Engage Peds: Infants - 1 Month to 1 Year

Engage Peds: Infants—1 Month to 1 Year Learning Objectives Assess and discuss biological development for infant clients (1  Scope of Practice Note month to 1 year). Assess and discuss behaviors related to infant clients. For di!erences in the scope of practice between RNs and PNs, Examine health promotion and prevention of disease and injury considerations. In addition, PN scope of practice varies by state. For example, some states may allow the PN to contribute directly for infant clients. Engage Pediatrics includes callout boxes focused on PN practice Discuss health concerns for infant clients. to a plan of care, while other states limit PN participation to assisting the RN in developing the plan of care. Similarly, most Apply the nursing process using clinical judgment functions while states require the PN to be under the supervision of an RN. As providing care to infant clients. such, PN students should reframe certain discussions in this product to align with their state’s scope of practice. Ultimately, the PN is responsible for functioning within their scope by knowing and abiding by state guidelines for safe practice. The period from 1 month to 1 year after birth is a time of development and change for the infant and their family. It is the period of most rapid growth physically, emotionally, and cognitively. From developing gross and fine motor skills to learning speech and independence, an infant spends the first year meeting milestones and learning how to navigate the world around them. Biologically, the most growth happens during infancy, including the development of motor skills, language, play, and cognitive development. By promoting health, safety, nutrition, and quality sleep patterns, the nurse strengthens the trust and security between the infant and their family. However, not every infant is healthy, and some disease processes are specific to this period of life. Nutritional deficiency, failure to thrive, food sensitivity, and sleep alterations can negatively impact the infant’s growth and development. It is the role of the nurse to educate infants’ caregivers, allowing them the opportunity to promote health and e!ectively navigate any issues in the infant’s life. In this module, the biological growth of the infant (which includes physical development, gross and fine motor skills, language, play, and psychosocial and cognitive development) will be discussed. This module will also examine important topics for anticipatory guidance in educating the family as they grow together and discuss health concerns specific to the infant. Engage Peds: Infants—1 Month to 1 Year Physical Development Health care providers use a variety of tools to gather objective data to monitor health and growth. Growth charts track the distribution of weight, length, and head circumference, as well as the proportionate weight-gain-for-length growth using percentile curves that compare infants across the country. It is expected that infants will grow at an even rate along a percentile. Growth charts for premature infants and infants who have Down syndrome are also available, allowing for a di!erence in growth standards for these client populations. According to the World Health Organization (WHO), 45% of all child deaths throughout the world are related to undernutrition, making the monitoring of growth essential in combating infant morbidity and mortality. The WHO growth charts should be used to trend the growth of children from birth to younger than 2 years old, and the Centers for Disease Control and Prevention (CDC) growth charts should be used to trend growth for those aged between 2 and 20 years. WHO growth charts for male infants: Head circumference Click to download this file. WHO growth charts for female infants: Head circumference Click to download this file. WHO growth charts for female infants: Length and   weight  Click to download this file. WHO growth charts for male infants with Down Syndrome: Length  Click to download this file. WHO growth charts for female infants with Down syndrome: Weight weight Click to download this file. Click to download this file. WHO growth charts for male infants with Down syndrome: Weight WHO growth charts for male infants: Length and   Click to download this file. WHO growth charts for female infants with Down syndrome: Length   Click to download this file. The infancy period of growth shows the most drastic changes in weight, height, and head circumference. Infants should double their birth weight by 6 months of age and triple their birth weight by 1 year. Infants gain an average of 1 or 2 pounds per month for the first 6 months and 1 pound per month from 6 months to 1 year. Growth in height is approximately 1 inch per month until 6 months of age and then ½ inch per month from 6 to 12 months. Other physical changes occurring during the first year of life include the closure of the posterior fontanel by 2 months of life as well as the transition from being obligatory nose breathers at birth to being able to breathe through both nose and mouth. Inborn reflexes, such as the Moro, stepping, and rooting reflexes, begin to fade and disappear by 4 to 6 months of age and are replaced by more voluntary reflexes. It is during this first year of life that deciduous teeth begin to erupt, and the infant begins chewing and biting. Q A male infant weighs 5.6 kg (12.3 lb) at 2 months, placing the infant in the 50th percentile for weight. What would be the infant's anticipated weight in kg at 8 months if the infant followed the same growth percentile? Select the applicable growth curve provided above to plot the infant's anticipated weight gain. Type your answer here. Submit Q × A female infant measured 49.5 cm (19.5 in) at birth. What would the anticipated length be in cm for the infant at 6 months of age? Enter your response and submit to compare to an expert response. Type your answer here. Submit Engage Peds: Infants—1 Month to 1 Year Gross Motor Skills Gross motor skills involve the large muscle groups and form the basis for developmental skills, such as rolling over, sitting up, crawling, and walking. During the first year of life, the infant strengthens and develops these muscle groups, learning to coordinate their movement and allowing them to gain some independence. It is during this time that the infant develops balance and coordination, setting the stage for fine motor development. Cephalocaudal and Proximodistal Development V Development occurs from head to toe in a predictable pattern, also known as cephalocaudal development. Proximodistal is the outward direction of development, taking place from the center of the body towards the periphery. Cephalocaudal: A child will gain control of the head before gaining control of the limbs. Proximodistal: Development of the arms occurs before the development of the hands. Development of the hands occurs prior to the development of the fingers. Key Gross Motor Development Milestones Average Age Attained Milestone 1 month Turns head in supine position Chin up in prone position 2 months When prone, holds the chest up Bobs the head when sitting 3 months Begins to roll to the side iStock/satura86 LIFTING CHIN WHEN PRONE head lag – When prone, props up on forearms 4 months Rolls front to back No head lag when pulled to sit An infant cannot hold their head up without it flopping around or lagging behind the upper body. Sits with trunk support Props up on wrists 5 months Rolls over from back to front When falling, puts arms out to the front Able to sit with pelvic support Able to sit with arms out in front, supporting the upper body 6 months Able to sit for a few moments propped up on their hands iStock/SelectStock COMMANDO CRAWLING Bears weight on one hand in prone position Pivots in prone position 7 months Uses arms out to the sides to balance Sits steadily without support Bounces when held 8 months Able to move into a sitting position Crawls in a commando position Able to pull to a sitting or kneeling position without assistance 9 months Begins creeping Engage Peds: Infants—1 Month to 1 Year 9 months Begins creeping Pulls to stand “Stands” on feet and hands 10 months Begins cruising Crawls well Able to stand if holding the hand of an adult Able to walk if holding both hands of an adult iStock/burrakarademir CRUISING AROUND FURNITURE 11 months Able to move around furniture by holding on with one hand Able to walk holding one hand of an adult 12 months  cruising – – – Pivots in sitting position creeping – Able to stand for a few seconds without support Able to stand up with arms upstretched and legs opened without falling Able to walk independently Q Match the gross motor skill with the average age attained. Drag the options on the left to the corresponding category on the right (or click the option on the left and then the corresponding category on the right). Stands for a few seconds 3 months Gets into sitting position 5 months Begins to roll to the side 8 months Cruises around furniture using two hands 10 months Rolls back to front 11 months Fine Motor Skills Fine motor skills involve small movements made by the hands and wrists, requiring coordination between the muscle groups and the brain. For infants, simple things, such as holding a bottle, transferring a toy, or placing blocks on top of each other, require the development of their fine motor muscles. This is when the infant starts making voluntary and coordinated movements with their hands and fingers, requiring precision. D Key Fine Motor Development Milestones Average Age Attained Milestone 1 month Hands in fist near face 2 months 50% of the time hands are open and unfisted Able to hold a rattle if placed in the hand Able to hold hands in the same spot together 3 months Inspects fingers Hits at objects close to body 4 months PALMAR GRASP Able to hold hands open most of the time Grabs at objects close to the body, particularly clothes Able to reach for objects tirelessly Engage Peds: Infants—1 Month to 1 Year Able to reach for objects tirelessly Able to play with toys placed in hands 5 months Grasps a cube with palm of hand (palmar grasp) Transfers objects hand to mouth and then mouth to hand RADIAL PALMAR GRASP Reaches/grasps things dangling in front of body Can take a second object still holding on to a first Reaches with one hand Uses open and extended fingers to rake for things 7 months Can hold an object between fingers and opposing thumb (radial palmar grasp) radial palmar grasp – scissors grasp – Objects are held between the thumb and the side of the index finger. pincer grasp Can take a cube out of a cup and pull out a large peg 8 months palmar grasp Transfers items from hand to hand 6 months Hits objects with other objects after demonstration Able to grasp things using all the fingers and the thumb (scissors grasp) 9 months Bangs two cubes together Able to grab things with the thumb and pointer or middle finger (pincer grasp) 10 months Isolates index finger and points at things SCISSORS GRASP Can use the pincer grasp to pick up small items clumsily 11 months Throws objects Can stir something with a spoon 12 months Scribbles after a demonstration Can use the pincer grasp to pick up small things without di%culty Holds a crayon Attempts to put blocks on top of each other PINCER GRASP Sort the following skills into fine motor or gross motor. Drag the options on the left to the corresponding category on the right (or click the option on the left and then the corresponding category on the right). Transfers items from one hand to the other hand Fine motor Begins to roll to the side Gross motor Gets into sitting position Bangs two cubes together Able to grasp things with the thumb and pointer finger Chest up in prone position Engage Peds: Infants—1 Month to 1 Year Q Match the fine motor skill with the average age attained. Drag the options on the left to the corresponding category on the right (or click the option on the left and then the corresponding category on the right). Radial palmar grasp develops 4 months Hands held predominantly open 5 months Palmar grasp develops 7 months Scribbles after a demonstration 9 months Pincer grasp develops 12 months Psychosocial Development of their caregiving environment and those who are strangers. Being able to be soothed by the touch of a familiar person or the smile of a familiar face is key to the development of their separation anxiety During the first year of life, infants begin to recognize those who are key and essential members stranger anxiety psychosocial milestones. Communication of the infant’s feelings and the response of the parent to the expressions creates an atmosphere of trust and security. The development of separation anxiety is an expected feeling of loss replaced by hope and trust when the parent returns. Stranger anxiety begins to develop as rational fear and can be essential in protecting the child from danger in the future. Through the relationship with the parents, the infant feels safe and secure, allowing for the appropriate development of trust, communication, and emotion. Q What is the importance of the familiarity of parents to the infant during the first year of life? Enter your response and submit to compare to an expert response. The fear and anxiety an infant experiences when encountering someone they are not familiar with. Type your answer here. Submit Key Psychosocial Developmental Milestones Average Age Attained Milestone 1 month Can discriminate parent’s voice Cries out in distress 2 months Smiles in return Responds to adult’s voice and smile 3 months PROTO-IMPERATIVE POINTING Follows movement in a room Can express dislike to taste or sound 4 months Smiles as a result of a sight or sound Stops crying when parent speaks 5 months iStock/leungchopan  proto-imperative pointing – Represents pointing to an object to communicate that it is desired or requested. Can recognize parent Bonds to parent Engage Peds: Infants—1 Month to 1 Year 1/12/26 (stranger danger anixety) 6 months Stranger danger and anxiety develop 7 months Looks back and forth from a parent to an object when wanting help 8 months Able to communicate emotions Follows the gaze of a parent to look the same way 9 months Separation anxiety Able to follow a point Visually recognizes people Vocal/makes sounds to get attention 10 months Has fears Responds to name 11 months Seeks out help from an adult for an object 12 months Seeks parent’s interest in objects Proto-imperative pointing Q Match the psychosocial skill with the average age it is attained. Drag the options on the left to the corresponding category on the right (or click the option on the left and then the corresponding category on the right). Looks back and forth from a parent to an object they want 1 month Stops crying when parent speaks 3 months Can discriminate a parent’s voice 4 months Follows the gaze of a parent to look the same way 7 months Follows movement in the room 8 months Cognitive Development Cognitive development is essential to the growth of memory, language, reasoning, and thinking throughout the first year. Infant brains are rapidly developing, including their cognitive processes, which encourage the formation of executive functions, especially impulse inhibition, attention, and reasoning flexibility. An ability to problem-solve and establish object permanence sets the stage for the continued cognitive growth of the child throughout their lifetime.  