Infant Development - Week 3 Student Copy PDF

Infant Chapter 11 Fall 2024 Alex Dampier & Rosemary Scofich Psychosocial Development: Erickson  Erikson’s psychosocial developmental theory is concerned primarily with a series of tasks or crises that each individual must resolve before encountering the next one.  The ce...

Infant Chapter 11 Fall 2024 Alex Dampier & Rosemary Scofich Psychosocial Development: Erickson  Erikson’s psychosocial developmental theory is concerned primarily with a series of tasks or crises that each individual must resolve before encountering the next one.  The central task during infancy is the development of a sense of trust versus mistrust.  This occurs when adults meet an infant’s basic needs for survival.  The establishment of this basic trust or mistrust determines the manner in which the infant approaches all future stages of growth.  The infant develops a sense of trust first in the mother (or other caregiver), and then in other significant people. Age Psychosoci Task Resolution of Crisis: Resolution of Crisis: al Crisis Successful Unsuccessful 1. Infancy Trust vs Basic needs of infant Trust in persons: faith General difficulties (birth to 18 mistrust are either met or not and hope about the relating to persons months) This will lead to environment and effectively: suspicion, whether trust and future trust, fear, conflict, hope is developed or and fear of the future. not Interventions to Assist the Client in Achieving Erickson’s Stages of Development Hold and touch the infant frequently Offer comfort after painful procedures Meet the infant's needs for food, hygiene, and comfort Encourage the parent to play an active role while the infant is hospitalized Toys include mobiles, rattles, squeaking toys, picture books, coloured blocks Cognitive Development: Jean Piaget Piaget's theory of cognitive development defines cognitive acts as ways in which the mind organizes and adapts to its environments. The period from birth to 24 months is termed the sensorimotor phase and is composed of five stages The newborn is capable of reflexive behaviour. Reflexes are involuntary muscle responses that are normally exhibited after particular types of new stimulation eg rooting and sucking Crucial events take place during this phase 1. The first event involves separation 2. The second major accomplishment is achieving the concept of object permanence  Cognitive Development: Piaget Piaget's Sensorimotor Five Stages of Infant Development Description Example 1. Birth to 1 month Practice and modification of reflexes in A newborn exhibits the sucking reflex response to new objects when a pacifier is placed in their mouth. As they repeatedly experience the pacifier, they start to modify the strength and rhythm of their sucking to better fit the shape and feel of the pacifier. 2. 1-4 months Primary circular reactions: repeats reflexive actions that were previously enjoyed An infant repeatedly sucks their thumb Only the infant’s own body is involved in because it feels comforting and enjoyable. activities This action involves only their own body, and Begins to notice when objects disappear they begin to notice the sensation and the disappearance of their thumb when they move their hand away from their mouth.  Cognitive Development: Piaget Piaget's Sensorimotor Five Stages of Infant Development Description Example 3. 4-8 months Secondary circular reactions: repetitions An infant shakes a rattle repeatedly involve objects in the external world because they enjoy the sound it Appears to perform actions with a purpose makes. The infant's action involves an external object, and they seem to shake the rattle with the purpose of hearing the noise. 4. 8-12 months Engages in goal-directed actions An infant sees a toy under a blanket and Combines two or more previously acquired first pushes the blanket aside (one strategies to obtain a goal strategy) and then reaches out to grab the They can experience an event by observing toy (another strategy). The infant it, and they begin to associate symbols with combines these actions to achieve the events goal of retrieving the toy. A. “bye-bye” with “Daddy or Mommy goes to work” 5. 