the day Ø infant who completes a feeding and still seems
vparents are usually advised to let a baby sleep in a restless and discontent who actively searches for
separate space rather than in their bed so the something to put into the mouth or who sucks on
parents do not awaken at every toss and squeak hands and clothes = may need a pacifier
vdoing so allows infants to learn to quiet themselves Ø Risks associated with pacifiers:
and go back to sleep should they awaken break § increased incidence of acute otitis media or ear
briefly infection
Ø this may help prevent sleep problems such as § Possibly a negative impact on breastfeeding
night walking in the future § dental malocclusion particularly if usage is
vother parents prefer to have infant sleep with them greater than 2 to 3 years old
in a family dad and they believe this practice for § Theoretically, a child who sucking needs are met
moves a feeling of security and infancy will not craves much oral
vBED SHARING = also promote breastfeeding but stimulation later in life and is less likely to
also has a danger of accidental suffocation become a pencilchewer, cigarette smoker,
Ø caution parents not to place pillows in an infant's nailbiter or the like
bed = avoid suffocation § a major drawback for pacifiers is a problem of
Ø SUPINE POSITION = always place and fans on cleanliness, others:
their back to sleep because this position markly § they tend to fall on the floor or sidewalk and are
reduces the incidence of SUDDEN INFANT DEATH then put back into an infant's mouth
SYNDROME / SIDS § if not well constructed they may come apart and
Ø use of pacifier = while and infant sleeps may the nipple part may be aspirated
further reduce the risk § hanging a pacifier on a string around and infants
vTHUMB- SUCKING neck could cause strangulation
Ø surprisingly strong need in early infancy Ø parents should attempt to wean a child from
Ø many infant begin to suck a thumb or finger at pacifier anytime after 3 months of age and
about 3mos of age and continue the habit through certainly during the time that sucking reflex is
the 1st year of life fading @ 6 -9 mos; weaning after this age is
Ø THE SUCKING REFLEX - peaks at 6-8mos difficult because a pacifier becomes a comfort
Ø THUMB-SUCKING = peaks at about 18 mos - mechanism like a warm blanket or fuzzy toy to
parents can be assured that that thumb-sucking is which a child may continue to cling
normal :
Page 114 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Head Banging vMany new parents also are unfamiliar with the
vStarts at the 2nd half of infancy until preschool consistency or color of normal newborn stools so
vassociated with nap time or bedtime they may mistakenly report normal stooling as
vLasting under 15 minutes = normal diarrhea
vchildren use this measure to relax and fall asleep Ø stool of breastfed infants = are generally softer
vinvestigating stress factors operating in the house than those of formula fed
may be helpful Ø if a mother takes a laxative while breast feeding an
Ø if some to stress can be relieved such as: infant stool may be very loose
Ø a parents overestimation of the child's Ø infant who is formula fed = can have loose stool if
development the formula is not diluted properly
Ø marital discord Ø occasionally loose stools me begin with the
Ø illness in another family member introduction of solid food such as fruit
Ø head banging may be decreased vwhen talking to a parent about loose stools ask
Ø ingrained habit = that it will persist for months or about:
even years Ø the duration of the loose stools
vadvise parents to pad the rails of cribs so infants Ø the number of stools per day
can't hurt themselves Ø color and consistency
vreassure them that is a normal mechanism for the Ø whether there is any mucus or blood in them
relief of tension in children of this age Ø is their associated fever cramping or vomiting
vno therapy should be necessary Suggests pathologic Ø does an infant continue to eat well
basis such as the following may need referral for Ø appeared well seem to be thriving
further evaluation : Ø is an infant wetting at least 6 diapers daily
Ø excessive head banging done to the exclusion of Ø Infants with associated signs and symptoms such
normal development or activity as:
Ø head banging past the preschool period § Fever
Ø if associated with other symptoms § Cramping
§ Vomiting
Bowel Pattern § loss of appetite
vCONSTIPATION § decreasing in voiding
Ø May occur in formula fed infants § weight loss
Ø If the diet is deficient in the fluid § should be examined by their health care provider
Ø This can be corrected simply with the addition of because this suggests an infectious process.
more fluid. DEHYDRATION occurs rapidly in a small infant
Ø Some parents misinterpret the normal pushing who is not eating and is losing body fluid for
movements of a newborn to be constipation when loose stools.