object permanence – Understanding that objects and people exist when they are not seen or heard. Using a computer, tablet, or television to keep an infant occupied has become a regular part of childrearing. However, screen time inhibits the interaction of the parent with the infant and decreases human interaction and stimulation of cognitive development. The American Academy of Pediatrics (AAP) recommends children from birth to 18 months of age engage in no screen time except for video chatting, and the WHO recommends no screen time until children are 2 years or older. Nurses should encourage parents to limit screen time and instead spend time reading, playing, singing, and cuddling with their infant. Discussion of the importance of playtime and personal interaction with the parents should be incorporated into every interaction and health care visit. Encouraging the usage of toys that are brightly colored and provide a variety of shapes can enhance visual and sensory development. Q How does screen time impact the cognitive development of an infant? Enter your response and submit to compare to an expert response. Type your answer here. Engage Peds: Infants—1 Month to 1 Year Type your answer here. Submit Cognitive Development Stages 1 MONTH TO 2 MONTHS Just as at birth, an infant’s optical focal length is approximately 10 inches. Actively seeking stimuli, these infants adjust to familiar objects and people and respond actively to changes in stimuli. Sucking and grasping are reflexive, and the infant can fixate and continuously follow a horizontal design, eventually past the middle visual setpoint. Infants prefer contrasts of shapes, colors, and faces and develop preferences for people, objects, and high-pitched voices. iStock/yoshiurara INFANT RESPONDING TO A FAMILIAR PERSON OR OBJECT 2 MONTHS TO 6 MONTHS As they begin to explore their environment by using their sense of touch, infants begin staring at their hands and touching parts of their bodies, allowing for self-understanding and a beginning grasp of cause and e!ect. iStock/jaqy 6 MONTHS TO 12 MONTHS 6-MONTH-OLD INFANT’S SENSORY EXPLORATION As object permanence develops, the infant will begin to play games, such as peek-a-boo, with the parent. Stranger and separation anxiety become apparent as object permanence develops. As the infant begins to recognize that something or someone leaving does not discount their ability to think about them, they also recognize the di!erence between someone they are familiar with and someone they are not. It is during this time that reaching, inspecting, holding, putting objects in the mouth, and dropping objects becomes a part of sensory exploration. The infant learns to manipulate the environment around them by using objects for a purpose. iStock/FatCamera 9-MONTH-OLD SENSORY EXPLORATION Q How does sensory development change for the infant during the first 6 months after birth? Enter your response and submit to compare to an expert response. Type your answer here. Submit Engage Peds: Infants—1 Month to 1 Year Submit COGNITIVE DEVELOPMENT CONCERNS Nurses are in an optimal position to be able to monitor the growth and development of infants through health care visits and interactions. Some disorders—such as Down syndrome, fragile X syndrome, and fetal alcohol syndrome—are known causes of cognitive delay. Early recognition and intervention are key to helping these infants receive the resources they require to develop cognitively as much as possible, and therapies have been noted to have promising results of improved cognition. Actively screening infants for developmental delays is an invaluable part of the well visit and can elicit a referral for developmental interventions and evaluation. Q The parent of a 6-month-old infant is concerned about their child constantly putting things into their mouth. Which of the following statements by the nurse is the most appropriate education for the parent? “Putting things into their mouth is something infants do to B O A C explore their environment. This is a very normal thing for the infant to do.” “Putting things into their mouths is a sign that the infant trusts D their surroundings and knows that they are safe with you.” “Oral fixations can be a manifestation of Down syndrome and will require us to do further testing.” “An infant should never be allowed to put toys in their mouth as they might think it's okay to put any object in their mouth.” Submit Language Development It is during this first year of life that the infant begins to develop verbal and nonverbal communication. As they spend time with their parents and interact with people and objects, the development of expression and the emergence of word mapping become a part of who they are. The more the infant hears and can associate words with objects, the better their language skills develop. A higher rate of parents labeling objects and helping their infant to focus for three seconds on pairing the word with the object is associated with a larger vocabulary. Interaction with parents and stimulation of language skills is vital to the infant’s development and is closely associated with future literacy, academic achievement, and health. Infants who are in households with low socioeconomic status (SES) are at higher risk of decreased language development. There is a direct link between reading to infants and increased language and vocabulary development. Reading to children starting in infancy is strongly encouraged in order to build a good language foundation. Another form of language and communication for the infant is the development of sign language for various key words that the infant may need to communicate to the parent. D Key Language Development Milestones Average Age Attained Milestone 1 month Reacts or startles to sounds and voices  echolalia – The often pathological repetition of what is said by other people, as if echoing them. Begins to make noises (such as cooing) 2 months Aware of voices and sounds Smiles socially and makes noises that sound like vowels 3 months Regards someone speaking Begins to laugh Responds with sounds when someone talks to them 4 months Turns their head towards a voice when heard Ceases crying when they hear a comforting voice Begins to laugh out loud Makes sounds even when alone 5 months Responds when name is said Engage Peds: Infants—1 Month to 1 Year 5 months 1/12/26 Responds when name is said Makes an “ah-goo” noise Squeaks and squeals with excitement Able to express anger using sounds other than crying Makes raspberries with lips 6 months Stops for a minute when told no Holds hands up when wanting to be picked up Uses consonants when babbling Stops to listen to someone and then vocalizes in response when they stop Smiles and speaks to themselves in a mirror 7 months Looks toward a familiar object when named Listens attentively to songs and music Uses an increasing number of syllables when making noise 8 months Responds when called Able to look for family members when asked Says “dada” nonspecifically Engages in echolalia Shakes head for “no” 9 months Enjoys games with arm movements Responds to name well Begins to say “mama” without regards to who it is being said to Babbles in a manner that cannot be copied Repeats heard sounds 10 months Actively engages and enjoys playing games (such as peek-a-boo) Begins to wave in response to someone else waving Says dada to the person recognized as the father 11 months Stops doing something when told no Dances to music Begins to say first word Makes noises or sings when listening to music 12 months Able to follow a simple one-step direction with hand/arm movements Can di!erentiate objects when two or more objects are named When desiring something, points in the direction of the desired object Uses hand and arm motions (such as grabbing or reaching) with vocalizing Q What interventions can a nurse provide to an infant to increase language development? Engage Peds: Infants—1 Month to 1 Year Q 1/12/26 下午6:55 Enter your response and submit to compare to an expert response. Type your answer here. Submit Play When adults play with the infant, it allows the infant to develop cognitive skills, express emotions, and react to situations. While play should be  enjoyable and entertaining, it is also an opportunity for the nurse to assess the abilities of the infant and their interactions with others. The first sign of play is the social smile, appearing by 4 to 6 weeks of age. Regular smiling and cooing develops by 3 months of age and encourages continued social interactions and the development of bonding. By 3 to 6 months of age, the infant will actively look for others to interact and play with. Repetitive games that range in intensity create a sense of enjoyment between the infant and parent, solidifying the feelings of comfort and security. The nurse should also be aware of any play that appears to border on abuse, such as attempting to throw a ball at the infant or withholding food or care while teasing the infant, and verify that the parent is aware of the developmental limitations of play by the infant. A lack of response by the infant to the parent when playing may indicate cognitive developmental delays. iStock/DarioGaona INFANT PLAYING Case Study Scenario Introduction Jasmine is a nurse caring for Andy, a 9-month-old infant who was brought to the clinic for a well-child visit. Graham, Andy's father, is concerned that Andy is not meeting milestones and is developmentally delayed.  Scene 1 – – Scenario Conclusion Jasmine reassured Graham again that each infant develops at their own pace and instructed him not to compare Andy with other siblings. Leaving the room, Jasmine went to get the provider for the examination. Q Which of the following milestones would be anticipated for Andy to be meeting at 9 months of age? A Follows one-step directions with hand/arm movements B Proto-imperative pointing C Scribbles after someone demonstrates how D Begins creeping and pulls to a stand Submit Communicating With Parents The first year of life is a period of rapid physical, emotional, and cognitive growth and brings great change within the family dynamic. As a nurse, https://pages-delivery.atitesting.com/s/1/o/2/a/1/p/1 第10/15⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:55 The first year of life is a period of rapid physical, emotional, and cognitive growth and brings great change within the family dynamic. As a nurse, educating parents on what to expect developmentally is vital in alleviating fears and anxieties. While many parents believe their infants to be developing perfectly, some have concerns that may alter the way they can e!ectively parent. Communicating expectations can alleviate those concerns, promoting a healthy and happy home environment. Encouraging healthy interaction with the infant can help in the progression of milestone development. General education for the parents of an infant would encourage smiling, singing, reading, and talking to the baby as well as responding to their coos and babbles. Cuddling, soothing, interacting, and holding the infant foster social and emotional development and should be promoted as a positive parenting technique. Establishing a routine throughout the first year, particularly a bedtime routine, is essential in helping support milestone development and the creation of a nurturing care environment. Parents should also be instructed in the importance of well-child visits for continued observation of growth, development, and vaccine administration. If the infant is not developing appropriately, begin the discussion by talking about the milestones the infant is meeting, reminding the parent that the infant is growing and developing. Encourage a sharing of concerns and observations by the parents, allowing for enough time to ask questions. Then, using visuals such as growth charts or developmental checklists, discuss concerns about growth and development with the parents. The health care team should listen actively and be supportive, respectful, and empathetic when discussing concerns about an infant with their parents. Be honest and direct, as the parent must be able to trust what is being conveyed and the potential diagnosis that accompanies these findings. Q What general education about growth and development should be provided to the parents of an infant? Enter your response and submit to compare to an expert response. Type your answer here. Submit Parent Well-Being The presence of postpartum depression (PPD) should be assessed during the well-infant visit.  postpartum depression (PPD) – Intense feelings that develop after birth that can include anxiety, sadness, irritability, loss of appetite, insomnia, and di%culty bonding with the baby.  Every New Mother (Birth or Adoptive) is Vulnerable to PPD Overall, 11% to 18% of postpartum clients report manifestations of PPD. 25% of postpartum clients who have a low-income level report manifestations of PPD. 40% to 60% of postpartum adolescents who have a low-income level report manifestations of PPD. The AAP recommends screening parents for PPD at the 1-, 2-, 4-, and 6-month infant well-child visits. A validated screening tool, such as the Edinburgh Postnatal Depression Scale (EPDS), is recommended when screening for PPD. The nurse should be alert to and assess for manifestations of PPD, which can include feelings of sadness, guilt, or incompetence; anhedonia; inability to concentrate; anxiety; and thoughts of selfharm or harm to the infant.  anhedonia – Di%culty finding joy or pleasure in everyday things. Research indicates that assessment for PPD is not commonly completed during pediatric visits. The risk of untreated PPD has negative impacts on both the parent and the infant. Postpartum clients who have PPD tend to discontinue breastfeeding and fail to bond e!ectively with the infant. Infants experience delays in brain development because of toxic stress, a!ecting https://pages-delivery.atitesting.com/s/1/o/2/a/1/p/1 第11/15⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:55 infant. Infants experience delays in brain development because of toxic stress, a!ecting language, cognitive, psychological, and emotional development. The whole family can also experience family dysfunction, and there is an increased risk of child maltreatment and neglect.  