12-18 months Uses active experimentation to achieve An infant wants to get a toy that is placed on previously unattainable goals a high shelf. They try different methods such Infant uses trial-and-error processes and as pulling a chair over to climb on it, stacking observes results blocks to reach higher, and even asking for help from a nearby adult. Through trial and error, the infant experiments with different approaches until they successfully obtain the toy. Question A new parent asks, “When will the soft spot near the front of the baby's head close?” When should the nurse tell the parent the soft spot will close? A. 2 to 3 months B. 6 to 8 months C. 9 to 10 months D. 12 to 18 months Question The nurse performs a head-to-toe assessment on a 2-month-old infant. Which structure should be closed by the time the infant is 2 months old? A. A D A B. B C. C posterior fontanelle B D. D C  The nurse assesses infant development at a well-child clinic. Which infant needs a developmental referral for a gross motor delay the most? A. 2-month-old who does not roll over Question B. 4-month-old who does not sit without support C. 6-month-old who does not crawl D. 9-month-old who does not stand holding on  Looksee Checklist: Can assist nurse and parent in the assessment of infant development from birth to 6 years of age A series of age-specific checklists track Infant & developmental skills in the areas of vision, hearing, communication, fine Child motor, gross motor, cognitive, social, emotional and self-help Developmen Rourke Baby Record: The Rourke Baby Record includes tal Tools sections for the health care provider to monitor developmental milestones, growth and nutrition, physical examinations, immunizations, and provide anticipatory guidance for health promotion for children 1 month to 5 years of age. Sex Boys: Boys are, on average, larger and have proportionately more muscle mass at birth Boys show more motor activity Girls: Girls are generally smaller but physiologically more mature at birth and are less vulnerable to stress. They display a greater response to tactile stimulation and pain By 6 months, girls respond to visual stimulation with longer attention spans and are more socially responsive than boys; Girls also tend to sit up, walk, and crawl earlier than boys. Girls also learn to communicate with language at an earlier age, whereas male infants use their whole bodies in communicating  Race as a Social Determinant of Health: How can healthcare professionals effectively incorporate the understanding of race as a social construct into their practice to better address health disparities? Race Health Inequities Among Minority Populations: and What strategies can be implemented at the community and policy levels to reduce the health disparities experienced by Indigenous and Black Ethnicit Canadians? y The Role of Nurses in Addressing Health Inequities: In what ways can nurses and other healthcare providers improve their cultural competency to ensure that they are providing equitable care to patients from diverse backgrounds? Consider the northern, rural, and remote context of Northwestern Ontario. Genetics An important aspect of primary prevention is identifying families at increased risk and referring them for counselling. The aspects to be reviewed in the initial interview include the following; o Maternal age o Ethnic background o Family history o Reproductive history o Maternal disease The nurse’s role throughout the genetic counselling process is to provide the vital link between the counselling team and the high-risk couple. The nurse is involved in case finding, referral, and family education Health Perception Health Management Pattern Promoting the health of an infant is additionally influenced by parental self-efficacy, which refers to parents’ belief in their parenting competence and capacity to support their child’s development With this understanding, the nurse uses every opportunity to convey confidence in the parents’ health perception–health management pattern and to improve their ability to implement behaviours that promote the infant’s health. When parents learn and adopt behaviours that improve their own health, they are more likely to ensure that the health needs of their infant are met. Parental modelling of a healthy lifestyle increases the chances that good health practices will be retained throughout the child’s life.  Infant Nutritional-Metabolic Pattern The nurse has an important role in educating mothers to assist them in making an informed decision about newborn feeding, and to provide feeding strategies and techniques. During infancy, a period of rapid growth, nutrient requirements per kilogram of body weight are proportionally higher than at any other time in the life cycle. Newborn caloric and nutritional needs are as follows: 110 kcal/kg (50kcal/lb) for the full-term infant per day (varies depending on feeding method and other factors) High fluid needs during the neonatal period, beginning at 64ml/lb/day (140ml/kg/day), and gradually increases  Essential Nutrients Protein Carbohydrate Fats Vitamins Minerals s Requirement: Requirement: Requirement: 31 g of fats per day Requirement: Requirement: Although 9.1 g during the 60 g for infants for