infants defecate:
§ their faces do turn red Colic
§ Grimace and grunt vParoxysmal abdominal pain that generally occurs in
vas long as stools are not hard and contain no infants under 3 mos of age
evidence of fresh blood (as might occur with a rectal vMarked by:
fissure) = normal infant behavior Ø loud intense crying
vif constipation persist beyond 5 or 6 mos of age = Ø an infant cries loudly and pulls the legs up against
encourage parents to check with the infant's health the abdomen
care provider about measures to relieve this Ø the infant’s face becomes red and flushed
Ø adding foods with both such as fruits or Ø the fists clenched
vegetables Ø Abd becomes tense
Ø increasing fluid intake generally relieves the Ø if offered a bottle the infantile stuff vigorously for a
problem few minutes as if starved then stop as another
wave of intestinal pain occurs
Page 115 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

vthe cause of colic is unclear it may occur in home; they may interpret this as vomiting or think
susceptible infants from: an infant is developing an infection
Ø Overfeeding Ø ask them to describe carefully what they mean by
Ø from swallowing too much air while drinking spitting up
vformula fed babies are more likely to have colic in Ø how long the baby been doing it
breastfed babies possibly because they swallow Ø how frequently
more air while drinking or because formula is harder Ø what is the appearance of the spit up milk
to digest valmost all note that is spit up smells at least faintly
valthough infants continue to thrive despite colic the sour but it should not contain blood or bile
condition should not be dismissed as unimportant va baby who spits up a mouthful of milk rolling down
vit is a distressing and frightening problem for parent the chin 2 or 3 times a day or sometimes after every
not only because an infant appears to be in acute meal = normal early infancy spitting up
pain but also the distress persists for hours usually vassociated signs suggests illness such as:
into the middle of the night so no one in the family Ø Diarrhea
gets adequate rest Ø Abd cramps
vNR: Ø Fever
Ø help in determining the ladies feeding pattern is it Ø Cough
breastfed or bottle fed Ø Cold
Ø If bottle-fed ask about the type of formula and how Ø Loss of activity
is it prepared vbeginning pyloric stenosis ( the abnormal tight valve
Ø ask parents if you're holding the baby up right so between the stomach and duodenum) = if an infant
air bubbles can rise is spitting up so forcefully that milk is projected 3 or
Ø whether they burp the infant adequately after 4ft away it may be; which require surgical
feeding intervention
Ø for breastfed baby, a change in maternal diet such vburping a baby thoroughly = after feeding often
as avoiding gassy foods like cabbage might be limits spitting up;
helpful to reduce or limit colic periods. vparents me try sitting and infant in an infant chair
Ø it may be helpful to recommend that both breast for half an hour after feeding
and formula fed infants received small frequent vchanging formulas generally is of little value
feedings = to prevent distension and discomfort vreassure parents that spitting up decreases in
Ø offering a pacifier may be comforting amount as a baby becomes better at coordinating
Ø AVOID HEAT = some parents try placing a hot swallowing and digestive processes in the meantime
water bottle under infant stomach for comfort but a bib can protect the babies clothing and the parent
this should be discouraged a basic rule for any vafter a few months the child will naturally stay in an
abdominal in case of appendicitis is developing upright position longer and gravity will help the
§ Highly unlikely in so young an infant but parents correct the problem
will remember they won't use heat may use it
again when the child is older Milaria
§ hot water bottles and heating pads also might vMILIARIA or prickly heat rash = most often in warm
burn the delicate skin of infants weather or when babies are overdressed or sleep in
overheated rooms
Spitting Up vCluster pinpoint reddened papules with occasional
vRolls down the chin vesicles and pustules surrounded by erythema
vAlmost all infants hiccup although formula fed usually appear on the neck first and may spread
babies appear to do it more than breastfed babies upward to around the ears and on to the face or
vparents who did not handle their infant much in the down into the trunk
healthcare facility where the child was born may vbathing & infant twice a day during hot weather
discover spitting up only after they take the baby particularly if a small amount of baking soda is
added to the bath water = may improve the rash
Page 116 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

veliminating sweating = by reducing the amount of patience and sensitivity and to learn methods for
clothing on an infant or lowering the room handling child’s frustration that arise for the quest
temperature should bring almost immediate of autonomy
improvement and prevent further eruption v“Autonomy vs Isolation”
Ø The developmental task of toddler years according
Baby-Bottle Tooth Decay to Erickson is a development of a sense of
putting an infant to bed with a bottle of formula, autonomy vs. shame / doubt
breast milk, orange juice, or glucose water can result Ø children who have learned to trust themselves and
in aspiration others during the infant year are better prepared
vit can also lead to decay of all the upper teeth and to do this than to those who cannot trust
the lower posterior teeth themselves or others.