Nursing Interventions for Postpartum Clients at Risk for PPD Refer any individuals identified as at risk for PPD to community resources, such as Early Head Start, public health nurses, and support groups for parents and postpartum clients. Provide the client with the phone number for Postpartum Support International (1800-944-4773), a resource for maternal mental health. Provide client education on: Understanding the cues of the infant and how to respond to them. The role of reading to the infant is to promote bonding. Establishing routines regarding sleep, diet, and stress management. The importance of maintaining social connections for maternal health and well-being. Ways to promote bonding with the infant. Q A nurse is preparing a poster presentation describing the e!ects of postpartum depression (PPD). Which of the following e!ects on the infant should the nurse include? Select all that apply. A Increased risk of infant maltreatment or neglect B E!ective bonding with the parent C Lack of response by the infant to the parent during play D Early achievement of language milestones E Decreased risk of mental health disorders Submit Understanding Postpartum Depression: A Nurse's Perspective ▶ 00:00 13:26  Luke, a pediatric nurse, shares an email from Caroline who is seeking advice on how to care for a baby and mother with postpartum depression. Luke interviews Erin, a nurse and mother who shares her personal experience with postpartum depression and emphasizes the importance of support systems and seeking help for those a!ected. ( Podcast Transcript – LUKE: Welcome back to Pediantics: Stories from the Frontlines of Pediatric Nursing. I'm your host, Luke, he/him pronouns. I've been a pediatric nurse for five years, but a storyteller all my life. And this show is for all you pediatric nurses, nursing students, and even the nursing-interested, who understand that just like no two children are the same, no two nurses are the same, and hearing di!erent perspectives and experiences can help improve the care we give the little ones and not-as-little ones. Now let's get to this week's topic. I have here an email from Caroline--she/her pronouns. She wrote, "Hi Luke, I recently saw an infant for his three-month-old well visit. During the visit, I noticed the mom was disengaged from her baby. I talked with the provider and learned that the mom had been diagnosed with postpartum depression. I know part of pediatric nursing is caring for the whole family, but I've never known someone with postpartum depression. Do you have any advice for how to best care for both the baby and the mom?" Thank you for your question. First, I want to say that everyone's experience with postpartum depression is unique to them. But I think that hearing someone's experience will help you better care for the family as a whole. https://pages-delivery.atitesting.com/s/1/o/2/a/1/p/1 第12/15⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:55 I recently spoke with Erin Corney--she/her pronouns--a wonderful nurse and person who shared with me her experience with postpartum depression. Now let's meet Erin. ERIN CORNEY: I am a nurse by background. My specialty is actually in OB. I'm a mother. I've got a one-year-old son and an eight-year-old stepdaughter. LUKE: While Erin had years of experience teaching clients about postpartum depression, she didn't think it would be an issue for her. ERIN CORNEY: It's something I never thought about. It's one of those things where you're like, this is not going to happen to me, like, OK. You hear the education, you talk about it, you know it exists, but I was just like, "oh, this won't happen to me." I just felt like I was very prepared, knowing so much about pregnancy, about newborn care, just all of that. I felt very prepared in that sense. So I went through my pregnancy, and then around 36 weeks, I think it hit me. Like, OK, I'm going to deliver this baby. It was a 32-hour induction that did end up in an emergency C-section because of fetal intolerance to labor. It was decided that for the well-being of the baby that I needed to deliver by Cesarean. And I did break down, and I cried because it was not something that I wanted. I just felt like everything that I did not want was happening, and I had zero control. And so I broke down. The team was awesome, though. They got me back to the OR within, like, 15 minutes. They started, and the baby did come out, and he wasn't crying. And, you know, that's major concern when you don't hear any crying. They had the nursery team there at the warmer, and they did work on him and had to deep suction, and his first Apgar was a 6. I could hear-you just hear everything going on. And they did deep suction him. He was okay. His second Apgar was 8. And so I thought the hardest part is over. He's here. He's healthy. He's safe. I'm okay. We're both okay. So I thought the hardest part is over. But little did I know it was only starting, in another sense. LUKE: Following her delivery, Erin's experience with postpartum depression evolved starting the moment she was discharged. ERIN CORNEY: The nurse who discharged did a wonderful job teaching. And thankfully, my partner, he was listening and taking everything in. And so I had to go for a two-week incision check, and I constantly felt weepy and emotional. But it's like, OK, hormones, you've got so many hormones shifting and lack of sleep. At this point, I was sleeping maybe two to three hours at night. It's a big change. It's just so much, so I would get super angry easily. I think I made a lot of excuses, like, "oh, this is what's happening," attributing it to a lot of outside factors. And then as we were journeying along towards probably, like, my six-week visit, I did talk to my doctor, and I said, you know, I'm not sure if it's postpartum depression. I feel so emotional all the time. I started to have anxiety attacks. I've never had anxiety. I was having, like, feelings of impending doom, like something horrible was going to happen just constantly. I couldn't even eat a lot of the time when I was home alone with my baby. During the week, my partner was at work, and just even thinking about, like, "what are you going to eat?" would give me such horrible anxiety. I just felt so bogged down, like dragging. I was so emotional constantly, it was hard to get through the day without crying and feeling sad. LUKE: But the e!ects of postpartum depression can extend beyond the person experiencing them and start a!ecting their relationships, even the relationship with their baby. ERIN CORNEY: Another thing that it was hard to admit is I didn't feel very bonded with my baby, I didn't really talk to him. It was just mostly like I was his care provider. I didn't feel that attachment. But I didn't tell her that at the time because I just felt like a bad parent. My parents had come in town, and I noticed how they were interacting with the baby, talking to him, singing to him, you know, and I'm like, I don't do any of those things. It was just like every day, I felt like it was a struggle just to get out of bed. But I just, again, attributed to I'm just so tired. And then we went to his two-month visit. And just some of the things the doctor was saying, like, "oh, continue singing to him and talking to him, making eye contact, just all those little things." And I'm like, gosh, I'm not even doing any of that. And then we started talking about his weight and his eating. He was below the one percentile in his weight. And I just--(crying) sorry--I just felt like a complete failure, like I was failing my child, and so that was really hard. LUKE: Postpartum depression also a!ects other parts of a client's life, as Erin explains. ERIN CORNEY: People would reach out and ask me "how are you doing?" Sometimes I wouldn't text people back for weeks because I feel like such a fraud if I say I'm okay, because I'm not okay. And then it was getting closer to coming back to work from maternity leave. And I was just an emotional wreck, I just could not get through the day without crying. I felt just so alone, so isolated. My partner and I were constantly arguing. He didn't understand. And I didn't feel comfortable really talking to anybody about it--like friends, family. My sister, I think, was the only one I talked to. I just felt so, like, ashamed as a nurse, as a woman. I just felt so ashamed. https://pages-delivery.atitesting.com/s/1/o/2/a/1/p/1 第13/15⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:55 LUKE: Not only does postpartum depression disrupt a client's life, but it also makes it hard to reach out for help. Thankfully, Erin did seek out help and found a wonderful support system. ERIN CORNEY: So when I went to my six-week appointment, my doctor had given me a list of therapists that they work with. And some of them solely specializes in postpartum depression. So I went through the list, started calling. And that was hard because I felt like I had to make myself very vulnerable to ask for help, I'm not good at asking for help, at all. Finally had somebody reach out. And they're like, "I'm so sorry. We don't have any appointments until May." And this was maybe in March, for example. And I can't go that long, but they were really awesome, and then they sent me a list of people that they refer out to, too. And finally, I found someone who is my therapist now. LUKE: As nurses, it's important to help people like Erin connect with resources like therapists. As her experience will show, their assistance is invaluable to clients experiencing postpartum depression. ERIN CORNEY: It was just so wonderful to know that you're not alone. I started, you know, just continually attending sessions and learning more about that, like, postpartum rage is a thing, because I just literally would get so angry, and so that was just really scary to me. And I've heard of intrusive thoughts, but learning more about those thoughts and how to talk them down was helpful. And then she told me about a support system called PSI, Postpartum Support International, and they have a number of groups for women every single day of the week. And so I started attending. LUKE: Now that she had a support system, Erin started to work through her postpartum depression. ERIN CORNEY: As I was continuing this journey, it was getting closer to going back to work. And my therapist, she gave me her opinion that "I don't think you're ready." She recommended going to see my provider and how I felt about medication. And she talked about how it may just really help, especially with the hormones and the chemical imbalances, just be an aid in helping to combat this, because I was still, again, feeling like a lot of anxiety, a lot of impending doom. And so I did make an appointment. I wasn't able to see my provider. But I saw one of the midwives in the practice and talked about how I was feeling. And she shared that she su!ers from depression or experiences depression. And she made me feel comfortable and letting me know that mothers experience that, commending me for getting help. And so starting on medication and, you know, starting on a lower dosage, kind of finding that dose, it took awhile. LUKE: Erin continued working through her postpartum depression with the help of her support system, getting the right medication and dosage. But, she also knew that her journey wouldn't be a straight line. ERIN CORNEY: And so finally I was able to get on a dosage that works for me, and I'm still on it. Every day is a journey. Some days, I feel down or very anxious. But I just take it day by day and try to use a lot of the strategies that I've been learning through PSI and through my therapist and talking about my emotions and not internalizing everything. LUKE: As she continued to improve and find help, Erin's perspective on postpartum depression changed a lot, from how she viewed the medication she needed to take to what postpartum depression took from her. ERIN CORNEY: My therapist said, "this is a tool." It doesn't make me any weaker of a person. It's going to help me be the best mother that I can be, the best partner that I can be, the best employee I can be, friend, and whatnot, sister. So I need this. My therapist talks about being on the other side and looking back, and there's a lot of grief involved. And I didn't know that grief and postpartum depression went together, so I had to process a lot of grief. I just feel like postpartum depression, it just can really isolate you, and it can really rob you of a lot of experiences.  It's kind of like a fog, like a very heavy fog. And I feel like that fog has lifted. And, you know, you can't go back in time, but I just try to make the most of every day with him and using the tools that I've learned and asking for help. LUKE: After hearing Erin's story, I thanked her for sharing her experiences with me. But I had one more question for her. As a nurse, she knew about the possibility of postpartum depression, and she had a great support system as she worked through it. I wanted to know what advice she had for nurses caring for people with postpartum depression and their families. ERIN CORNEY: You may not be working in an OB population, but you may know someone, whether that be a family member, a friend. And if you're able to also recognize those signs and maybe potentially be that person. My OB o%ce, they are amazing. Even just one of the receptionists when I went in for my initial visit about my postpartum depression, she would check me in and whatnot. And after the visit, she even came over and hugged me and said it was going to be okay. That encouragement, just from the nurses, my OB provider's nurse, that support was just so, so helpful, because I just felt so alone. They'll also connect you with counselors in your area as well. There's so many di!erent groups that are amazing. LUKE: Erin's journey shows us not only how disruptive postpartum depression can be for our clients and their families, but just how important nurses are in helping care for and guide them through postpartum depression. Thank you so much for joining me for this episode of Pediantics. See you next time. https://pages-delivery.atitesting.com/s/1/o/2/a/1/p/1 第14/15⻚ Engage Peds: Infants—1 Month to 1 Year https://pages-delivery.atitesting.com/s/1/o/2/a/1/p/1 1/12/26 下午6:55 第15/15⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:56 Separation anxiety is an expected part of development from 6 months to 3 years, sometimes developing suddenly, and often resolves as the infant ages. The infant may go from contentment with others in strange environments to screaming inconsolably when found amongst people unfamiliar to them or in a place they do not recognize. The infant is now realizing how much they need and depend on the people in their lives, particularly their parents. A sense of security surrounds these familiar people and places, and when that security is removed, the infant begins to feel fear and anxiety. The rapid brain development of the infant plays a vital role in their emotional and social growth for the first 18 months of life. Up through 6 months of age, the emotions of the infant are simple and instinctive, taking place in the limbic system, an area of the brain responsible for subconscious thought. As the areas of the brain responsible for conscious thought and regulating emotions develop, emotional processing begins to take place, allowing the infant to develop more nuanced emotions, including attachment to familiar people and places. The response of the parent to the infant’s emotional outcries encourages the attachment of the baby to the parent and is pivotal in the emotional development of the infant. It is the foundation of responding to emotional interactions that develops an infant’s sense of security, encourages self-esteem development, and builds the ability to regulate emotions and skills of self-control. Parental bonding from early infancy progresses into social and emotional development as the relationship with the parent grows. Responding to emotional cues and meeting the needs of the infant builds a sense of trust and confidence that their needs will be met appropriately and in a timely manner. The parent is the protector and the one the infant looks toward in times of stress. Attachment is a pivotal development for the emotional progression of an infant throughout their lifetime. In the 1960s, John Bowlby developed a theory related to children and their ability to attach to other people and things, called attachment theory. Bowlby thought infants would react physically, such as with an increased heart rate, to parent-child attachment issues. The ability to cope or respond to various attachment situations can be altered by the infant’s individual strategies to process and handle the situation and can present a myriad of physical reactions. However, the development of separation anxiety by an infant does not determine the development of future attachment disorders. Q A nurse is gathering vital signs and a history of present illness during a sick visit for a pediatric client. When the nurse attempts to weigh the child, the child clings to the parent and begins crying loudly, displaying separation anxiety. Which of the following ages would the nurse expect the child to be? A 2 months old B 5 months old C 10 months old D 7 years old Submit Separation Anxiety Complications While separation anxiety is expected, prolonged separation anxiety can become detrimental to development and potentially turn into a chronic disorder. The fear of being lost or separated from the parent can create an environment where the infant loses a sense of trust and security; this can interfere with daily activities. Feelings of worry and the fear of being apart from the home and family can deter the infant from forming psychosocial bonds with others and from exploring their surroundings in a healthy way. Physical manifestations for the infant, such as incessant crying, poor feeding, and clinginess to the parent, can become chronic. Interventions for Separation Anxiety The first step for parents dealing with an infant who has separation anxiety is to remember that it is an expected part of childhood development. Even though the infant is crying and reacting emotionally, the fear of not being around familiar people or places is not detrimental to the infant’s mental health and will help them develop coping mechanisms in the future. Developing ways to cope with and process anxiety and fear is an important outcome of separation anxiety in the infant. To assist with a healthy resolution of separation anxiety, the parent should begin by leaving × ▶ the infant for a short period with a responsible caretaker in an environment the infant is familiar with. Working up toward longer separation times, the infant will be able to associate the parent leaving with the parent returning and feeling safe and secure again. A familiar object, such as a toy, blanket, or stu"ed animal, can lessen the stress and anxiety of the parent leaving and can help the infant with a sense of security. Q A nurse is discussing separation anxiety with the parents of a 7-month-old infant. Which of the following statements by the nurse is the most appropriate? https://pages-delivery.atitesting.com/s/1/o/2/a/2/p/1 第1/2⻚ Engage Peds: Infants—1 Month to 1 Year A C “Separation anxiety is an expected part of psychosocial development for the infant.” 