the first 6 months and 30 g of fat Vitamin D 400 IU iron in human milk is first 6 months and up to 6 months per day for the second 6 months for all bioavailable, both 11 g during the and 95 g for 7-12 breastfed/Chest breastfed and formula-fed second month months fed infants from infants should receive an birth to one year additional source of iron by 6 months of age. Found In: Found In: 37% Found In: These quantities are Found In: Vit D Found In: Meat, meat Human milk, of the calories in present in human milk and in all supplement is an alternatives, and iron- formula, and human milk and formulas prepared for infants. over-the-counter fortified cereals are good introduction of 40% to 50% of Significantly lower intakes, such medication sources of iron solid foods such the calories in as in cow and goat milk or plant- Paired with foods high in as meats, dairy, commercial based milks, can result in an vitamin C to help with iron legumes ect. formulas are inadequate energy intake and are absorption derived from inappropriate substitutes for lactose or other breast milk or formula. carbohydrates. Introduction of solid foods. Infant Nutrition and Feeding Breastfeeding/Chest Feeding: According to research and recommendations, infants should be breastfed exclusively for the first 6 months of life and should be encouraged for 2 years and beyond with appropriate complementary feeding. Benefits for the Infant:  Improve cognitive development and reduce the risk of gastrointestinal illness, otitis media, respiratory infections, SIDS, and obesity  Composition meets and adapts to nutritional needs  Easily digested and absorbed; less likely to result in overfeeding, contamination, or dilution Benefits for the Parent:  Oxytocin release, delayed return of menses  Enhanced binding  Convenient and economical How Do you Know Breast/Chest Feeding is Going Well? Feeding at least 8 times in 24 hours Your infant is content when you finish breastfeeding. You see at least one wet diaper for each day of your infant’s age (e.g., three wet diapers on day 3), up until day 5, and at least six wet diapers daily thereafter. Baby loses weight for the first 3 days (up to 10%), but regains birth weight by 10 to 14 days Signs that a good latch has been made are: The infant’s nose is free from the breast. The infant’s chin is firmly pressed against the breast. The infant has round cheeks. Question The nurse cares for a newborn on the third day of life. Progress Notes: Day Pounds Grams Day 1 (birth) 7 lb 8 oz 3,401 g Day 2 7 lb 4 oz 3,288 g Day 3 7 lb 3,175 g The nurse reviews the daily weights of the breastfeeding term newborn. Complete the sentence from the list of options below. The nurse's best action is to: A. Reweigh the newborn B. Provide supplementation C. Continue routine monitoring D. Notify the health care provider Normal During the first 6 months, the infant will gain 140 to 200 g (5 to 7 oz) Weight weekly from 1 to 6 months. Gain: Infants typically double their birth weight by six months of age and Infancy triple their birth weight by 1 year of Period age.  Growth Chart Activity and Plotting Age Weight 2 months 4.9 kg 6 months 10kg Infant Nutrition and Feeding Bottle Feeding: If the mother makes an informed choice to formula- feed rather than breastfeed her infant, it is important that the nurse provide nonjudgmental care and education in a way that supports the mother’s autonomy and the therapeutic nurse–patient relationship. Potential Reasons for choosing formula feeding over breast/chest feeding:  Pain or leaking with breast/chest feeding  Embarrassment with public breastfeeding  Unequal feeding responsibilities of the other parent/caregiver  Dietary restrictions (limitations on alcohol, caffeine intake)  Contraindications may include medications, certain viruses, or chemo/radiation  Breast/Chest Feeding Bottle/Formula Feeding Education on: Education on: Increased thirst with feeding Powdered and liquid Watch the infant, not the concentrate formulas clock. Look for early signs of require mixing with boiled wanting-to-feed behaviours. water; read and follow Provide your breastfeeding instructions carefully. infant a vitamin D Check the expiration date supplement of 400 IU. and condition of each Try to rest when the infant container of formula. sleeps Preparation of formula- Diet, no need to alter Bring water for mixing with however, alcohol and formula to a rolling boil for 2 medications pass into minutes, handwashing, Nurses Role breast milk, so check with your HCP Sore nipples may mean sanitizing, Store the prepared formula in the refrigerator for no baby is not latched on well; more than 24 hours. seek assistance regarding Warm the formula by your technique. placing