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Health Problemsof Infants
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Nutritional Disorders
Vitamin imbalances:
Vitamin D deficiency rickets
Complementary and alternative medicine (CAM)
Review Table 11-1
Mineral imbalances Esp. iron, calcium, zinc, phosphorus, magnesium
Phytates, oxalates
Review Table 11-2
Vegetarian diets
Need to watch for deficiencies in protein, calories,vitamins, minerals
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Protein-Energy Malnutrition
Kwashiorkor deficiency of protein withadequate calorie supply; may result frominterplay of nutrient deprivation and infectious
or environmental stresses; causes thin,wasted extremities and prominent abdomenfrom edema (ascites)
Marasmus results from general malnutritionof both calories and protein; causes gradualwasting and atrophy of body tissue; childappears very old with loose, wrinkled skin
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Nursing Care Management
Initial nursing goal is identification of nutrientintake which requires assessment based on adietary history and physical exam for signs of
deficiency or excess. For PEM, prevention is key with focus on
parent education about feeding practices,especially during infancy
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Food Guide
FIG. 11-1 MyPyramid for Kids. (From Food and Nutrition Service, US Department ofAgriculture: MyPyramid for kids[FNS-381], Washington, DC, April 19, 2005, The
Service, available online at http://www.mypyramid.gov.)
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Food Sensitivity
Any type of reaction to food or food additives Two broad categories:
Food allergy or hypersensitivity -- ImmunoglobulinE (IgE)mediated immune response
Example: cows milk allergy
Food intolerance -- Non-IgEmediated immuneresponse
Example: lactose intolerance
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Clinical Manifestations
Systemic anaphylactic, failure to thrive(FTT)
Gastrointestinal abdominal pain, vomiting,
cramping, diarrhea Respiratory cough, wheezing, rhinitis,
infiltrates
Cutaneous urticaria, rash, atopic dermatitis
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Sensitization
The initial exposure of an individual to anallergen, resulting in an immune response
Subsequent exposure induces a much
stronger response that is clinically apparent Deaths have been reported in children who
suffered anaphylactic reaction to food
Onset usually rapid (5-30 min. after ingestion) Most reactions mimic an acute asthma attack
Other symptoms include cough, dyspnea,urticaria, cramps, V/D, shock, restlessness,
irritability, listlessness, unresponsivenessMosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
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Atopy
Allergy with a hereditary tendency Children who have one parent with allergy have a
50% or greater risk of developing allergy
Children who have both parents with allergy have
a 100% risk of developing allergy
Breastfeeding is now considered a primarystrategy for avoiding atopy in families withknown food sensitivities
BF mother encouraged to avoid foods such aspeanuts, tree nuts, fish, shellfish during first 6mths of BF
Epi-Pen!!!Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.
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Cows Milk Allergy Adverse systemic and local GI reactions to
cows milk protein
May be manifested as colic, V/D, GI bleeding,GER, chronic constipation, or sleeplessness in anotherwise healthy infant
Diagnostic tests include stool for heme,serum IgE levels, skin-prick/scratch testing,radioallergosorbent test (RAST)
Management includes prevent/reduceexposure of infants to cows milk protein,
formula change to hydrolyzed formula(Alimentum, Pregestimil, Nutramigen)
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Lactose Intolerance
Involves a deficiency of the enzyme lactase,which is needed for the hydrolysis ordigestion of lactose in the small intestine
Primary/Secondary/Developmental lactasedeficiency
Primary symptoms include abd pain, bloating,
flatulence, and diarrhea after ingestion oflactose
Treatment reduce/eliminate the offendingdairy product; probiotics; lactase tablets
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Feeding Difficulties
Regurgitation and spitting up Not to be confused with vomiting
Frequent burping and proper positioningduring/after feeding will help
R/O GERD if regurgitation is persistent Colic paroxysmal abd pain or cramping
manifested by loud crying and drawing legsup to abdomen
Multifactorial in nature; no single treatment will beeffective for every colicky infant
Most important intervention is reassurance!!!
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Colic Carry
FIG. 11-2 The colic carry may be comforting to an infant with colic. (Photo
by Paul Vincent Kuntz, Texas Childrens Hospital, Houston.)
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Failure To Thrive (FTT)
No universal definition although a commonparameter is weight that falls below the 5thpercentile for the childs age
Three general categories:
Organic result of physical cause (microcephaly,GER, congenital heart defect, etc.)
Nonorganic unrelated to disease; most oftenresult of psychosocial factors (deficiency in
maternal care, inadeq. nutritional info, separationissues
Idiopathic unexplained by the usual etiologies
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Nursing Care Management Four primary goals of nutritional mgmt;
Correct nutritional deficiencies and achieve idealweight for height
Allow for catch-up growth
Restore optimum body composition
Educate the parents regarding childs nutritional
requirements and appropriate feeding methods
Assess child, parents, and family interactions
Assess initial ht/wt and daily weights Consistent nursing care
Educate/reassure parents r/t feeding
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Positional Plagiocephaly
Since the infants sutures are not closed, the
skull is pliable and, when the infant is placedon the back to sleep, the posterior occiput
flattens over time; mild facial asymmetry maydevelop
Teach parents to alter infants head position
during sleep, place infant prone on firm
surface during awake time
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Disorders of Unknown Etiology Sudden infant death syndrome (SIDS)
Third leading cause of infant deaths Cause remains unknown
Back to Sleep campaign
Since 1992, incidence of SIDS in US decreased
by 53% to all-time low of 0.57 per 1000 live births
Risk factors for SIDS:
Maternal smoking
Poor prenatal care
Low maternal age
Prematurity
Prone sleeping, cosleeping, non-standard beds
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Nursing Care Management
Educate families about the risks of pronesleeping position in infants from birth to 6mths, use of appropriate bedding, dangers of
cosleeping Non-judgmental approach toward parents
who are grieving loss of child to SIDS
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Apnea and ALTEs
Apnea of infancy unexplained respiratorypause of 20 sec. or more, or pauses less than20 sec. accompanied by pallor, cyanosis,bradycardia, or hypotension in the term infant
ALTE event that is sudden and frighteningto the observer, in which the infant exhibite acombination of apnea, change in color,change in muscle tone, choking, gagging,
coughing, and which usually involves asignificant intervention and even CPR by thecaregiver who witnesses the event
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Treatment/Management
Usually involves continuous home monitoringof cardiopulmonary rhythms and, in somecases, the use of methylxanthines
(theophylline, caffeine) Education/support of family regarding use of
home monitoring systems and anxiety thatgoes along with them
CPR training for the family
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Apnea Monitoring
FIG. 11-5 Placement of electrodes or belt for apnea monitoring. In smallinfants, one fingerbreadth may be used.
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