Menoufiya

University
Faculty of Nursing
Pediatric Nursing Department
PHD
2nd semester

Health promotion of the Infant and

Family

Prepared by:
C.I/ Doaa Abd El_Sattar Zayed
Pediatric Nursing Department

Under Supervision of:

Prof / Maha.I. Khalifa

Head of Pediatric Nursing Department

- 2014 -
 Outlines
 Introduction
 Nutrition
 Weaning
 Sleep and activity
 Dental health
 Immunizations
 Injury prevention
 Motor Vehicle Accidents
 Falls
 Suffocation or Choking
 Drowning
 Poisoning
 Scalds and Burns
 Bodily damage
 References
 Health promotion of the infant
 Introduction:
The infancy stage is the period from 1 month to 1 year or to advent walking.
It is the period of rapid growth and mental development. The infant growth
influenced by genetic, metabolic, environmental, and nutritional factors.
 Nutrition:
Despite adequate availability of optimum nutrient sources, some parent may
not feeding infants appropriately. Nurses must be proactive in teaching
parents about what constitutes appropriate infant nutrition and nutritional
habits that help the child to grow and develop into a healthy child and adult.
The first 6 Months:
 Human milk is the most desirable complete diet for the infant during
the first 6 months.
Kamar, 2010 stated that the benefit of breast feeding in reducing morbidity
and mortality of CIT, Respiratory infections and sudden infant death
.syndronte in preterm infants
 It is recommended that all infants receive a daily supplement of 200
IU of vitamin D beginning in the first 2 months of life to prevent
rickets and vitamin D deficiency.
 Infants who are breast-or bottle-feeding don't require additional
fluids, specially water or juice, during the first 4 months of life.
Excessive intake of water in infants may result in failure to thrive and
hyponatremia.
  An acceptable alternative to breast-feeding is commercial iron-
fortified formula. Pasteurized whole cow's milk is deficient in iron,
zinc, and vitamin C
 Employed mothers can continue breast-feeding by using expressed
breast milk, it may be stored in refrigerator (40 c) without danger of
bacterial contamination for up to 5 days, and may be frozen for up to
12 months. Expressed breast-milk shouldn't be rewarmed in
microwave.
 The addition of solid foods before 4 to 6 months of age is not
recommended to avoid protein allergy and the incompatibility of
solid foods with the ability of the GIT and the infant's nutritional
needs.
Koplin et al., 2010 suggested that introduction of cooked egg at 4to 6 months of
.age might protect against egg allergy
The second 6 Months:
 During the second half of the first year human milk or formula
continues to be the primary source of nutrition.
Selection and preparation of solid foods:
 The solid food is to supply nutrients not found in formula or breast
milk.
 Rice is usually suggested as an initial food because of its easy
digestibility and low allergenic potential.
 New foods should be added one at a time; therefore parents should
avoid cereal combination when beginning a new grain.
 Infant cereal may be mixed with formula until whole milk is given or
mixed with expressed milk or water.
 Fruit juice can be offered a cup for its rich source of vitamin C and as
substitute for milk for one feeding a day. Some fruit juices should be
 avoided as apple, pear, and grape because it causes gastrointestinal
distress.
 Avoid heating to prevent vitamin C loss.
 Only one solid is introduced every 5 to 7 days so that a reaction to a
particular food can be known, the food sequence is fruits followed by
vegetables, and finally meat.
 Fruits and vegetables can be steamed in a small amount of water and
pureed in food processor.
 Weaning
The term weaning means the introduction of semisolid and solid foods 
to the infant gradually until he is accustomed to the regular family
.diet
 Weaning should be gradual by replacing one bottle-or breast-feeding
at a time. The nighttime feeding is usually the last feeding to be
discontinued.
 If breast-feeding is terminated before 5 or 6 months of age, weaning
should be to a bottle to provide for the infant's continued sucking
needs.
 If breast-feeding discontinued later, weaning can be directly to a cup,
especially by age 12 to 14 months.
 Any liquid containing sucrose or other sugars should be given in a
cup.
 Sleep and activity:
 Sleep patterns vary among infants. By 3 to 4 months of age most
infants have developed a nocturnal pattern of sleep that lasts from 9 to
11 hours, the total day sleep is 15 hours.
 The number of naps per day varies, but the infant may take 1 to 2 naps
by the end of the first year.
  Daytime naps usually decline during the toddler years to no daytime
naps by the preschool age.
 Breast-fed infants usually sleep for shorter periods, with more frequent
waking especially during the night than bottle-fed infants.
 Dental health:
 Good dental hygiene begins with appropriate maternal dental health
and counseling during early infancy regarding dietary intake for the
promotion of optimum oral hygiene.
 Once the primary teeth erupt, cleaning should begin by wiping the
gum and teeth with a damp cloth.
 Toothbrush is too harsh for the render gingiva.
 Fluoride is an essential mineral for building caries-resistant teeth;
needed beginning at 6 months of age if infant doesn't receive water
with adequate fluoride content.
 Dietary considerations are also important; foods with concentrated
sugar are used sparingly in the infant's diet, avoid using candy pacifier.
Arrow et al., 2013 stated that an early oral health promotion intervention
through the use of brief motivational interviewing (MI) and anticipatory
guidance (AG) approaches can reduce the incidence of early childhood
dental decay and obesity.
 Immunizations:
 Immunization is the process of inducing or providing active or passive
immunity artificially by administering an immunobiologic.
Immunization schedule:
Age Disease Vaccine Dose & Site
At Hebatitis B HBV 0.5ml IM
Birth