it in warm water, Expose nipples to air after never in a microwave oven. each feeding and allow Shake the bottle well and some breast milk to dry on feed the formula to the nipples for their lubricating infant. and anti-infective Discard any formula the properties. infant did not drink within 2 Learn about the use of hours. breast pumps and milk storage, which can allow you to go back to work or school and continue Infant Nutrition and Feeding Feeding Cues:  Sucking on the hands or hand-to-mouth movements  Sucking motions  Rooting reflex: Attempting to suck on objectives that touch near the mouth  Smacking the lips Nursing Note: Crying is a late sign of hunger. The infant must be calmed down prior to feeding. The mother should attempt to feed the infant before it becomes irritable. The infant should be fully awake when feeding Infant Nutrition and Feeding Frequency of Feedings: Infants are usually breastfed 8-12 times in 24 hours (breast milk is digested faster than formula) Frequency should be determined by infant cues, not by a predetermined schedule Duration of Feedings: Feeding time is generally 15 to 20 minutes per breast, and this length may increase over time Parent/caregiver should be instructed to allow the infant to determine the feeding time and respond to infant cues such as slowing sucking, falling asleep or breast softening Feeding Positions: Introduction to Solid Foods  Most children are physiologically and developmentally ready for their first foods at about 6 months of age  The infant should be able to do the following developmental tasks before solid foods are introduced:  Sit with support  Have good head and neck control  Keep food in their mouth without pushing it out with their tongue  Lean forward and open mouth when interested in food  Turn away when not hungry  Risks of introducing complementary foods too early include: When introducing foods that are common  Eczema allergens, introduce no more than one new  Diabetes food that day and wait  Overweight status at a later age two days to identify if it caused a reaction! Impact What are the impacts s of of poor feeding? Poor What are nursing Feedin interventions to aid in the child's growth and g development?  Introduction to Solid Foods Dietary ✅ Feeding Recommendations✅ Foods to Avoid❌ Recommendations Iron-rich foods Meats, meat Expose children to a  Salt alternatives (such as eggs, variety of tastes, colours,  Sugar tofu, legumes), and iron- and textures.  Spices fortified cereals are all Textures should be soft at 6  Chocking hazards in the good choices after 6 months (minced, pureed, form of round shape foods months of age mashed, or ground), to like while grapes or Foods like pureed fruits and lumpy textures by 8 hotdogs vegetables, dairy products months as the biting  Honey should be avoided like yogurt and cheese, and motion is developing,  until they are older than 1 grains like toast or rice can texture range of typical year of age, due to the risk be introduced according to family foods of tender of botulism culture and family consistency by 12 to 18 preferences. months when children Breast milk or formula will acquire full chewing remain the most important movements drink until the child is at Finger foods should be least 12 months of age offered all along to support infants’ oral and motor development. Children can eat soft food from a spoon between 6 Infant Nutrition and Feeding Weaning: is a gradual, caring process that introduces the infant to a cup, which replaces the bottle or breast. Weaning should not be started until the infant can sit only slightly supported. By 6 months: Developmentally, the infant can usually learn to use a cup Breast/Chest Feeding Infants (recommendations to 2 years of age and beyond) Use of a cup can be accomplished by offering small sips of water from an open cup between feeds Bottle-fed Infants: Transition to a cup should take place by about 12 months of age and be complete by 18 months of age. Cow’s Milk: Can be introduced between 9 and 12 months of age, once the infant is eating a wide variety of iron-rich foods, and should not total more than 750 mL per day Drinking milk from an open cup rather than from a bottle can help prevent excessive consumption Elimination Pattern Breast/Chest Fed Infants: Mushy golden-yellow colour and a seedy consistency, with a slightly sour but clean smell, dissimilar to stools passed later in life. The breastfed infant has many daily stools during the first and second months of life, progressing to one stool per day or even one stool every 4 to 5 days in the later months before solid foods are introduced. Formula Fed Infants: Firm, pasty, and smellier and resemble those of an infant eating