1/12/26 下午6:56 B “Separation anxiety is not normal for a 7-month-old infant. We may want to consider some developmental testing.” “The more often you leave the infant for extended periods of time, the more quickly the anxiety will resolve.” “Leaving the infant is di#cult for you and for them. Perhaps D you could consider just staying home with the infant until this passes.” Submit Communicating With Parents When discussing separation anxiety with the parent, the nurse should convey it as an expected part of infant development. Establishing a sense of trust, safety, and self-confidence, the infant recognizes the parents who help to meet their daily needs and provide them with a secure care environment. The parent should be encouraged to establish a bonding relationship and continue to live as usual with an established routine and separation, despite the emotional anxiety in the infant. Developing patience and acting as a calming influence, the parent should always return and greet the infant with a smile and reassurance that they were cared for appropriately. The nurse should o"er a calm voice and reassurance to the parents that, just like other developmental stages, the infant will grow through this one and eventually will be able to handle being left more e"ectively. Reminding the parent of the importance of e"ective bonding, the nurse should encourage establishing a sense of trust and a caring environment for the parent to express stresses of the developmental stage. Q What techniques should a nurse recommend that a parent use to decrease separation anxiety? Enter your response and submit to compare to an expert response. Type your answer here. Submit https://pages-delivery.atitesting.com/s/1/o/2/a/2/p/1 第2/2⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:56 As infants grow and develop, three critical qualities provide an appropriate environment for successful health promotion: safety, stability, and nurturing. Safety allows the infant to feel secure in their environment. Stability allows predictability and consistency in the social, emotional, and physical environments. Nurturing means the infant’s physical, emotional, and developmental needs are met successfully. These three qualities combined allow the freedom the infant needs to be able to explore, meet developmental milestones, and grow. In 2020, approximately 20,000 infants died in the United States, with the five leading causes being birth defects, preterm birth and low birth weight, sudden unexpected infant death (SUID), injuries such as su!ocation, and maternal pregnancy complications. Health promotion for the infant  sudden unexpected infant death (SUID) – begins with a healthy full-term pregnancy without complications, a nurturing and caring home, and the best nutrition possible. Also included for the prevention of disease are the appropriate health care visits and immunizations throughout the first year. The unexpected death of an infant under the age of 1 year. Prior to investigation, there may not be a known cause of death. An infant is born with an immature immune system, so vaccines are essential in protecting them from illness. A goal of Healthy People 2030 is a decrease in infant morbidity and mortality to less than five infant deaths per 1,000 live births. By encouraging vaccines, Healthy People 2030 intends to decrease infant morbidity and mortality. In 2020, 16 states had met this goal; however, southern states were still struggling with high infant morbidity and mortality rates. Anticipatory guidance at every well-child visit and educating parents can make a positive impact on the health promotion of the infant. The use and encouragement of vaccines and attending well-child visits can help to deter these statistics. Q Describe three qualities that are critical to providing an appropriate environment for successful health promotion of the infant. Enter your response and submit to compare to an expert response. Type your answer here. Submit Safety Promotion During the first year of life, the promotion of safety relates primarily to the home environment and relationship with the family. Safety measures can help prevent su!ocation injuries, falls, burns, motor vehicle accidents, choking, drowning, violence, and other injuries from  hazards. Parents must keep a watchful eye and not underestimate their infant’s motor abilities or overestimate their ability to avoid danger. The home should be childproofed with electrical outlets covered, sharp edges padded, and dangerous substances locked away. Infants rapidly advance from totally immobile to mobile in the first year and actively explore the environment around them. The parent should be reminded and educated on how to maintain a safe space for the infant and how to foster a positive caring relationship while carefully monitoring the exploration of the infant. × ▶ INFANT CAR SEAT SAFETY Q According to the AAP, which of the following is one of the leading causes of infant morbidity and mortality? https://pages-delivery.atitesting.com/s/1/o/2/a/3/p/1 第1/7⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:56 A Motor vehicle accidents B Preventable illnesses C Developmental delays D Injuries Submit Q A 6-month-old infant has increased safety risks related to their continuing growth and development. What milestones might contribute to this safety concern and how might they lead to injuries? Enter your response and submit to compare to an expert response. Type your answer here. Submit The use of car seats in vehicles has been shown to decrease the rate of death and serious injury in infants and children. When riding in a car, the infant should be safely secure in the middle of the back seat in a rear-facing car seat. Nurses have an integral role in preventing injury to infants. Nurses can provide education that is evidence-based regarding the importance of the use of proper types of car seats, car seat installation, and adjusting the seat as the child grows. View the video below regarding client teaching about car seat safety.    00:00 / 00:00      Teaching About Car Seat Safety Q A nurse has completed reviewing car seat safety with the parent of a 6-month-old infant. Which of the following statements by the parent indicates an understanding of the information presented? Select all that apply. https://pages-delivery.atitesting.com/s/1/o/2/a/3/p/1 第2/7⻚ Engage Peds: Infants—1 Month to 1 Year A 1/12/26 下午6:56 “I should turn his car seat forward when his legs begin to touch B “I should adjust the shoulder harness straps as he gets bigger.” D “I will need to get a bigger seat when his head is about an inch from the top of the car seat.” the seat back of the car.” C “I should place a heavy blanket between my baby and the harness straps.” E “The top of the chest clip should be placed level with his armpits.” Submit Nutrition For the first 4 to 6 months of an infant’s life, most calories and nutritional intake come in the form of breast milk or infant formula. Through the appropriate intake of calories (including carbohydrates, protein, and fats), vitamins, and nutrients, the infant grows and develops. As 40% to 50% of the energy needed to continue growth comes from fat consumption, intake of fats should not be restricted in the infant. During the first 4 to 6 months of life, the infant’s primary function of their tongue and mouth is the sucking of a nipple to take in food. The tongue thrusts or pushes out in the sucking motion, hindering the infant’s ability to take in solid food until developmentally appropriate. Case Study Scenario Introduction Cassie, a nurse, is caring for Olivia, a 2-month-old infant who was brought to the clinic for a well-child visit. Olivia has been breastfed for the first 2 months of life, and Ashley, Olivia’s mother, is considering changing to formula. Olivia is currently at the 50th percentile for weight, height, and head circumference and is meeting developmental milestones. Ashley would like to discuss the change to formula with a nurse prior to making the decision.  Scene 1 – Ashley: “I don’t know if I want to keep breastfeeding my baby.” Cassie: “Please tell me more about why you might want to stop.” Ashley: “I’m so exhausted, and my baby is growing fine. If I stop, she’ll be fine now. Formula is so much easier for me.” Cassie: “I’m so sorry to hear you feel exhausted. The first few months of life with an infant can be overwhelming. Formula will provide the infant with all the essential calories, nutrients, and vitamins. However, it can be expensive and is not the best form of feeding an infant according to the American Academy of Pediatrics. Breastfeeding is highly recommended to help Olivia continue to grow and develop appropriately. The average infant will start sleeping through the night by 4 to 6 months of age.” Ashley: “I understand breastfeeding is best, but I’d still like to start formula feeding.” Cassie: “I understand. Would you like to discuss the various types of formulas and how to transition Olivia over? We support your decision and your care of your baby as we only want what’s best for Olivia and for you.” Scenario Conclusion Cassie and Ashley discussed various types of formula. Cassie sent Ashley home with various formula samples to try with Olivia. Q When discussing breastfeeding versus formula feeding with a parent, which of the following statements by the nurse is the most appropriate? A “Breastfeeding should be your only choice as it is better for the baby.” C “Both breastfeeding and formula feeding will provide the nutrition your infant needs.” https://pages-delivery.atitesting.com/s/1/o/2/a/3/p/1 B “If you really loved your baby, you would keep breastfeeding.” D “Breastfeeding is a much easier way to feed the baby and should be considered despite your concerns.” 第3/7⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:56 Submit Breastfeeding Breastfeeding is the best source of infant feeding and, in most cases, is the healthiest for the infant and mother. The AAP recommends feeding infants only breast milk for the first 6 months of life. The infant should eat on demand, which equates to approximately every 2 or 3 hours (8 to 12 times in 24 hours), and the mother should feel as if the breasts have been emptied of milk. By 6 months of age, the energy and caloric requirements of the infant cannot be met solely by breastfeeding, so nutritious foods need to be added. There are many benefits to breastfeeding, including a decreased risk of the infant developing ear infections, upper respiratory infections, asthma, or SUID. It may also increase bonding between the mother and the infant. Studies have also linked higher IQ scores with breastfeeding. Breast milk is easier for the infant to digest and does not require preparation. Storage techniques can be used if the mother is preparing to be away from the infant or if the choice is made to exclusively pump and bottle-feed the breast milk. By pumping breast milk and using bottles to feed, the feeding and care responsibilities can be shared among parents, enabling the mother to return to work or engage in other situations that would limit the availability to breastfeed. There are immunological benefits of breastfeeding, as the mother’s antibodies pass to the baby through the milk. Q What are the benefits of breastfeeding for the infant? Enter your response and submit to compare to an expert response. Type your answer here. Submit There are some situations in which breastfeeding may be harmful to the mother or the infant. Mothers who have HIV/AIDS should not breastfeed, as the virus can transfer to the infant through breast milk. Mothers who have alcohol or substance use disorders should not breastfeed because alcohol or drugs can also transfer to the infant through breast milk. The exception to this is the neonate dealing with withdrawal who will be helped by continuing to nurse immediately after birth. Certain medications can also transfer to the infant through breast milk and make it unsafe for the infant to breastfeed. Instances when breastfeeding is not encouraged for mothers include the presence of active herpes sores on their breasts and nipples, active and untreated tuberculosis, or severe malnutrition. Breastfeeding may be di#cult for mothers who are working and do not have the ability to pump during working hours, adoptive parents,  parents who want to share the responsibility of feeding the infant, mothers who are experiencing sleep deprivation, and mothers who do not produce a lot of breast milk. Mothers who have breast inflammation or infections may have trouble with latching or experience pain during feeds and may not be able to breastfeed. Some infants struggle with breastfeeding if they have congenital birth defects, are premature, have complications with sucking, have gastrointestinal di#culties, or have other challenges a!ecting eating. If infants are losing weight or not gaining enough weight, feeding the child pumped breast milk or formula supplementation may be implemented. iStock/Fly View Productions INFANT BREASTFEEDING Q Which of the following reasons is why the AAP highly recommends breastfeeding as the nutritional source for infants? https://pages-delivery.atitesting.com/s/1/o/2/a/3/p/1 第4/7⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:56 A Breast milk is easier to digest. B Breastfed infants are at decreased risk for injury. C It increases bonding with caregivers other than the mother. D Breast milk has an increased amount of vitamin D. Submit Formula Feeding An alternative to infant nutrition is infant formula, either as a full or partial replacement for breast milk. Infant formula is available as ready-  to-feed, powder, and concentrated liquid. These formulas can be specific to the infant's needs, supplying nutrients and calories to preterm and full-term neonates, as well as the type of protein base used to create the formula, including cow milk, goat milk, soy, and amino acidsbased formulas. Formulas provide between 19 and 20 kcal/oz, comparable to breast milk, which averages between 18 and 20 kcal/oz. There