vteeth decay occurs because while an infant sleeps Ø To develop a sense of autonomy is to develop a
liquid from the prop bottles continuously soaks the sense of independence
upper front teeth and lower back teeth the problem vPoisoning
is called baby-bottle syndrome Ø never take medication in front of child
vBABY-BOTTLE SYNDROME = occurs because the Ø place all medication and poisons in lock cabinets
carbohydrates in solutions such as formula or or overhead shelves where child cannot reach
glucose water ferments two organic acids that them
demineralize the tooth enamel until it decays Ø never leave medication in parents purse or pocket
vPrevention: where child can reach it
Ø Advise parents never to put their baby to bed with Ø always store food and substances in their original
a bottle containers
Ø If parents insist that a bottle is necessary for the Ø Know the names of house plant and find out if they
baby to fall asleep, encourage them to fill it with are poisonous
water and use a nipple with a smaller hole to Ø hang plants or set them in high surfaces beyond
prevent the baby from receiving a large amount of toddlers grasp
fluids Ø be certain at small batteries or magnet that are out
Ø If the baby refuses to drink anything but milk, the of reach
parents must dilute the milk with water more and Ø post telephone numbers of nearest poison control
more each night until the bottle is down to water centers by the telephone
only Ø inspect toys to be certain there are free of
leadbased paint
Toddler vAspiration
During the toddler period, the age at span from 1- 3 Ø piration - Examine toys for small parts that could
years enormous change has taken place on a child be aspirated
and consequently in a family. Ø Remove toys that appear dangerous
vDuring this period children accomplish a wide array § Do not feed toddler popcorn, peanuts, etc
of developmental tasks and change from a largely § Urge children not to eat while running
immobile and pre-verbal infants who are dependent § do not leave taller alone with a balloon
on caregivers vMVA (Motor vehicular accidents)
vfor the fulfillment of most needs to walking, talking Ø maintain child in car seat -
young children with a growing sense of autonomy or Ø do not be distracted from safe driving by a child in
independence a car -
vto match this growth parents must also change Ø do not allow child to play outside unsupervised
during this period, if a parent enjoyed being the Ø do not allow child to operate electric garage doors
parent to an infant because time could be spent Ø supervised toddler who is too young to be left alone
rocking or singing to the child they may not enjoy on the tricycle
being a parent of a toddler as now their task is to Ø Teach safety w/ pedaling toys
support their child’s growing independence with Ø look before crossing driveways
Page 117 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Ø do not cross streets vdo not allowed toddlers to blow out matches
Ø Do not expect not expected the toddler will obey vstore matches out of reach
these rules at all times = it is important that the vkeep electric wires and cords out of toddler’s reach
provider should stay close by so cover electric outlets with safety plugs
vPlayground injuries vdo not allow toddler to approach strange dogs
Ø do note that some children are more active curious vsupervise child's play with family pets
and impulsive and therefore more vulnerable to
unintentional injury than others Nutrition
vFinger-food
Child Proofing vProvide options
vBABY GATE or FENCE = The best baby proofing v1000kcal/day = sedentary lifestyle
solution to prevent the child climbing the stairs. v1400kcal/day = active lifestyle
vwill prevent the child from going anywhere near the vToddler’s appetite decrease over time so food
staircase consumption will be less
vA properly installed baby gate will hamper the valways remember that recommended calorie intake
curious child’s access even when the guardian is not for toddlers would be
watching Ø 1000 kcal per day for toddlers with sedentary
vit is important that we teach the parents to keep the lifestyle
house windows closed or keep secure screens in Ø 1400 kcal per day for hyperactive toddler
vPlace gates at top and bottom of stairs vbecause the actual amount of food eaten daily varies
vsupervised @ playing grounds from one child to another it is important that we
vDo not allow child to work with sharp object in teach parents to place a small amount of food on a
parent or mouth plate and allow the child to eat it and ask for more
vraise crib rails and check to make sure they are rather than serving a large portion the child cannot
locked before walking away from crib finish
vSince children want to cruise around the house, they vallow self-feeding which is a major way to strengthen
may wander into the kitchen: independence in a toddler
Ø Hot pots and cause burns vFINGER FOODS= offer finger foods and allow each
Ø it is important to teach the parents to cook on the choice between two types of food helps promote
back burners of stove if possible independence while exposing children to varied
Ø turn handles of pots toward back of stove to foods
prevent toddler from reaching up and pulling them vnutritious finger foods that toddlers enjoy include:
down Ø Pieces of chicken
Ø slices of banana
Fire and Burn Hazards Ø pieces of cheese and crackers
vif a vaporizer is used use a cold mist type rather than vmost others insist on feeding themselves and
steam vaporizer so child cannot be scalded generally will resist eating if a parent insist on
vkeep screen in front of fireplace or heater feeding them
vmonitor toddlers carefully when they are near lit van individual child may react after repeated
candles attempts at being fed by refusing to eat at all
vdo not leave toddlers unsupervised near hot water vmany toddlers prefer to eat the same type of food
faucets over and over because of the sense of security this
vcheck temperature setting for hot water heater so offers
thermostat is not over 125 degrees fahrenheit vfrequently they eat all of one item before going on to
vDo not leave coffee or tea pots on the table where another
child can reach them vthey often prefer brightly colored foods to bland
vnever drink hot beverages when a child is sitting on colors
the lap or playing within reach -
vbuy flame retardant clothing
Page 118 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Dressing Ø the parent and say simply “it's nap time now”and
vparents will be reluctant to encourage toddlers to then give a secondary choice “do you want to sleep
dress themselves because it is easier and quicker for with your teddy bear or your ragdoll?”