solid food The bottle-fed infant has two to four stools per day during the first month, tapering to one a day or even fewer at the end of infancy Nurse Education: Advise parents to delay toilet training until developmentally ready, usually age 2-4 Reassures breastfeeding parents who may become concerned if their infant goes for several days without having a bowel movement An infant who voids 6 to 12 times a day during the first few months of life is usually healthy and well hydrated  The amount of sleep that infants need is closely related to their rate of growth. Initially, infants sleep approximately 80% of the time, as demanded by their rapid growth. As growth begins to slow toward the middle of the first year of life, less sleep is needed. Sleep Rest Anticipatory Guidance:  The nurse stresses that longer sleep patterns Pattern are signs of maturation and that sleep and rest are recognized as having a significant influence on the infant’s growth and development.  The nurse may offer the parents helpful comments for promoting infant sleep patterns, such as the following:  Establish a bedtime routine (e.g., bath, pyjamas, feeding, and singing a song) and a consistent sleep schedule.  Put the infant down in the crib or bassinet when they are drowsy but before they fall asleep.  Comforting a crying infant will help them feel secure—you cannot spoil an infant!  Sudden Infant Death Syndrome (SIDS) SIDS is defined as the sudden death, during sleep, of an infant less than one year of age, which remains unexplained after a thorough case investigation, including the performance of a complete autopsy, an examination of the death scene and a review of the clinical history. Incidence: Decreased by over 300% from 2000 to 2013, likely due to fewer women smoking during pregnancy, more women breastfeeding, and the Back to Sleep campaign that encouraged caregivers to lay infants on their backs to sleep. SIDS continues to be the second leading cause of death for healthy infants under 1 year old in Canada Causes: The exact cause of SIDS is unknown; however, it is believed to be related to a convergence of extrinsic stressors, a critical period of infant development, and dysfunctional or immature cardiorespiratory and arousal systems Risk Factors: The risk of dying from SIDS is highest between 1-4 months of age; it is uncommon after 8 months  Safe Sleep Recommendations Provide a smoke-free environment before and after your baby is born. Breastfeeding can protect your baby for the first 6 months Always place your baby on his or her back to sleep, at naptime and nighttime. Provide your baby with a safe sleep environment that has a firm surface and no pillows, comforters, quilts, or bumper pads. Place your baby to sleep in a crib, cradle, or bassinet next to your bed for the first 6 months Plagiocephaly Prevention Cognitive Perceptual Pattern Vison Is the least developed at birth By 1 week old, infants can focus on objects about 20-30cm away 3 month vision is 20/40 6 months vision is 20/20 Hearing After the amniotic fluid has drained from the middle ear several days after birth, the infant’s hearing becomes acute. Hearing is one of the better-developed senses in the infant. It is important that any hearing loss be detected early in life because of its impact on language development Smell Fully developed at birth Within 2 weeks after birth, the infant can differentiate the odour of the parent's milk from other sources of milk and begins associating the parents/caregivers with their body odours Cognitive Perceptual Pattern Taste Present at birth, and salivation begins at approximately 3 months of age An infant’s reaction to salty foods does not come until approximately 4 to 5 months of age Touch and Motion Is by far the most developed Tactile sensation is well developed at birth, particularly around the lips and tongue Perception of motion and touch are mots important eg rocking, skin-to-skin Language Development During the first 2 months, most of the infant’s sounds are vowels and are made primarily in the front part of the mouth, crying is the major means of communication during this period. Cooing sounds are heard at approximately 2 to 3 months, usually in response to an adult’s voice. By 6 months, babbling sounds are heard 9 to 10 months, the infant forms two-syllable sounds. By 12 months, words such as “ma-ma,” “bye-bye,” and “da-da” are emerging 15 to 18 months, an expressive jargon with rhythmical intonations develops, but words are recognized only rarely. Question The nurse is teaching the parent of a newborn about their baby's sensory system. To further improve the infant's most developed sense, the nurse should instruct the parent to perform which