are some major di!erences in the impact of formula milk on the gut microbiome compared to breast milk. Infants who are breastfed, for example, develop a more stable gut microbiome than those who are formula-fed. These di!erences are linked to an increased risk of increased body mass index and allergies in formula-fed infants. Some research has also linked an increased risk of chronic diseases such as asthma and diabetes mellitus or acute illnesses such as respiratory tract infections and ear infections in children who are formula-fed. iStock/StefaNikolic INFANT FORMULA FEEDING Parent education should include information on the proper mixing and preparation of the formula unless it is a ready-to-feed formulation. Proper cleaning and sanitization of bottles and other feeding supplies should be emphasized during parent teaching. Formula can spoil if opened ready-tofeed or prepared formulas are left at room temperature. Prepared formula should be used within 2 hours of mixing or stored in the refrigerator for up to 24 hours. Any formula that is left in the bottle after infant feeding should be discarded because there is an increased risk for bacterial growth. When bottle-feeding the infant using expressed breast milk, donor breast milk, or formula, the parent should position the bottle at an angle from the infant to avoid aspiration or choking. The bottle should be held and never propped up to avoid increasing the risk of infant ear infection, choking, or tooth decay. Further, infants should not be placed in bed with a bottle, as this also increases the risk of choking and tooth decay. Solid Food Around 6 months of age, the infant will begin eating solid foods in addition to breast milk or formula. This food is not meant to replace breast milk or formula. When an infant is developmentally ready to begin solid foods, they will be able to learn to coordinate their tongue so that it no longer thrusts and pushes food out of the mouth. The infant’s  tongue will be able to elevate and move food around in their mouth. This can often take a few weeks for the infant to learn how to control their tongue when eating. The infant will also be able to hold their head up with control of the head and neck, engage in self-support while sitting, and open their mouth and lean forward when needing food. Parents should try giving their infant a new food every 3 to 5 days. Beginning with cereal mixed with formula or breast milk allows the infant to continue to receive the necessary primary nutrients while becoming familiar with the use of a spoon and the texture and taste of food. Gradually, the parent should introduce vegetables, then fruit, and finally meat. iStock/Jovana Stojanovic INFANT SOLID FOODS Vegetables are introduced before fruit in hopes that the infant will develop a taste for vegetables versus a sweet tooth for fruits. Honey, which can be a source of the bacteria Clostridium botulinum, is unsafe for infant consumption. The parent should begin with solid food one time a day and progress to two or three times daily. Foods should be pureed to start, progressing to thicker pureed foods when the infant starts grasping for the food. A sippy cup with juice or water can be introduced when the infant starts grasping for food with the palms of the hand. Q Which of the following statements by a nurse about infant feeding is the most appropriate? https://pages-delivery.atitesting.com/s/1/o/2/a/3/p/1 第5/7⻚ Engage Peds: Infants—1 Month to 1 Year Q A C 1/12/26 下午6:56 Which of the following statements by a nurse about infant feeding is the most appropriate? “Formula feeding is the best option for the infant because it B provides all needed vitamins and minerals.” “The infant can receive table food as soon as beginning solids and should avoid eggs and peanuts.” D “The infant should begin solid foods at 4 months of age so that the parents can decrease the amount of milk given.” "Breastfeeding is the best option for the baby and should be continued as long as it is working for both the mother and the baby.” Submit Sleep Infants do not develop a regular sleep schedule until around 6 months of age. For the first few months, infants awaken every 2 to 4 hours  throughout the day and night to feed. During this time, infants can sleep for up to 16 or 17 hours a day, lessening as they grow and develop. However, every infant is di!erent and has di!erent sleep schedules and sleep needs. The most important part of infant sleep is positioning. The AAP recommends placing infants on their backs to sleep. An infant sleeping on their back is less likely to experience SUID than an infant who sleeps on their side or stomach. A firm, flat mattress should be used, and it should fit snugly within the crib walls without any open areas. SAFE VS. UNSAFE CRIB No loose blankets, toys, stu!ed animals, or bumper pads should be placed in the crib. Any infant that falls asleep in a swing, car seat, or carrier should be moved to the crib on their back as soon as possible. The crib mattress should be lowered as the infant becomes more mobile. Parents should never sleep with their infants and should put the infant back into their own bed after feedings, even in the middle of the night. Accidental su!ocation and strangulation during infant sleep is a major cause of mortality in infants less than 4 months of age. Deaths are commonly the result of airway obstruction from soft, loose bedding, someone or something rolling onto the child, or from the child being wedged between two objects. Educating the parents about the importance of not co-sleeping is vital for the safety of the infant. While cuddling and bonding are important parts of development, the risks of su!ocation during co-sleeping should be communicated to the parents, encouraging physical touch at times when the parent is awake. Q What instructions should a pediatric nurse give a parent about providing a safe sleep environment for the infant? Enter your response and submit to compare to an expert response. Type your answer here. Submit Activity Physical activity is vital to the growth and development of all children, even infants. Infants should be encouraged to explore movement in  their physical environment for short periods of time several times a day with supervision. Tummy time should be encouraged as long as the infant shows enjoyment. The infant should not fall asleep on their abdomen during tummy time and should be placed in a bed if that occurs. During this first year, the infant goes from lying flat to sitting upright, https://pages-delivery.atitesting.com/s/1/o/2/a/3/p/1 第6/7⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:56 During this first year, the infant goes from lying flat to sitting upright, crawling, and eventually walking. They also begin to play with toys and parents, interacting in a positive manner with those around them. Keeping the infant active and engaged can encourage development. The nurse should encourage parents to read to the infant, play music and dance with them, play on the floor with them, and take them out for walks and other outings. iStock/yaoinlove INFANT TUMMY TIME Q Which of the following three critical qualities provide an appropriate environment for successful health promotion? A Safety, stability, and nurturing B Safety, stability, and communication C Caring, compassion, and communication D Stability, nurturing, and caring Submit Communicating With Parents Discussing health promotion and prevention measures with the parents of an infant requires the nurse to use therapeutic communication techniques and a judgment-free attitude. For many parents, this first year is a time of doubting their ability to care for their infant, questioning their decisions about that care, and experiencing excitement about all the new experiences. When discussing breastfeeding versus formula feeding, it is essential that the nurse recognize the decision is a personal choice. Despite their own beliefs about feeding methodologies, the nurse must support the parent and help them to navigate the preparation, storage, and delivery of nutritional sources. Providing education objectively and thoroughly can help parents make the best decisions for their own situation and feel confident that the choices they make are appropriate for the infant. The nurse should also discuss safety concerns with the parents as they relate to sleeping and activity. Having a separate sleeping space for the infant and only placing them on their back for sleep maintains a safe environment for the infant and the family. Instructing the parents on how to make the best decisions for the infant is an intricate part of maintaining the health of the family unit and helping prevent illness and injury. Discussing the value of tummy time and active monitoring of the infant allows the nurse to educate the parents on valuable ways to keep the infant developing in a safe manner. By communicating about health promotion and prevention, the nurse can educate, guide, and encourage a safe, healthy, and happy care environment. Q When discussing health promotion and prevention with parents, what is the best way for the nurse to approach these topics? Enter your response and submit to compare to an expert response. Type your answer here. Submit https://pages-delivery.atitesting.com/s/1/o/2/a/3/p/1 第7/7⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:57 When a family brings home an infant from the hospital and begins to care for them over the first year, they might not consider the possibility of their infant becoming sick or having di!culties. However, these situations can arise and challenge the parents and nurses in being able to provide care. While many infants are healthy and never experience any concerns during their first year, this is not true for all infants. Health concerns during the first year of life can range from mild to severe, including food sensitivities, sleep disturbances, failure to thrive, or sudden unexpected infant death (SUID). Food Sensitivity Hypersensitivity to foods can result in irritability, hyperactivity, gastrointestinal upset, eczema, and asthma; however, true food allergies are not common. Cow’s milk is the most common food that infants exhibit allergic reactions to, with 2.5% of infants and children exhibiting an allergic reaction to cow’s milk. Other common food allergens are eggs (1.5%), peanuts (1%), soy (0.4%), and wheat (1-3%). When introducing new foods, the AAP recommends waiting 3 to 5 days between new foods to monitor for any adverse reactions. While previous reports suggested waiting to introduce foods that could cause hypersensitivity reactions, research shows early introduction can actually decrease the development of hypersensitivity reactions. When highly reactive foods were introduced after 6 months of age, the infant had a higher risk of food allergies or eczema. Therefore, the AAP recommends these foods be introduced before 1 year of age. Q How should a nurse explain food sensitivity to the parent of an infant? Enter your response and submit to compare to an expert response. Type your answer here. Submit Q Which of the following foods should not be introduced to an infant who is younger than 1 year old? A Cow’s milk B Peanuts C Eggs D Honey Submit Altered Nutrition The rapid period of growth and development in the first year of life requires a great deal of energy expenditure. Calories and nutrients are the fuel for this growth. If an infant is not obtaining all the calories and nutrients needed, then their growth and development will be adversely a#ected. A healthy infant should take in around 100 kcal/kg/day, with 40 to 60 kcal/kg/day used for metabolic activities and processes that keep the infant × ▶ healthy, such as thermoregulation, feeding, digestion, absorption, energy storage, and elimination. Infants experiencing illness, certain genetic disorders, or prematurity may need specialized formulas prescribed by the provider to meet their individual needs for proper growth and development. Although traditionally physically unstable after birth, the preterm infant should be fed enterally as soon as possible using colostrum and breast milk as the first options. Starting with 20 to 30 mL/kg  colostrum – and advancing rapidly as tolerated, the preterm infant should be up to full feeds by 7 to 10 days https://pages-delivery.atitesting.com/s/1/o/2/a/4/p/1 第1/6⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:57 and advancing rapidly as tolerated, the preterm infant should be up to full feeds by 7 to 10 days after birth. Q Fluid excreted from a breast at the onset of milk production. What is the benefit of giving a high-calorie formula to a preterm infant? Enter your response and submit to compare to an expert response. Type your answer here. Submit Food/Bottle Aversion An infant with a food or bottle aversion may refuse the breast, bottle, or eating in general. This refusal may be related to a sensitivity, anxiety, or fear of food. Premature babies are twice as likely to have feeding aversions compared to healthy infants, and 20% to 50% of all healthy children may struggle with a feeding complication. The care premature infants initially receive in the neonatal intensive care unit (NICU) may create a trauma experience near the mouth, making it sensitive to touch. The infant struggling with the discomfort of gastroesophageal reflux may also have an aversion to letting anything touch their mouth due to a fear of pain or discomfort. The preterm infant in the NICU may have their mouth swabbed, be encouraged to use a pacifier, or be put to the breast for non-nutritive sucking or cue-based feeding. The infant may also be provided with a sweet taste during feeds to elicit a pleasant feeling surrounding oral interactions in order to overcome oral aversions. For infants at home, food should be implemented during playtime to encourage a more positive experience with oral interactions. If the infant continues to struggle with oral aversion, then a speech or behavioral therapist may need to be consulted to help overcome the aversion. Q For what reasons may an infant have an aversion to food or bottles? Enter your response and submit to compare to an expert response. Type your answer here. Submit Vitamin Supplementation Infants who were born prematurely, are breastfed exclusively, or are fed formula that is not iron-fortified are at high risk of iron deficiency. Ironfortified formulas have helped to decrease the need for additional iron  administration for some infants. However, for others, the iron intake is not su!cient to help in psychomotor development, resulting in cognitive and motor deficiency. Prevention of iron deficiency is imperative since long-term e#ects are not known. With only enough iron stores to last until 6 months of age, the AAP Committee on Nutrition recommends oral iron drops from 4 months of age until iron-fortified cereals and meats are added to an infant’s diet. Administering the supplements depends on the disposition of the infant, including their ability and cooperation in taking medications. Equipment such as dosing devices or syringes should be used to administer accurate doses. Vitamin D deficiency is more prevalent in infants who are exclusively breastfed, so the AAP recommends these infants receive vitamin D https://pages-delivery.atitesting.com/s/1/o/2/a/4/p/1 第2/6⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:57 supplementation beginning within the first 2 months of life. Breastfed infants of mothers who eat a vegan or vegetarian diet or who are vitamin-B12 deficient require supplementation of vitamin B12. VITAMIN D ADMINISTRATION Q What education about vitamin and mineral supplementation should the nurse provide to the breastfeeding mother? Enter your response and submit to compare to an expert