a parent to do so vAlthough toddlers need to be independent they also
valso a toddler who is dressed by parents will usually need a feeling of security just as adults like to know
be wearing clothes in the correct way there are guardrails along steep mountain roads =
vwhen toddlers dress themselves they invariably put toddlers like to see parents as firm consistent people
shoes on the wrong feet and shirt and pants on you can be counted on to be reliable over and over
backward especially when they are tired
vencourage parents to give a perfection for the benefit vBy the end of toddler period = Many toddlers are
of the child's developing sense of autonomy ready to be moved out of a crib into a youth bed or
vif they feel they must change the child's clothes, urge regular in bed with protective side rails or a chair
them to begin with a positive statement such as “you strategically placed beside it
did a great job!” before making the switch vremind parents/ stress that sleeping in the regular
vas soon as children are off on their feet and walking bed does not give children the right to get in and out
they need shoe soles that are firm enough to provide of bed as they choose
protection from rough surfaces however toddlers do Ø some toddlers do well if they are allowed to sleep
not need extremely firm or ankle high shoes because in a regular bed and a folding gate is placed across
a toddler’s arcs are still developing the door to their room = this arrangement gives
vit is better for their arc to provide foot support rather them a feeling of independence but still keep them
than having it provided by shoes safe
vSNEAKERS = are an ideal toddler shoe because the Ø when first moved to a bed without side rails many
soles are hard enough for tough or for rough children are found sleeping on the floor of the room
surfaces and arcs support is limited in the morning = no harm in this unless it is cold
or drafty
Sleep Ø dressing the child in warm pajamas or putting a
vThe amount of sleep children he gradually decreases blanket on the floor might be solutions to help
as they grow older parents accept this
vThey may begin the toddler period nappings 2x/day
and sleeping 12 hours each night and end it with Bathing
one nap/day and only 8 hours of sleep at night vStill not safe for parents to leave toddlers
vparents who are not aware that the need for sleep unsupervised
declines at this time made you a child's disinterest Ø Might slip and get head underwater
in sleeping as a problem Ø Reach and turn on hot water faucet
vif a child has difficulty falling asleep at night = omit vDo not add bubble bath to water
or shorten and afternoon nap Ø Associated with vulvovaginitis and UTI especially
vif a child is so short-tempered at dinner time that in girls
eating is impossible = perhaps the child needs 2
naps/day Dental Care
vsome toddlers begin having night terrors or awake vTo help prevent dental caries from frequent snacking
crying from a bad dream → so may receive little sleep vEncourage parents to offer fruits or protein foods
because they are reluctant to fall back asleep vRather than high carbohydrate items such as
vother toddlers resist nap time as part of their cookies
developing negativism = parents might minimize this vLimit exposure to carbohydrates
by including a nap as part of lunchtime routine not vCalcium
as a separate activity Ø Especially important for development of strong
Ø E.g the child always goes from the table directly to teeth
bed as if the two things are connected Ø Good as snack foods
vContinue to drink fluorinated water
Page 119 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Ø If not available Ø They must have a desire to delay immediate

§ Use fluoride supplements gratification for a more socially accepted action
Ø So that all new teeth form with cavity resistant vSome toddlers smear or play with feces
enamel Ø Often at the time toilet training has started
vDo not put a child to bed with a bottle of milk or juice § Occurs because they have become fully aware of
Ø Help prevent development of caries body excretions but do not have adult values
vToddlers need a toothbrush that they recognize is towards them
theirs Ø Stool seem a little different than the modelling clay
vToward the end of toddler period that they play with
Ø Can begin brushing themselves under supervision Ø Solution:
until 8 years old § Provide toddlers with substances of similar
vReminder: texture
Ø Better for a child to brush thoroughly once a day § Changing diapers immediately after defecation
at bedtime and do it poorly at other times § Teach parents to accept this behavior for what it
Ø After brushing is, an enjoyment of the body and of the self and
§ Parents can use dental floss to clean between the the discovery of new substances
child's teeth and remove plaque § After child is toilet trained
vFirst dental visit § Playing with feces rarely happens
Ø 12 months of age
Ø Dentist skilled with pediatric dental care Negativism
Ø Screening and assessment of dentition vDo not want to do anything a parent wants them to
§ 6 months of age do
§ Should not go beyond 24 months of age vReply to every request is no
Ø Dental services can begin by aged 3 years vSolution:
Ø Parents can prepare child for first and subsequent Ø Reduced by limiting number of questions asked to
dental visits the child
§ Reading stories § Father: are you ready for dinner?