action? A. Speak in a high pitch voice to get the newborns attention B. Place the newborn about 12 inches from the maternal face for best sight C. Stroke the newborn’s cheek with the nipple to direct the baby's mouth to the nipple D. Give the infant formula with a sweetened taste to stimulate feeding Question The nurses completed discharge teaching with new parents who will be bottle-feeding their term newborn. Which statement by the parents reflects the need for more teaching? A. “Our baby will require feedings throughout the night or several weeks or months after birth” B. “The baby should burp during and after each feeding with no projectile vomiting” C. “Our baby should have two to four soft-form stools a day” D. “We should weigh our baby daily to make sure they are gaining weight” Language development or Saying “mama” and “dada” During the first 2 months, most of the infant’s sounds are vowels and are made primarily in the front part of the mouth. Crying is the major means of communication during this period. Cooing sounds are heard at approximately 2 to 3 months, usually in response to an adult’s voice. By 6 months, babbling sounds are heard, and by 9 to 10 months, the infant forms two-syllable sounds. By 12 months, words such as “ma-ma,” “bye-bye,” and “da-da” nonspecifically are emerging. From 15 to 18 months, an expressive jargon with rhythmical intonations develops, but words are recognized only rarely. The infant uses jargon along with pointing to express wishes.  Many researchers believe that the infant determines self-existence by first noting that actions such as crying or smiling have an effect on others, which depends on Self- receiving feedback The infant’s development of body image is perception gradual. At birth the infant has diffuse -Self- feelings of hunger, pain, anger, and comfort, but no body image. Concept Initially, the infant knows only the self and regards the external world as an extension Pattern of the self. Only when infants begin to experience the environment through sensory modalities are they able to distinguish their bodies from animate and inanimate objects.  Attachment and Bonding: The infant associates the pleasurable feeling of being satisfied with the parent, Roles who becomes a significant other in the infant’s life. T The bonding process is the basis for the Relationsh parent–infant relationship, which, in turn, forms the basis for the interdependence ip that is necessary for the infant’s psychological and physical development. All infants are born with the building Patterns blocks that develop into attachment behaviours, and thus all infants have the ability to form an attachment relationship with their primary caregiver Research has shown that if the process of attachment is encumbered, problems are Infant and Child Abuse  The scope of child abuse is extensive: approximately 33% of Canadians aged 15 and older experienced maltreatment as a child (Statistics Canada, 2017b).  Child maltreatment refers to physical and/or sexual abuse experienced before the age of 15 and witnessing violence by their caregiver against another adult.  Women were more likely to have been sexually abused, while men were more likely to have experienced physical abuse, and 93% of the abuse victims did not report it to police or child protection services.  Children less than 4 years of age and those with special needs are the most vulnerable to abuse and neglect (CDC, 2018b). Risk factors: Parents’ own history of experiencing abuse Substance use and/or mental illness Having many dependent children Being a young parent Experiencing low socioeconomic status Community violence and deprivation Poor social connections (CDC, 2018b) Infant and Child Abuse: Assessment Findings Neglect can be in the form of physical or emotional neglect and involves the deprivation of basic needs, supervision, medical care, or education and failure to meet a child's needs for attention and affection Child Neglect: Failure to provide a child with the basic necessities, this may be classified as physical or emotional neglect for example failure to thrive, infant or child does not appear to be physically cared for, evidence of malnutrition (lack of adequate supervision, withdrawal, language development may be delayed. Physical Child Abuse: 1. Extensive dental caries, untreated diaper dermatitis, or neglected wounds 2. Any injuries (fractures, bruises, mouth trauma, head or abdominal injuries) in a pre- ambulatory infant 3. Multiple injuries at different stages of healing 4. Explanation for an injury that is inconsistent with its pattern, age, and severity 5. Notable delay in seeking medical attention 6. Markedly different explanations for an injury from different