health problems of infants

8/3/2019 Health Problems of Infants

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Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

Health Problemsof Infants


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2Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

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

methods, nutritional requirementsMosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.


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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.

health problems of infants

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