Breastmilk Nutrition and Infant Development
Breastmilk Nutrition: Benefits and Production
Reduce infection, antibodies immunity (IgA), protect against allergies, asthma, SIDS, skin-to-skin, taste introduction, and digestible (less gas) – recommended until 6 months or iron formula, vitamin D supplements, 2x living cells as blood, avoid if chemo, TB, HIV, herpes. Milk production: prolactin due to suckling and oxytocin. Colostrum: clear yellow, more concentrated with immunity and nutrients, less fat. Assess/implement latch, audible swallow, nipple, comfort and hold, latch-on, milk, frequency, and duration of feeds.
Mother’s Health and Formula Feeding
Mother: 350-500 extra calories, more water, weight loss, exercise, rest, breast care (comfort, mastitis, plugged ducts). Formula: boiled water until 4 months, supplements.
Pediatric Hospital Stressors and Vitals
Pediatric Hospital Stressors: separation anxiety, loss of control, pain, injury, no coping/expression. Admission/History: vitals, current meds, lifestyle, home life, fears, routine. Separation Anxiety – outcome: child relates to staff and routine appropriately for their age and development stage, implementation: promote visits. Assent: patient informed and gives permission. Peds vitals: P 70-120, BP 90/65, R 24-30, T 35.5-37.5.
Common Childhood Illnesses and Developmental Stages
RSV Human respiratory syncytial virus – wheeze, mucus cough, respiratory distress, contagious and life-threatening, winter, prevention: handwash, no kisses, away from public, wash toys, environment, limit exposure to other kids, avoid smoke. Kawasaki Disease inflammation of vessels, fever for days, rash, swollen neck glands, hands, feet, red eyes, lips, and tongue. Asthma – cough (especially at night), wheeze, shortness of breath, related to cold, accessory muscles to breathe, sits up, inhaled corticosteroids (flovent), theophylline, leukotriene modifiers (singulair).
Childhood Development Theories
Freud – 1st theory of personality development, observed mentally disturbed adults but did not focus on wellness, blames sexual instinct. Erikson Psychosocial development (importance of culture and society, social view of self is more driving than instinct; optimistic view of human growth). Piaget: cognitive development (how learn and think, 4 stages, criticized for small sample using own kids, possibly outdated due to current norms). Kohlberg – moral development: right or wrong, rules; Preconventional (2-3y) punishment-avoidance and obedience – would do it if they knew they wouldn’t get caught; self-interest (4-7) exchange of favors, others have needs but prioritize self. Conventional (7-10) orientation; follow rules for good person, considers pleasing others and keep interpersonal relationships (10-12) maintain social order, fixed rules. Postconventional (12+) rules are social agreements that can be changed, inner conscience.
Newborn and Infant Care
Neonate = <28 days, infant 1m-1y, toddler 1-3y, preschool 3-5y, school-aged 6-12y. First period of reactivity: 30 mins. HR 160-180, Resp. 60-80, decreased motor. Second reactivity (4-8h after, 10min-hours, tachycardia and tachypnea, meconium, muscle tone, change in skin color, mucus). Physiological adaptations 30-60 resp/min, HR 80-90 asleep, 170 awake, 180 crying, BP 80/50 or lower. Thermogenesis, 2-6 pees day 1-2, 6 pees day with hydration, 5-10% weight loss first days. Jaundice: abnormal in 24hrs or >7days. Coagulation: Vit K for clot due to lack in sterile newborn gut. Immunity: passive from mom. Mongolian: blue butt. Cephalhematoma: blood under scalp. Sub. hem. blood under galea. Cap succ. edema under scalp. Skeletal: cartilage > os. Newborn assess: appearance, vitals, baseline weight and head size for growth, neuro 0-2h after birth: airway and temp maintenance, eye prophylaxis, vit K. 2hrs after: gestational age (neuro). Preterm: Resp. distress. Temp instability, hypoglycemia, apnea, feeding diff, jaundice. Labs blood glucose, bilirubin, CCHD, handwash, ID bracelets. Discharge education, circumcision. Discharge: temp, resp. feeding schedule, elimination, safety, rash, clothes. SIDS prevention: supine, smoke free, safe crib, room share 6m, soother, supervised tummy time, no side lay, car seat, purple crying, bathing, umbilical care, clamp removed when dry (24hr-23h). Follow-up: 2-3 days jaundice, feed, elim, 1-3-5-7m Then q 3 months til 18 months.