Ø Children rarely have any cavities this early Meaning = come to the table. Its dinner time
§ First dental visit are painless § Mother: will you come take a bath now?
§ Sets positive stage for future dental supervision Meaning = its time for a bath
visits Making a statement instead of asking question can
avoid many negative responses
Toilet Training vToddler needs experience in making choices
vOne of the biggest task a toddler tries to achieve vTo provide opportunity to do this, a parent could give
Ø It is important to explain to parents that toilet a secondary choice
training is an individualized task for each child Ø No is not an allowed answer for major task
and should begin and completed with the child's Ø Example:
ability to accomplish it and not according to a set § Parent: its bath time now. Do you want to take
schedule your duck or your toy boat into the tub with
vBefore children can begin toilet training, they must you?
reach three important developmental levels § Parent: its lunch time. Do you want to use a bib
Ø One is physiologic and the other two are cognitive or a small plate?
Ø They must have control of rectal and urethral § Parent: its time to go shopping. Do you want to
sphincters, usually achieved at the time they walk wear your jacket or sweater?
well
Ø They must have a cognitive understanding of what
it means to hold urine and stools until they can Discipline
release them at a certain place and time vSetting roles or road signs so children know what is
expected of them
Page 120 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

vPunishment Ø May cry when seeing the babysitter or greet the

Ø Consequence that results from breakdown in babysitter when she arrives but cries when toddler
discipline or child's disregard of role that were sees the parents grabbing their coats
learned Ø Solution:
vTwo general rules needs to be followed § Say goodbye firmly and repeat the explanation
Ø Parents need to be consistent and then leave
Ø Rules are learned best if correct behavior is § Prolonged goodbyes
praised rather than wrong behavior punished § lead to more crying
vTime-out § Sneaking out (must be discouraged)
Ø Technique to help children learn that actions have § may prevent crying and ease parents guilt but
consequences can strengthen fear of abandonment
Ø To use this effectively
§ Parents must be certain that child understands Temper Tantrums
the rule that they are trying to enforce vChild may kick, scream, stomp feet, shout, flail arms
Ø Parents should give one warning and legs, bite, or bang head on the floor
§ If child repeats the behavior, parents select an vNatural consequence of toddler's development
area that is non stimulating (corner of room or vOccur because they are independent enough to
hallway) know what they want but does not know how to
• Child is directed to go immediately to timeout express their feeling in a more socially accepted way
space vResponse to difficulty making choices or decisions or
• Child then sits there for a specified period of to pressure to activities such as toilet training
time vExpress their feelings in some way and do so with
• If child cries or begin to do disruptive behavior, temper tantrum
timeout does not begin until it is quiet Ø Hold breath until they become cyanotic
• When specified time has passed, child can § Distended chest
return to the family § Often has air filled cheeks
• Using a timer that rings when time is up § Shows increasing distress as body registers
(Effective way to let children know when they oxygen want
can return with the family) vIgnoring child makes it an ineffective technique for
v1 minute = 1 year of age expressing frustrations or getting what they wanted
vBreathing holding
Separation from anxiety Ø Unprovoked neurologic problem
vFear of being separated from parents begins at 6 Ø Children under stress appear to forget to breathe
months of age throughout the preschool period or halt breathing after expiration
vToddlers who have this have § Usually at the peak of anger
Ø Difficulty accepting being separated from a § Become so short of breath they slump to the floor
primary caregiver to spend the day at a daycare vTrue breath holding
center Ø Needs to be separated from temper tantrums
Ø Or if primary caregiver is hospitalized vSolution:
vReact best if regular babysitter is employed or if Ø Tell child that they disapprove of the tantrum and
daycare center have consistent caregivers ignore it
vHelps if toddlers are given fair warning that they will § I'll be in the bedroom. When you're done kicking,
have a babysitter come into the bedroom too.