response. Type your answer here. Submit  Medication: Vitamin D  Medication: Ferrous sulfate Class: Vitamin Class: Iron salt Action: Stimulates absorption of calcium and phosphate from the small intestine, phosphate uptake from the renal tubule, and secretion of calcium from the bones into the blood stream. Action: An essential body mineral, becomes part of the hemoglobin and myoglobin to help carry and store oxygen throughout the body in tissues and organs. Therapeutic Use: Treat vitamin D deficiency due to insu!cient dietary sources Therapeutic Use: Prevent or treat iron deficiency anemia Adverse E!ects: Hypervitaminosis of vitamin D Interactions: Other vitamins containing vitamin D can lead to vitamin D toxicity Contraindications: Hypercalcemia, vitamin D toxicity Client Teaching: Take daily as directed as long as the infant is being breastfed. Use the dropper that comes with the medication to avoid dosing errors. Monitor for manifestations of vitamin D toxicity (nausea, vomiting, fatigue, irritability, weight loss, dehydration, poor feeding, weakness) and notify the provider should these occur. Avoid vitamin D products containing propylene glycol as this can be toxic when taken in large amounts. Adverse E!ects: Diarrhea, constipation, nausea, abdominal pain, green/dark colored stools, anorexia, gas, vomiting Interactions: Baloxavir marboxil (influenza antiviral medication) Contraindications: Hemochromatosis, hemolytic anemia, hypersensitivity to iron salts, premature infants until vitamin E levels are within the expected reference range Client Teaching: Contact poison control immediately in the event of accidental overdose. Keep out of reach of children to avoid accidental overdose, as this can be fatal. Avoid iron products that contain propylene glycol, which can be toxic when taken in large amounts. Some liquid forms of iron supplements can stain the child’s teeth temporarily. Be aware that iron supplements come in various dosages. Administering a dosage other than prescribed can lead to toxicity or continued iron deficiency. Sleep Issues Infants 3 months and younger get 16 to 17 hours of sleep per day, including naps, and infants 4 months to 1 year old should get 13 to 14 hours of sleep per day, including naps. An improper amount of sleep hours or interrupted sleep for an infant can be associated with sleeping problems later in childhood and can cause health problems throughout the lifespan. Because most infants up to 6 months of age do not have a set sleep schedule, sleep issues are often not identified until the second half of the first year. Infant temperament, family environment, and cultural traditions all play a role in establishing a stable sleep schedule for an infant. An infant who has di!culty with self-soothing cries a large amount or is di!cult to console can have di!culty sleeping. A family environment with a lot of people, loud noises, or varying sleep schedules can cause di!culty sleeping. Living environments such as a crowded living space with a lot of activity may negatively impact an infant’s ability to acclimate to a schedule. When establishing a sleep schedule, parents need to make sure that the schedule works for their situation. For example, a parent who goes to bed in the early hours of  temperament – The way in which the infant approaches and reacts to the world. the morning may not want to place their infant on a schedule in which the infant goes to bed in the early evening and wakes up in the morning as the parent is just going to sleep. Encourage parents to establish a sleep routine for the infant so it is easier for the infant to calm down and sleep. For example, giving the infant a https://pages-delivery.atitesting.com/s/1/o/2/a/4/p/1 第3/6⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:57 Encourage parents to establish a sleep routine for the infant so it is easier for the infant to calm down and sleep. For example, giving the infant a bath before reading a book together and then putting them to bed can be a relaxing and enjoyable sleep routine. The AAP recommends not rushing in to soothe a crying baby but allowing them time to self-soothe and put themselves back to sleep. Attending to a crying baby every 2 to 5 minutes, soothing them without picking them up, and leaving the room again allows the infant to trust the parent is present but will not interfere with the sleep schedule. Q By allowing an infant to self-soothe, what skills are parents encouraging in a baby? Enter your response and submit to compare to an expert response. Type your answer here. Submit Failure to Thrive An infant’s inability to convert calories to energy or an inappropriate  intake of calories can lead to failure to thrive (FTT). In the U.S., up to 10% of infants experience FTT. Used to indicate inadequate weight gain in a pediatric client, FTT is a weight for age that is less than the 5th percentile on CDC growth charts, a decrease in weight that results in a change of more than two percentile lines on the CDC growth charts, or less than 80th percentile of weight to length ratio. FTT can be caused by many di#erent factors, requiring the health care team to rule out metabolic, respiratory, and cardiac disorders, such as malabsorption syndrome, cystic fibrosis, and congenital heart defects. Social and familial factors must also be investigated, as neglect or a lack of parent education can result in a lack of feeding of the infant. INFANT WITHOUT FAILURE TO THRIVE AND INFANT WITH FAILURE TO THRIVE At each well-child visit, weigh the infant and measure their height and head circumference, compare previous data, and plot data on growth charts to determine if appropriate growth is happening. A discussion about the preparation of formula and the amount of formula or breast milk taken in is valuable in determining whether the appropriate calories are being provided. Also, inquire about the number of wet diapers and stools the infant is having to verify that calories are being processed appropriately throughout the digestive system. Q An infant measuring at the 3rd percentile for weight and 25th percentile for height on the CDC growth charts presents to the clinic. Does this client meet the criteria for failure to thrive (FTT)? What other diagnoses must be ruled out before determining FTT? Enter your response and submit to compare to an expert response. Type your answer here. Submit Sudden Unexpected Infant Death SUID is an umbrella term that refers to the abrupt and unexpected death of an infant less than 1 year old. SUID is one of the leading causes of death https://pages-delivery.atitesting.com/s/1/o/2/a/4/p/1 第4/6⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:57 SUID is an umbrella term that refers to the abrupt and unexpected death of an infant less than 1 year old. SUID is one of the leading causes of death in infants 1 to 12 months of age in the United States. It includes sudden infant death syndrome (SIDS) and accidental su#ocation during sleep (caused by either soft bedding, another person rolling on top of or against the infant, or trapping the infant between two objects). SUID involves the death of an infant less than 12 months of age with no known cause. In contrast, when an infant succumbs to accidental su#ocation and strangulation in bed (ASSB), the cause of the death is known due to the environment in which the infant is found. Risk factors for SUID include maternal age of 20 years or younger, maternal smoking during pregnancy, lack of prenatal care, secondhand smoke exposure, prematurity or low birth weight, infant of male sex, overheating, prone placement in crib, soft surfaces for sleeping, loose bedding in the sleeping space, infant sleeping on a couch or cushioned surface, and an infant sharing a bed with a parent. Q What are the risk factors for SUID? Enter your response and submit to compare to an expert response. Type your answer here. Submit With a lack of family support strategies in the U.S., many parents are not  benefitting from education programs, breastfeeding support programs, and safe and secure homes. A lack of consistency amongst parents, limited resources, and a decrease in education for new families can be noted as playing a role in the continued infant deaths. Supporting families and educating them on the proper care of the infant, particularly back sleeping in a secure and safe environment, can help to decrease the incidence of SUID. Encouraging breastfeeding is another way health care team members can deter the risk factors of SUID. To help prevent SUID, parents should be encouraged to keep infants in their room with them in a separate bed, breastfeed, give their infant a pacifier, and not allow their infant to become overheated. As discussed earlier, teach parents to place infants on their backs for sleep and to not share a bed or sleeping space with their infant. iStock/monkeybusinessimages SAFE SLEEPING Q A C The parent of a 2-month-old infant comes to the clinic for a well-child visit. The parent expresses a fear of SUID. Which of the following statements about SUID is the most appropriate response from the nurse? “If you keep the infant in the bed with you, there is less of a “Using toys and blankets in the bed to keep the baby safe will chance of the infant being a#ected by SUID.” B “Placing your infant on their back in their crib for sleep can help to decrease the incidence of SUID.” D keep the baby from experiencing SUID and will make you feel more secure.” “You took really good care of yourself when you were pregnant, so your baby is not at risk for SUID.” Submit Communicating With Parents For the parent of an infant under the age of 1 year, the possibility of any health concern can be overwhelming and devastating, producing a large amount of angst and anxiety. The nurse should recognize how important calm and comforting communication can be in these health care situations. https://pages-delivery.atitesting.com/s/1/o/2/a/4/p/1 第5/6⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:57 amount of angst and anxiety. The nurse should recognize how important calm and comforting communication can be in these health care situations. Many times, it is the nurse who o#ers a soothing voice or words of encouragement as the parents begin to navigate the discovery of health issues. Using therapeutic communication techniques, such as emotionally supportive language, empathetic discussions, and listening to parents, can strengthen the collaborative e#ort to care for the client and aid in making important clinical decisions. When discussing SUID with parents, the nurse should remember that the promotion of safe sleep habits is key to the prevention of infant death. Infants sleeping alone on their backs in an unencumbered bed can help to decrease the incidence of SUID, and this should be communicated to the caretakers of infants. However, the nurse will also encounter parents who have experienced the loss of an infant related to SUID. These families should be supported with empathy and understanding, as the death of an infant is an insu#erable loss, and most cannot even conceive the gravity of the situation. As the death is unexplainable and unanticipated, the parents may be in a state of denial, anger, or overwhelming grief. The nurse’s role is to support these parents and to provide resources, such as social work and chaplain services, for their continued support. When it comes to infants with a feeding aversion, sensitivity, or di!culty, continued therapy from speech, occupational, and physical therapists is required. However, they also require work at home to continue the therapy in their natural setting where most of their feeding takes place. Nurses should encourage the parents to attend appointments, stay in close contact with the therapy team, and use strategies implemented in therapy to continue change in the infant. Discussing concerns with parents while also strongly supporting collaborative e#orts with the health care team can encourage the best health outcomes for the client and family. By helping the parent to feel essential in the treatment outcomes of the infant, the nurse supports and reassures the family of the importance of continued care. Q When speaking to parents about SUID, what information should the nurse include? Enter your response and submit to compare to an expert response. Type your answer here. Submit https://pages-delivery.atitesting.com/s/1/o/2/a/4/p/1 第6/6⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:58 Biological Development Behaviors Health Promotion Injury/Disease Prevention Health Concerns Biological Development  Case Study 1: Part 1 Enrique, the parent of 6-month-old Mateo, brings the client to the clinic for a well-child visit. Upon assessment, Mateo's weight is noted in the 75th percentile, length in the 75th percentile, and head circumference in the 25th percentile on the WHO infant growth charts. Vital signs are heart rate 108/min, respiratory rate 25/min, blood pressure 90/65 mm Hg, oxygen saturation 98% on room air, and temperature 36.9o C (98.4o F). Anterior and posterior fontanels are open and full. Moro, rooting, and stepping reflexes are present. Recognize Cues (Assessment) Q Which of the assessment findings for Mateo are concerning? Enter your response and submit to compare to an expert response. Type your answer here. Submit In biological development, recognizing cues would include completing a head-to-toe assessment, measuring the weight, height, and head circumference, checking vital signs, and determining whether developmental milestones are met. Take a full history of the client, including collecting medical, surgical, family, and social data, to obtain a complete background. Developmental assessment would include an evaluation of whether the infant can successfully perform tasks appropriate for their age. Evaluate fine motor skills, gross motor skills, cognitive skills, language, and play, and assess and note reflexes. Analyze Cues (Analysis) Q Based on Mateo's assessment findings, answer the following questions: Why are the assessment findings concerning and what would the next step be? Enter your response and submit to compare to an expert response. Type your answer here. × ▶ Submit After recognizing cues, analyze those cues. Plot the client’s weight, height, and head circumference on the WHO growth charts applicable to the sex of the infant and visualize how the infant compares to other infants of the same age. Analyze the vital signs and the expected reference ranges, and more closely examine any abnormal findings from the head-to-toe assessment. Take this opportunity to review the developmental milestones and https://pages-delivery.atitesting.com/s/1/o/2/a/5/p/1 第1/14⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:58 determine if the infant is successful in meeting these milestones. Visualizing the medical history of the infant, determine if any findings in the history can a#ect the infant or their care.  