people 7. poor performance in school 8. apprehensive child, extreme aggressiveness or withdrawal 9. fear of parents/caregivers 10. lack of crying in the older infant Sexual Abuse: May include genital tissue injury, STIs, most often complaints of GI symptoms or demonstrate behavioural signs of sexual abuse during a physical exam, including anxiety or withdrawal Shaken Baby Syndrome: Caused by the violent shaking of an infant and results in intracranial (usually subdural hemorrhage) trauma; this can lead to cerebral edema and death  Infant and Child Abuse Before focusing on nursing interventions, the nurse makes several observations to assist in identifying a high-risk infant by answering some of the following questions: Does the caregiver hold the infant close and establish eye contact? Does the caregiver speak negatively about the infant? Nursing Interventions:  Support the child through a thorough physical assessment  Assess injuries  Report a case of suspected abuse, nurses are legally required to report all cases of suspected child abuse to the appropriate local authorities/children's aid society  Place the child in an environment that is safe, preventing further injury  Document information related to the suspected abuse in an objective manner  Assess parents' strengths and weaknesses, normal coping mechanisms, and presence or absence of support systems  Assist the family in identifying stressors, support systems and resources Values Beliefs Patterns Nursing Interventions: By understanding and respecting the parents’ value system, nurses works within their framework of values in the counselling situation. Nurses have an ethical responsibility to respect and value each patient’s culture and beliefs, and to practice based on the principles of cultural competence and cultural safety (Canadian Nurses Association [CNA], 2018). This may be accomplished by the following:  Consider how one’s own cultural beliefs, values, and behaviours influence interactions with families.  Assess and respect families’ health-related values, attitudes, and beliefs, and incorporate these into the care plan.  Be adaptable and flexible in working with diverse families.  Recognize your own position of power in the nurse–client relationship and seek to move away from a paternalistic model of care to one where families share power and responsibility  How can you implement these practices within your nursing practice?  Physical Agents: Accidents occur in many situations: in the home, outdoors, on the playground, and in automobiles. Most accidents, however, occur in the home. Their number and seriousness is closely linked to the infant’s developmental stage Nurses have the opportunity to help parents and caregivers anticipate and understand the common hazards of early life and provide specific guidance for accident prevention. Unintentional injuries are a significant cause of Environment childhood morbidity and mortality in Canada; The top there leading causes of death in Canada for al Processes children aged 01-14  Transport-related injuries  Drowning  Suffocation or choking It is believed that 90% of unintentional childhood injuries are preventable. For children less than 4 years of age; Suffocation or choking is the number one cause of death Falls are the leading cause of hospitalization The rate of mortality from childhood injuries has declined significantly over the past 60 years   Falls Most common after 4 months of age  Swallowing/choking on foreign objects Choking is the leading cause of unintentional death in children aged 0 to 4. Any small object that an infant puts in the mouth has the potential to be swallowed and choked on. Unintentio Liquids are the most common cause of choking in infants, whereas balloons, small objects, and foods nal Injuries are the most common causes of foreign-body airway obstruction in children  Burns While burns are not one of the three leading causes of death or hospitalizations for Canadian children there are likely many burn or scald injuries that are not accounted for in reported statistics because most people seek medical attention outside of the hospital setting Motor Vehicles: Car Seat Safety Government of Canada, 2  A nurse is providing discharge teaching to a mother and father of a newborn infant regarding safe use of a car seat. Which of the following statements indicates a correct understanding of the teaching? A. The car seat should be rear-facing B. The car seat should be placed in the back Question seat of the car behind the driver's seat C. The harness and clip of the car seat should be placed at the level of the abdomen to avoid the neck area D. I can place a foam roll or firm fabric under the seat to achieve an