Ø Example: Mommy is fixing dinner because mommy § Children who are left this way will not usually
and daddy are going to visit some friends tonight. continue their tantrum but will stop after one or
Maria will come and babysit for you. She'll put you two minutes and rejoin their parents
to bed. When you wake up in the morning, mommy Ø Parents should then accept the child warmly and
and daddy will be here again proceed as if the tantrum had not occurred

Page 121 Compiled by TEAM SHAWTIES

 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

§ Also helps with nurses taking care of tantrums vNever use a cellphone or text while driving
in hospitals vDo not drink alcohol while driving
vAlways refused to ride with anyone who is has been
Autism Spectrum Disorder (ASD) drinking
vComplex range of neurodevelopmental disorder
vCharacterized by Adolescent and MMDST
Ø Communication difficulties vName a designated driver or arrange with the
Ø Poor social interactions parents to be picked up or provide money for a taxi
Ø Frequent, repetitive and stereotyped movement vWear a helmet and long trousers as driver or
vSymptoms begin to appear in infancy passenger on a motorcycle except there has no place
vObvious enough in toddler years in safe driving
Ø Child tend not to speak any words vTake the driver program seriously so child learn safe
Ø Does not make eye contact with others driving habits for both two wheel and four-wheel
Ø Has difficulty interacting with playmates vehicles
§ Prefer to watch spinning toy, water swirling vFor sports, it is important to use protective
down the toilet or repeating song phrases equipment such as face mask for hockey and pads
vScreened for autism symptoms by 12 months of age and helmet for football ●
v18 and 24 months of age by observation and parent vDo not attempt to participate beyond physical limits
report vKeep well hydrated by drinking fluid before and after
play
Adolescence vCareful preparation for sports through training is
vperiod between 13 – 20 yrs old essential to safety and recognize and set one's own
vtime serves as transition from childhood to limit for sports participation
becoming a late adolescent vOther common causes of death in adolescents are
vdivided to: homicide and self-harm or suicide these are related
Ø early period (13-14yrs old) to easy accessibility of guns when adapt added to
Ø middle period (15-16) depression binge drinking and impulsivity
Ø late period (17-20) vGang violence and the desire to protect themselves
vduring all periods adolescence is defined not so are additional factors
much by chronological age as by physiologic,
psychological and sociological changes Nutrition
vthe drastic change in physical appearance and the vAdolescents experience such rapid growth that they
change in expectations of others, esp parents that me always feel hungry if their eating habits are
occur during the period can lead to both emotional unsupervised because of peer pressure and when in
and physical health concerns hurry to get to other activities they tend to eat fattish
or quick snack foods rather than more nutritional
Promotion of Safety ones
vMotor vehicle accidents are the most leading cause vAdolescents who are slightly of obese because of
of death among adolescents prepubertal changes may begin low-calorie or
vAlthough teenagers are at the peak of physical and starvation diets during adolescence to lose weight
sensory motor functioning, their need to rebel some diet so excessively they develop eating
against authority or to gain attention through risk- disorders such as bulimia or anorexia nervosa
taking leads them to take careless action such as vAnorexia often stems from a distorted body image
speeding or driving while intoxicated. Some which may result from an emotional trauma
adolescents dismiss seat belts as childish and so depression or anxiety some people may view extreme
need extra instruction that is why to use every safe dieting or weight loss as a way to regain control in
precaution available when in a motor vehicle. their lives
vSo instruct them to always use a seatbelt whether a vThere are many different emotional behavioral and
driver or passenger physical symptoms then can signal anorexia
Page 122 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

vWhile someone with bulimia may develop an all adolescent health appraisal to detect the
unhealthy relationship to food over time they may difference between simple poor posture and the
get caught up in damage in cycles of binge eating beginning of spinal dysplasia or scoliosis
and then panic about the calories dave consume this vBody piercing and tattoos
may lead to extreme behavior to prevent weight gain Ø are a strong mark of adolescents. Body piercings
vWeight loss diet is appropriate during adolescence and tattoos have become a way for adolescents to
but it must be supervised to ensure the adolescent make a statement of who they are and that they
is consuming sufficient calories and nutrients for are different from their parents. Be certain they
growth know the symptoms of infection at a piercing or
vFor example many adolescents entirely omit breads tattoo site such as redness, warmness, swelling
and cereals to lose weight rather than just reducing and mild pain and to report these to their
the amount they eat healthcare provider if they occur because serious