Case Study 1: Part 2 The nurse discusses Mateo's findings with Enrique and asks some questions about motor skills, language, play, and cognitive development. Enrique reports Mateo is not able to complete the following tasks: rolling from back to front, palmar grasp, recognizing strangers, and bonding with parents. Prioritize Hypotheses (Analysis) Q Which of the following hypotheses is the priority for the nurse? A Developmental delay B Failure to thrive C Neglect D Cerebral palsy Submit Prioritize the hypotheses of what is happening with the client. If the growth charts are not consistent in growth, consider a deficit in nutrition or failure to thrive. If the vital signs and head-to-toe assessment are concerning, there may be a medical consideration. If the client’s developmental assessment is not consistent with their age, consider a developmental delay. Prioritizing the hypotheses allows the nurse the opportunity to decide what is concerning about the infant and place these in order of importance of being addressed. Generate Solutions (Planning) Q Sort the following referrals into groups by identifying whether they are applicable or not applicable for this client. Drag the options on the left to the corresponding category on the right (or click the option on the left and then the corresponding category on the right). Developmental pediatrician Applicable Neurology Not applicable Nutrition Social work Genetics Endocrinology Physical therapy https://pages-delivery.atitesting.com/s/1/o/2/a/5/p/1 第2/14⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:58 Physical therapy Occupational therapy When generating solutions for the biological development of an infant, the goal is to provide intervention as early as possible to procure the best outcomes. If an infant is struggling with weight gain, length gain, or altered head circumference growth, plan to recheck the measurements before making any decisions. Consults and developmental interventions are essential in decreasing long-term e#ects. Further testing and evaluation may be indicated, depending on the results of the head-to-toe assessment and vital signs.  Case Study 1: Part 3 After determining Mateo is not meeting developmental milestones, the nurse discusses some interventions Enrique can do at home to help with motor skills, language, and cognitive development. Also discussing impending referrals, the nurse educates Enrique about expectations for collaborative visits with various specialists. Enrique understands and agrees to call with any further questions. Take Action (Implementation) Q What home interventions should the nurse suggest to the parents? Enter your response and submit to compare to an expert response. Type your answer here. Submit Interventions to implement are related to the hypotheses and to the analysis of the cues of the infant and family. For a client who is experiencing developmental delay, the use of physical therapy, occupational therapy, speech therapy, and developmental pediatrics are coordinated to work with the infant in achieving milestones the infant is not meeting. For an infant who is not meeting growth milestones, further diagnostics and laboratory work should be completed, including a full cardiac evaluation and nutritional counseling. An assessment that reveals unexpected findings should be followed up with the health care provider, including a discussion about the nurse’s findings and concerns. Evaluate Outcomes (Evaluation) Q What evaluation of Mateo should occur and when? Enter your response and submit to compare to an expert response. Type your answer here. Submit For biological development, a positive evaluation would be noted if the infant is growing and developing appropriately and without delays. An infant who had an assessment within expected limits and vital signs consistent with their age would be evaluated and would be considered positive. However, not only must their assessment be considered but also the assessment of the parents, as these are the people most frequently with the https://pages-delivery.atitesting.com/s/1/o/2/a/5/p/1 第3/14⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:58 However, not only must their assessment be considered but also the assessment of the parents, as these are the people most frequently with the infant. The use of appropriate therapies and meeting developmental goals would be evaluated for the success of the nursing plan. Behaviors  Case Study 2: Part 1 A nurse is caring for a 7-month-old infant, Danielle, in the pediatric unit at the hospital. Every time her mother, Sarah, leaves the room, Danielle cries inconsolably and will not allow anyone to comfort her or allow for any care to be provided. Danielle is refusing to eat and sleep when Sarah is not around. Sarah has just informed the nurse that in a few days, she will need to come only once a day as she will lose her job if she does not go back to work, despite Danielle being in the hospital. Recognize Cues (Assessment) Q What is concerning about Danielle's behavior? Enter your response and submit to compare to an expert response. Type your answer here. Submit With infant behaviors such as separation anxiety the ability of the nurse to recognize cues during the interaction of the infant with the parent is essential. An infant who is inconsolable when their parent is leaving or absent, has an increased heart rate, will not allow any interaction with others, and has a decreased nutritional intake is noted as going through separation anxiety. Observing and assessing the family dynamics can indicate behavioral concerns. Analyze Cues (Analysis) Q What potential complications can occur from Danielle's separation anxiety? Enter your response and submit to compare to an expert response. Type your answer here. Submit Analyzing the behavior of the infant in relation to their interaction with others can enlighten the nurse as to the concerns of separation anxiety. Checking a full set of vitals would indicate an increased heart rate, demonstrating stress and anxiety. Maintaining a full nutritional record would indicate decreased nutritional intake and decreased fluid intake. Nurses’ notes would indicate a di$cult time caring for the client due to crying and frustration from missing their parent. The analysis of the behavior would allow the nurse to put the recognized cues into a clinical picture.  Case Study 2: Part 2 The nurse is concerned that because Danielle is refusing care when Sarah is not present, the care will be negatively a#ected when Sarah cannot be there more often. The nurse https://pages-delivery.atitesting.com/s/1/o/2/a/5/p/1 第4/14⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:58 care will be negatively a#ected when Sarah cannot be there more often. The nurse discusses concerns with Sarah, and a plan is developed for the upcoming days to help the infant with separation anxiety. Prioritize Hypotheses (Analysis) Q What is the priority concern for the nurse caring for Danielle? Enter your response and submit to compare to an expert response. Type your answer here. Submit When prioritizing hypotheses for an infant experiencing behavioral concerns, begin by using Maslow’s hierarchy of needs. If there are physiological changes, such as an increased heart rate for the infant, then the priority is airway, breathing, and circulation, particularly the heart rate and the control of the heart rate. A client who has behavioral issues does not eat, drink, or sleep e#ectively, and so those concerns are the next priority for the nurse. The next priority would be the infant’s bonding or psychosocial status, as the infant cannot relax and heal without a resolution to these concerns. Generate Solutions (Planning) Q What plan-of-care interventions could the nurse and Sarah engage in to help alleviate some of the separation anxiety for Danielle? Enter your response and submit to compare to an expert response. Type your answer here. Submit Behavioral concerns require generating solutions and a plan for how to help the infant to adjust. Making a plan with the parents to start by leaving for short amounts of time, leaving a familiar object with the infant, and leaving the infant with someone they are familiar with allows the infant to grow accustomed to the change gradually. Encourage continuity of care with other sta# and try to provide as much stability in interactions with others as possible. Behavioral concerns can be detrimental to the infant and should be addressed in a timely and consistent manner.  Case Study 2: Part 3 After developing a plan for Danielle to help with the separation anxiety, the nurse and Sarah put the plan into action and began to work on some of the interventions. Danielle reacts well to the stability of a nursing sta$ng schedule as she begins to build trust with the nurses. Danielle also feels much more secure with a favorite toy from home. Sarah also feels much more comfortable knowing she will have to be gone for longer periods of time. Take Action (Implementation) Q What intervention would be the priority? Enter your response and submit to compare to an expert response. https://pages-delivery.atitesting.com/s/1/o/2/a/5/p/1 第5/14⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:58 Type your answer here. Submit Encourage the parent to remain in the room as much as possible with the infant, and then have them slowly start taking small breaks from which they always return to the room. Leaving a familiar stu#ed animal, toy, or blanket with the infant helps comfort them and provides a sense of stability. Implement a caretaker team for this infant so that the nurses are coordinated and consistent in the room. This allows the infant to build up a sense of trust with caregivers and alleviates some of the psychosocial e#ects of separation. Move the infant to a room closer to the nurses’ station so the infant does not feel alone. Evaluate Outcomes (Evaluation) Q How would the nurse know that the plan and interventions are working? Enter your response and submit to compare to an expert response. Type your answer here. Submit The infant is evaluated for behavioral concerns with the monitoring of vital signs, intake and output, and sleep schedule, as well as the overall ability of the nurse to provide care to the infant. If the infant can be cared for appropriately without significant emotional outbursts or crying, then the plan of care would be successful in allowing the infant to receive appropriate care. Evaluation of outcomes is an ongoing process and may need to be adjusted as the infant’s development changes and the infant becomes more comfortable with the nurse. Health Promotion  Case Study 3: Part 1 Sam, a 6-month-old infant, presents to the clinic for a well-child check. Sam was brought by his parents. When discussing anticipatory guidance, the parents express their joy at being able to feed the infant table foods now. They also mention having recently bought a frontfacing car seat since Sam has outgrown the car carrier. They are also excited about Sam sleeping throughout the night in his own crib. The parents are curious about vaccines and the importance of continuing to receive them. Recognize Cues (Assessment) Q What questions should the nurse ask to obtain further information? Enter your response and submit to compare to an expert response. Type your answer here. https://pages-delivery.atitesting.com/s/1/o/2/a/5/p/1 第6/14⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:58 Submit When discussing health promotion, recognize parenting behaviors that are indicated in infant care. Assess car seat safety, nutrition administration, sleep safety, and activity safety. The infant should be riding in a car seat that is rear-facing in the back seat, sleeping in their own crib with no stu#ed animals or blankets, sleeping on their back, breastfeeding or formula feeding with the introduction of solid foods, and being monitored closely for safety as they continue to develop and meet developmental milestones. If any of these safety measures are not being followed by the parent, there are potential safety concerns for the infant. Analyze Cues (Analysis) Q The nurse is analyzing the data collected during Sam's assessment. Which statements by Sam's parents are concerning? Enter your response and submit to compare to an expert response. Type your answer here. Submit When analyzing cues for health promotion, safety is an intricate aspect of care for the infant. If the infant is safely restrained in the car seat, sleeping in a safe environment, eating appropriately, and being monitored during periods of activity, then the cues would demonstrate appropriate parenting and protection of the infant. The interaction of the parent with the infant can also demonstrate health promotion to the nurse and clarify for the health care team that the infant is safe.  Case Study 3: Part 2 Discussion about the safety of car seats reveals that the parents can keep the infant rearfacing in the new car seat they purchased. They also state that they have not started the infant on any foods, such as cereal, vegetables, or fruits. The parents have been formulafeeding since 2 months of age when the mother went back to work. The parents mention that their other family members do not immunize their children, and they are fine. They also mention an article they read on the dangers of vaccine administration. Prioritize Hypotheses (Analysis) Q Place the following client concerns into priority order. Drag the options on the left to their match on the right (or match pairs by first selecting the option on the left and then selecting its match on the right). Food administration and safety 1 Vaccine safety and education 2 Car seat safety 3 Health promotion hypotheses are primarily prioritized based on safety. Since car safety, sleeping safety, nutritional safety, and activity safety are all vital to health promotion, the nurse would have to distinguish where the infant is on these topics in order to prioritize. Using Maslow’s hierarchy of needs, the infant’s safety is essential for the nurse to observe. For example, if the infant is leaving the hospital, then car seat safety would be the priority. If the infant is in the room sleeping, then sleep safety is the priority. If the infant is eating, then nutrition safety would be the priority, and activity safety would be the priority when the infant is awake and active. Generate Solutions (Planning) https://pages-delivery.atitesting.com/s/1/o/2/a/5/p/1 第7/14⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:58 Generate Solutions (Planning) Q The nurse is preparing to provide anticipatory guidance to Sam’s parents. Which of the following educational topics should the nurse prioritize? A Food safety B Sleep safety C Physical development D Cognitive development Submit Generating health promotion solutions would include planning with the family to make sure a car seat is available and can be secured in the rear seat of a car. The family would also plan to have a crib that is safe for the infant with no excess blankets or toys and the ability for the infant to sleep alone and on their back. The infant should have breast milk or formula available and, dependent on the age, solid foods. There should also be an active plan for monitoring the infant when they are playing or moving about. Solutions should be generated to encourage regular vaccines and wellchild visits.  