appropriate angle E. My baby should be at a 60° angle or greater to prevent airway obstruction Biological Agents Immunizations Herd immunity refers to when a large portion of the population is vaccinated and therefore the opportunity for spread of vaccine- preventable disease throughout the community is reduced Active immunization, all or part of a disease-causing microorganism or a modified product of that microorganism is injected into the body to make the immune system react defensively. Example: Diphtheria, Tetanus Passive immunization is accomplished by injection of pre-formed antibodies from an actively immunized person or animal. Example: Protection from drinking breast milk Recommended Immunization Schedule for Infants In Ontario  At 2, 4, 6 months remember DIH-PER  Dtap.  IPV.  Hib.  Pneumococcal. E  Rotavirus. At 12 months, remember More Money  Men-C-C  MMR RSV Question: Upon discharge you noticed that the patients' vaccinations are due, and some are not up to date, What would the patient be due for at 12 months of age? What other vaccinations should have been done by this age? As a 12-month-old where would you administer the vaccination? What discharge teaching should you provide to the child's parents? Think about anticipatory guidance. Question: A mother calls into the clinic regarding her 15-month-old child. The child received the DTaP vaccine 2 days prior, and the mother is complaining that he is developing symptoms. Which of the following symptoms would require immediate attention from a health care provider? Select all that apply A. Tenderness at the injection site B. Fever of 40.5 degrees Celsius C. The child has been crying for three hours D. Mild swelling at the injection site E. The child is pale F. The child was developed shortness of breath Chemical Agents Drugs and Medications Unintentional poisonings are an unfortunate and usually preventable cause of death and disability in infants and children. Among children younger than 5 years of age in Ontario, the top 10 exposures managed by the poison control centre are 1. Pain relievers (ibuprofen and acetaminophen) 2. Cleaning substances 3. Cosmetics and personal care products 4. Vitamins 5. Foreign bodies 6. Skin cream 7. Plants 8. Cough and cold medicines 9. Pesticides 10.Antihistamines Since the 2018 legalization of marijuana an increase in cannabis poisoning across Canada among children of all ages, including those younger than 4 years of age Toxins Daily activities of infants, such as proximity to the floor or carpet inside the home and the lawn or soil outside, hand- to-mouth behaviours, and smaller body size and composition, place them at great risk of exposure to environmental toxins. Infants are exposed to a host of environmental pollutants on a regular basis. These exposures occur through all possible environmental media: air, water, soil, and food. o Houseplants o Pesticides: Internationally used harmful chemicals that are used to control pest attack on crops. In general, pesticides are used to kill insects (insecticides), weeds (herbicides), fungi (fungicides), and rodents (rodenticides). o Lead Exposure: Can still be found in Social Determinants of Health  Many factors influence health. In addition to our individual genetics and lifestyle choices, the conditions in which we are born, grow, live, work, and age play a significant role in determining our health outcomes. Some important social determinants of health (SDOH) that can lead to health inequalities, particularly in infancy and family health, include: Physical Environments: The housing crisis in Canada, particularly in rural, remote, and northern areas, affects access to safe and stable living conditions. Income Status: Low-income households often face financial barriers that limit their access to adequate healthcare, nutrition, and living conditions. Childhood Experiences: Early childhood experiences, including exposure to stress, trauma, and lack of access to early education, significantly impact long- term health and development. Access to Health Services: Limited access to health services, including preventive care and timely medical interventions, can lead to poorer health outcomes. Culture: Cultural factors, including beliefs, practices, and social norms, influence health behaviors and access to health resources. Nursing Application What are our key nursing roles when caring for the infant and their family? Health education and health promotion  SIDS education  Health assessment and abuse screening  Ensure immunizations are up to date  Assess for normal growth and development. What tools are used?  Care safety  Nutrition and counseling  Culturally competent care  Leadership and Collaboration  Advocacy