vDiet can be deficient in vitamin B - thiamine and B2 staphylococcal or streptococcal infections can
- riboflavin which are necessary for growth occur at piercing sites. It is important to caution
vSometimes adolescents may be unaware that their adolescents that sharing needles for piercing or
food intake is excessive because they have been told tattooing carries the same risk for contracting a
they need excess nutrients for healthy and blood borne disease as sharing needles for
adolescent growth and everyone in their family eats intravenous drugs
large portion vFatigue
vHealth teaching with adolescents need to begin with Ø because so many adolescents comment that they
a discussion of a normal weight and standard food feel fatigued to some degree it can be considered
because they do not begin to own this problem as normal for the age group however fatigue may also
adolescent they run a high risk of becoming obese be a beginning symptom of disease so it is
adults important that it is not underestimated as a
vSo general measures to help adolescent decrease concern. always assess a diet sleep patterns and
overeating include making a detailed log of the activity schedules of fatigued adolescence. be
amount they eat the time and the circumstances and aware that is affecting a short period of extreme
then changing those circumstances always eating in tiredness it suggests disease more so than a long
one place like the kitchen table instead of while ill defined report of always feeling tired. Blood tests
walking home from school or watching television may be indicated to rule out anemia and common
vSlowing the process of eating by counting mouthfuls infections in adolescents such as infectious
and putting the fork down between bites or being mononucleosis. chronic fatigue syndrome
served food on small plate so helping it look larger although not seen as often in this age group as in
adults may also need to be ruled out.
Health Problems vMost common menstrual irregularities would be
vHYPERTENSION Acne
Ø is present if the blood pressure reaches above 127 Ø Acne is a self-limiting inflammatory disease that
over 81 mmhg for 16 year old girls and 131/81 for involves the sebaceous glands which empty into
16 year old boys for two consecutive readings in hair shafts. it is the most common skin disorder of
different settings all children older than three adolescents and it's frequently occurring in boys
years of age should have a blood pressure than girls. Changes associated with puberty that
routinely taken at all health assessments to detect cause acne to develop include the increase in
this. this is particularly important for adolescents androgen level in both sexes and sebaceous glands
because new medications + education can help to become active. The output of sebum which is
greatly reduce the incidence of cardiovascular largely composed of lipids mainly triglycerides
disease as they reach adulthood increases. trapped sebum causes whiteheads or
vPOOR POSTURE closed comedones. As trap sebum darkens from
Ø Urge children of both sexes to use good posture accumulation of melanin and oxidation of the fatty
during these rapid growth years. assess posture at acid components on exposure to air, blackheads
Page 123 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

are open comedones. leakage of fatty acid causes requirements for membership are. help
a dermal inflammatory reaction. bacteria lodge adolescents make sound decisions about what
and thrive in the retained secretions and ducts. type of hazing their organization advocates by
Ø Acne is categorized as: asking them about the subject at all health
§ Mild - made up of comedones , those are blocked assessments. Substance use disorder formerly
hair follicle referred to as substance use disorder refers to the
§ Moderate - such as papules and pustules are use of chemicals to improve a mental state or
also present induce euphoria. This is so common among
§ Severe - is when there is a cyst present adolescents that as many as 50% of high school
Ø Risk factors seniors report having experimented with some
§ emotional stress form of drug according to the CDC in 2012. Of the
§ menstrual periods many the view substances would include
§ use of makeup and harsh hair prescription and over-the-counter drugs alcohol
§ Treatment tobago steroids marijuana amphetamine cocaine
§ Decrease table formation hallucinogens, opiates
§ Prevent comedones vIt is important to promote therapeutic
§ Control bacterial proliferation (there are communities or 24-hour facilities in which
systemic medications and external medications adolescents can live while they recover from a
that can be applied as ordered by the doctor). chemical dependency which may be necessary for
some adolescents
Sexuality vThe aim of all these programs is to increase
vStalking refers to repetitive intrusive and unwanted adolescent’s sense of self-esteem, improve solving
actions such as constant threatening, pursuit ability and realign them. adolescents should be
directed at an individual to gain the individual's encouraged to seek care for themselves or others
attention or to evoke fear. Electronic media can be whenever an overdose situation is apparent as
used for cyber stalking, internet harassment and prompt treatment can be life-saving.