Case Study 3: Part 3 The parents verbalize understanding about feeding and car seat safety. However, they continue to express concern over the vaccines. The nurse provides them with educational information about the vaccines and notifies the provider so that a discussion can continue before the end of the visit. Take Action (Implementation) Q What additional education about health promotion should the nurse include at the 6-month well-child visit? Enter your response and submit to compare to an expert response. Type your answer here. Submit If the infant does not have access to a car seat, the Department of Motor Vehicles can be contacted to help provide one or the hospital may have a reserve system that can provide one. Provide nutritional education, including when to start solid foods and the most appropriate way to start solid foods. Educate parents on the importance of back sleeping and a safe sleep environment for the infant. Provide vaccine education to the parents and encourage administration. Safe play and careful monitoring should also be implemented as the infant’s ability to be mobile might be underestimated, allowing for the opportunity for the infant to incur harm. Evaluate Outcomes (Evaluation) Q How should the nurse evaluate the outcomes of the education provided? Enter your response and submit to compare to an expert response. Type your answer here. https://pages-delivery.atitesting.com/s/1/o/2/a/5/p/1 第8/14⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:58 Submit An infant reaching 1 year of age without any adverse events related to health promotion represents an e#ective outcome evaluation. The infant’s safe care by their parents, which allows the infant to grow and develop appropriately, is essential in providing a healthy home environment. Evaluation of the promotion of health can also be noted by the overall health of the infant during the first year after birth and the preventable illnesses incurred. E#ective outcomes would indicate an infant who has been healthy without any preventable illnesses or any alterations in safety. Injury/Disease Prevention  Case Study 4: Part 1 The pediatric nurse is working in the emergency department (ED) when Mei, a 3-month-old infant, presents after being found unresponsive in the crib. The parents are at the bedside. Upon assessment, the vital signs were heart rate 84/min, respiratory rate 24/min, blood pressure 74/52 mm Hg, oxygen saturation 94% on room air, and temperature 36.2o C (97.2o F). The paramedics report the parents were able to easily resuscitate Mei with stimulation. The parents show a video of the infant’s bed, which reveals stu#ed animals, bumper pads, and extra blankets are present. Recognize Cues (Assessment) Q What other questions should the nurse ask about Mei's health history? Enter your response and submit to compare to an expert response. Type your answer here. Submit Assessment cues of injury and disease prevention include maintaining a safe care environment for the infant. When the infant develops failure to thrive, SUID, or feeding or sleep issues, the nurse can identify an abnormality based on the activity or assessment of the infant. However, to prevent injury and disease, the nurse must recognize the characteristics of dangerous situations, high risks for disease, and the overarching potential for poor outcomes for the infant. Analyze Cues (Analysis) Q What client assessment data is of immediate concern? Enter your response and submit to compare to an expert response. Type your answer here. https://pages-delivery.atitesting.com/s/1/o/2/a/5/p/1 第9/14⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:58 Submit Recognizing cues is essential in being able to analyze them. If the nurse has not noted the history and physical, then cues such as not meeting growth and developmental milestones may be overlooked. The nurse should also be able to determine if the infant is at high risk for SUID based on history and physical information. A previous history of a SUID and other risk factors can be used to analyze the potential for this infant to have a complication related to SUID. Also, pay close attention to other indicators of injury from the family and infant, such as bruises or inappropriate interaction. Analyze these cues and make determinations to promote the safety of the infant.  Case Study 4: Part 2 The infant’s vital signs are stabilized, and the infant is placed on a monitor. The nurse completes a health history on the infant and recognizes no significant risk factors for SUID or apnea. Prioritize Hypotheses (Analysis) Q What is the priority educational goal for this infant and her parents? Enter your response and submit to compare to an expert response. Type your answer here. Submit Prioritizing hypotheses is always conducted using Maslow’s hierarchy of needs, with safety at the base of all care provided to the infant. When discussing disease prevention, SUID is the biggest safety concern, as it can directly lead to the death of the infant. Sleep safety would be the next priority, as it is of utmost concern to the infant’s ability to awaken from naps and bedtime. Injury and disease prevention are centered around the concept of safety and the protection of the infant. Generate Solutions (Planning) Q What outcomes would be anticipated for Mei? Enter your response and submit to compare to an expert response. Type your answer here. Submit When generating solutions for the infant’s care, consider educational objectives for the parents that cover sleep safety, nutritional safety, and disease processes such as SUID. Discussing risk factors for SUID is essential in alerting the family to the potential for devastating outcomes. Discuss injury prevention in the home, including safety regarding the mobility of the infant, keeping chemicals and poisons up and away, and any other relevant education or anticipatory guidance.  Case Study 4: Part 3 Mei does not experience any further apneic spells and is not noted to have any further risk https://pages-delivery.atitesting.com/s/1/o/2/a/5/p/1 第10/14⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:58 Mei does not experience any further apneic spells and is not noted to have any further risk factors. The parents are anxious about taking Mei home. However, the nurse provides appropriate education to reassure them. Take Action (Implementation) Q How would the nurse best alleviate any anxieties for Mei's parents? Enter your response and submit to compare to an expert response. Type your answer here. Submit Begin by taking action and developing an educational plan for the family of the infant that includes all ways to prevent injury and disease, including car seats and vaccines. Prepare the family to prevent any adverse outcomes for this infant by developing a plan to teach about SUID and risk factors. Implementing education for parents provides preventative resources and increases positive outcomes. Evaluate Outcomes (Evaluation) Q How would the nurse know the education was successful? Enter your response and submit to compare to an expert response. Type your answer here. Submit Education of the parents has been successful if the infant is appropriately developing and growing and has not presented to the hospital for a preventable injury or disease during the first year. Evaluating outcomes for injury prevention also includes making sure the family unit is strong and without any adverse interactions, adverse communications, or abuse. Health Concerns  Case Study 5: Part 1 The nurse is caring for 4-month-old James, who has been breastfeeding since birth. The mother states, “I only give the baby breast milk. I haven’t started feeding solids yet.” James is in the 5th percentile on the WHO growth charts for weight and height. He was in the 50th percentile for weight and height for the first month of life and has been steadily dropping in the percentile groups on the growth charts. Recognize Cues (Assessment) Q What relevant information should the nurse ask? Enter your response and submit to compare to an expert response. https://pages-delivery.atitesting.com/s/1/o/2/a/5/p/1 第11/14⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:58 Type your answer here. Submit Obtaining a complete health history, specifically a sleep and feeding history is essential in being able to put the picture of the care of the infant together and verify concerns. The nutritional history will verify vitamin supplementation and the ability of the infant to take in the appropriate amount of fluids and calories daily. An aversion to a bottle or food will be indicated by the infant refusing to eat. Food sensitivity will be indicated if the infant has a reaction to a food trial. If the infant is not meeting growth parameters on the WHO growth charts or not meeting developmental milestones, there are potential health concerns. Analyze Cues (Analysis) Q What does it mean to be on the 5th percentile for weight and height? Enter your response and submit to compare to an expert response. Type your answer here. Submit Once cues are recognized, they must be analyzed for potential complications for the infant. Cues for failure to thrive, such as poor weight gain, will have to be evaluated to determine if this is a possible concern. If the infant develops hives or an anaphylactic reaction to food, then food sensitivity should be suspected. If the infant pushes away the bottle, breast, or food, then food or bottle aversion may be suspected. The infant’s weight, length, and head circumference should be plotted on the WHO growth charts to monitor for meeting growth milestones compared to other infants of the same age.  Case Study 5: Part 2 The mother reports she has not started vitamin D, iron, or a multivitamin for James because she believes that the breast milk is enough for him. She also states she pumps after every feed and gets 1 to 2 ounces of additional breast milk after James has eaten. She states she feeds James every 4 to 5 hours and lets him sleep 8 hours at night. Prioritize Hypotheses (Analysis) Q What is a priority concern for this client? Enter your response and submit to compare to an expert response. Type your answer here. Submit Establishing the priority hypotheses for an infant who has health concerns starts with the airway, breathing, and circulation and moves to Maslow’s https://pages-delivery.atitesting.com/s/1/o/2/a/5/p/1 第12/14⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:58 Establishing the priority hypotheses for an infant who has health concerns starts with the airway, breathing, and circulation and moves to Maslow’s hierarchy of needs with safety. Failure to thrive would be a priority concern for a client who has poor weight gain as many adverse outcomes are related to this disease process. Maintaining adequate nutrition, including appropriate vitamin supplementation, would be another priority in health concerns as the infant cannot obtain these vitamins on their own and would be lacking in essential nutrients for growth and development without the supplementation. Generate Solutions (Planning) Q What interventions would be appropriate for this client? Enter your response and submit to compare to an expert response. Type your answer here. Submit A plan should be developed for the infant who is experiencing failure to thrive, including increasing caloric intake and closely monitoring the WHO growth charts for continued weight gain and growth. Vitamin supplementation should be discussed for parents who are breastfeeding and methodology to decrease food or bottle aversion should be investigated. Continuing to monitor growth and development and possibly supplementing with formula if the infant is breastfeeding are possible solutions.  Case Study 5: Part 3 James is admitted to the pediatric unit at the hospital, and all lab work reveals failure to thrive. He will begin receiving vitamin D and a daily multivitamin. Calories will be increased in the breast milk to help with weight gain. The infant will be transferred in care to the hospital nursing sta#. Take Action (Implementation) Q What other areas of specialty should be consulted for collaborative care? Enter your response and submit to compare to an expert response. Type your answer here. Submit Vitamin supplementation, high-calorie formula, and nutrition supplementation are all possible actions to be implemented in treating an infant who has health concerns related to feeding. The use of sweet substances during feedings can help with food or bottle aversions and can have a positive impact on the infant’s ability to gain weight and develop appropriately. Implementing a set feeding schedule and administering vitamins daily can encourage a routine for the family that enhances the development of bonding and delivery of care. Health concerns can create a di$cult situation for the infant and family and should be addressed by the nurse in an empathetic and comforting manner. Allow parents to continue to provide as much care as possible and act as advocates for continued bonding and support. Evaluate Outcomes (Evaluation) Q What discharge criteria will be required for this client? Enter your response and submit to compare to an expert response. https://pages-delivery.atitesting.com/s/1/o/2/a/5/p/1 第13/14⻚ Engage Peds: Infants—1 Month to 1 Year 1/12/26 下午6:58 Type your answer here. Submit The infant’s outcomes when having health concerns are determined by the disease process and the ability of the infant to adapt to the treatment options. Also playing a role is the support of the family for the infant and for the infant’s parents. An infant who is growing and developing appropriately without missing any developmental milestones and continuing to gain weight, length, and head circumference can be evaluated as overcoming the obstacles. Evaluation of the infant often requires a regrouping and a new plan for care, as those with health concerns often are not better quickly and require long-term care. https://pages-delivery.atitesting.com/s/1/o/2/a/5/p/1 第14/14⻚ Engage Peds: Infants—1 Month to 1 Year During the first year of life, an infant rapidly grows physically, cognitively, and developmentally. This period of growth and development is characterized by navigating sleep schedules and meeting the needs of the infant while simultaneously watching the infant learn and develop from a completely dependent being into a walking and talking person. As the infant develops a personality, the family learns how to navigate the waters of being responsible for this new life. While most infants are healthy, some infants can encounter di!cult medical conditions, such as failure to thrive, sleep issues, and food sensitivities. It is the role of the nurse not only to assess and evaluate the care the infant is receiving, but also to educate the parent so they may provide the safest and most nurturing environment. 1/12/26 下午6:59 Credits Click to download this file. Legal Disclaimer Click to download this file. The infancy period of growth shows the most rapid changes in weight, height, and head circumference. An infant is expected to meet certain developmental milestones regarding gross and fine motor, psychosocial, cognitive, and language skills. Human interaction and play allow the development of cognitive skills and the expression of emotion and growth. Separation anxiety is an expected part of infant development for infants 6 months of age to 1 year and often resolves as the infant ages. A parent’s response to the needs of an infant solidifies the infant’s ability to trust and feel secure in their environment. Health promotion for an infant begins with a healthy full-term pregnancy; a nurturing, caring, and safe environment; and the best nutrition possible. While breastfeeding is best for an infant, formula and solid food after 6 months of age can provide the needed nutrients, calories, and vitamins for appropriate growth and development. Safe sleeping for an infant includes sleeping on their backs in their own bed with no loosefitting items in the crib, and the mattress should be firm and fit appropriately. SUID is one of the leading causes of death in infants 1 month to 12 months of age in the U.S. When an infant cannot obtain or use the needed calories, their growth and development can be a#ected, leading to failure to thrive (FTT). Introducing common foods that cause hypersensitivity before 1 year of age can decrease the incidence of food allergies or eczema. The history of the infant’s care is most appropriately obtained from the parent and requires asking specific and direct questions. Educating parents about sleep, eating, activity, growth and development, and safety is imperative in providing the best care for an infant. Use the clinical judgment guide to e#ectively implement therapeutic communication and education to encourage safe and appropriate care of the infant. https://pages-delivery.atitesting.com/s/1/o/5/a/1/p/1 第1/2⻚ Engage Peds: Infants—1 Month to 1 Year – – ! Lesson References × 1/12/26 下午6:59 ▶ https://pages-delivery.atitesting.com/s/1/o/5/a/1/p/1 第2/2⻚