internet bullying to embarrass, harass or threaten Self-injury includes a range of self destructive
adolescents. This is one of the concerns regarding actions from cutting to suicide, the plan or intent to
sexuality and sexual activity that can threaten end one’s life. Cutting is found more frequently in
especially female adolescents. to avoid stalking girls than boys and can begin as early as grade
adolescents should be aware of and avoid situations school. successful suicide occurs more frequently in
where they will be vulnerable to be alone with a males than in females. Although more females
stalker and with assistance reports talking to law apparently attempt suicide than males, adolescent
enforcement suicide stand to be attempted most often in the
spring or in the fall reflecting school stress at this
vDuring school age, can easily continue into times of year and between 3 p.m. and midnight.
adolescence and actually becomes more serious Reflecting depression that increases with the dark.
because this can be the time the bullied child has Because suicide usually reflect a problem in family
the ability to retaliate through self destructive interaction, a family assessment is helpful. A
behavior or school violence. thorough family history may reveal conflict with one
vHazing is a form of organized bullying that refers or both parents or reveal how little support the
to the degrading or humiliating ritual that adolescent receives at home. School friends may
prospective members have to undergo to join often be the ones who are first aware that an
sororities fraternities and adolescent gangs or adolescent is contemplating suicide. Caution
sports teams. parents not to discount reports from their child's
vTo help prevent this from happening or the friends who tell them they are concerned. Close to
dangers of bullying and hazing to happen to the the chosen time of suicide some adolescents
child urge parents to be aware of what clubs or demonstrate characteristic behaviors that show
organizations their adolescent joints and what they are making preparations to end their life. Teach
Page 124 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

family & friends these typical danger signs. When vGuidelines

caring for a child after a suicide attempt, ask as Ø if the child is less than 6 months it is best if your
enough questions on a health history so you can place on the lap of the provider or by the examiner
help to analyze whether an adolescent made a Ø Associate play - introduced during the whole test
detailed suicide plan. Ø identify the age of a child based on the date of
examination and consider the prematurity if the
Metro Manila Developmental Screening Tool child is 2 years old and below
(MMDST) Ø start and task below the child's age level
vScreening is a presumptive identification of an Ø allow three trials per task
recognize disease or defect it is used for early vScoring and point system:
detection and test child with problem facilitates Ø “P” - pass
early referral and treatment and detects Ø “F” - failure
developmental disabilities Ø “R” - refusal/pass by report (instances we cannot
vThe MMDST is indicated for children 6 and a half elicit the test however the examiner can testify that
years old and below the child can do it in some instances)
vMMDST is a simple and clinical useful tool that is Ø “N.O.” - no opportunity
used to determine early serious developmental vFailure of an item that is completely to the left of the
delays and is organized by Dr. William K. child age is considered a developmental delay
Frankenberg and modified and standardized by Dr. vFailure of an item that is completely to the right of
Phoebe DauzWilliams from DDST or the Denver the child's age line is acceptable and not a delay
Developmental Screening Tool to MMDST. It is vSpecial considerations in this test manner in which
developed for health professionals such as doctors, test is administered must be exactly the same as
nurses, etc. It is not an intelligence test, it is a stated in the manual words or direction may not be
screening instrument to determine if a child's changed
development is within normal. The objectives of vIf the child is premature subtracted number of
MMDST is to measure developmental delays and to weeks of prematurity
evaluate four aspects of development such as: vBut if the child is more than two years of age during
Ø Gross motor adaptive - this includes task which the test, subtracting may not be necessary
indicate the child's ability to sit walk and jump vIf the child is shy or uncooperative the caregiver may
Ø Fine motor adaptive - covers tasks which indicate be asked to administer the test provided that the
the child's ability to see and use his hands to pick examiner instruct the caregiver to administer it
up objects and to draw exactly as directed in the manual
Ø Language - this covers tasks which indicate a vIf the child is very shy or uncooperative the test may
child's ability to hear follow directions and to be deferred.
speak
Ø Personal social - covers tasks which indicate the
child's ability to get along with people and to take
care of himself
vMaterials to be used:
Ø Bright red yarn pom pom
Ø Rattle with narrow handle
Ø Eight 1-inch colored wooden blocks (red, yellow,
blue, green)
Ø Small clear glass/bottle with ⅝ inch opening
Ø Small bell with 2 ½ inch-diameter mouth
Ø Rubber ball 12 ½ inches in circumference
Ø Cheese curls
Ø Pencil
Ø Mat to play on
Page 125 Compiled by TEAM SHAWTIES
 WEEK 12 – INFANT AND TODDLER
Miss Jugasan || BSN || BATCH 2024 MOTHER AND
CHILD CARE

Page 126 Compiled by TEAM SHAWTIES