2 Diphtheria, tetanus, pertussis "whooping cough") DTaP 0.5ml IM,

months polio IPV 0.5ml IM,
Haemophilus influenza type b Hib 0.5ml IM or SC
 Pneumococcal disease PCV 0.5ml IM
Rotavirus Rotavirus (Rotarix) 1.0 ml oral
Hebatitis B HBV 0.5ml IM
Diphtheria, tetanus, pertussis whooping cough) DTaP 0.5ml IM,
4 polio IPV 0.5ml IM,
months Haemophilus influenza type b (Hib ) Hib 0.5ml IM or SC
Pneumococcal disease PCV 0.5ml IM
Rotavirus Rotavirus (Rotarix) 1.0 ml oral
Diphtheria, tetanus, pertussis "whooping cough") DTaP 0.5ml IM,
6 polio IPV 0.5ml IM,
months Haemophilus influenza type b Hib 0.5ml IM or SC
Pneumococcal disease PCV 0.5ml IM
Rotavirus Rotavirus (Rotarix) 1.0 ml oral
Measles, Mumbus, Rubella MMR, 0.5ml SC
chickenpox varicella, 0.5ml SC,
12-15 polio IPV 0.5ml IM
months Pneumococcal disease PCV, 0.5ml IM
Haemophilus influenza type b (Hib ) Hib 0.5ml IM or SC
Hebatitis A HAV 0.5ml IM

Diphtheria, tetanus, pertussis" whooping Cough") DTaP 0.5ml IM

Hebatitis B HBV 0.5ml IM
18
Hebatitis A HAV 0.5ml IM
months
Influenza Influ 0.25 mL IM

Possible Side Effects of Recommended Childhood Immunization

 Soreness, redness & swellening at the injection site
 Behavioral change :drowsiness , anorexia ,prolonged or unusual
crying, loss of consciousness , convulsion for pertusis
 Low grade fever
 Anorexia, malaise, rash & fever 7-10 days after immunization and
encephalitis may occur for measles
 Fever, lymphadenopathy or mild rash 1-2days , arthralgia ,arthritis, or
parasthesia of hands & fingers 2 weeks after immunization
Frunesca et al., 2010 stated that MMR vaccination is known to cause
serious adverse events as fever, rash, gland inflammation and neurologic
disorders. These include third and sixth cranial nerve palsies.

Nursing Responsibilities
  Explain to parents reason for immunization
 Advise parents of possible side effects & use of antipyretics for fever.
 Check with the doctor to see if you can give either medication, and to
find out the appropriate dose.
 Warm cloth or heating pad may also help to reduce soreness.
 Moving the limp that has received the injection often reduces the
soreness
 Use acetaminophen for pain. (acetaminophen is recommended for
prophylactic use and every 4-6 hrs)
 Injury
The Major Causes of Injury
 Scalds and Burns  Falls
 Motor Vehicle  Suffocation or
Accidents Choking
 Drawing  Poisoning
Falls prevention:
 Never leave infants on a raised surface such as a
changing table or a counter top unattended.
 Always pull the crib side all the way up when
children are in the crib. 
 Don't allow children to play on balconies
unsupervised
 Cover all sharp furniture edges.
 Make sure all play areas are free of falling hazards
such as deep holes and glass
 Avoid walkers especially near stairs.
 Dress infant in safe shoes and clothing.
 Erkarl, 2010 shown that 37.9% of the 0-6 age group
children had had
ahome accident with fall the most common 75.4%.
Motor Vehicle Accidents
 Always restrain children in automobile safety seats.
 Make sure infants are placed in safety seats facing
rearward instead of forward.
 Make sure the seat belts used to secure children
into the safety seats are tight enough.
 Never leave a stroller behind a parked car.
Numann et al., 2010 stated that injuries ( Motor Vehicle
Accidents)
need to implement evidence-based, cost effective
strategies that target
increasing seat belt use, increasing childhood safety seat
use, increasing motor cyclist and pedal cyclist helmet
use and decreasing
alcohol- impaired driving available.
Aspiration, Suffocation or Choking
 Do not cover mattresses or pillows with plastic.
 Store all plastic bags out of reach.
 Use baby powder cautiously. It can be dangerous if
large amounts are inhaled.
 After meals, remove bibs before taking children out
of their high chairs.
 Never pin or tie pacifiers to children. The strings
can easily wrap around children's necks.
 Never leave infants unsupervised near water.
  Keep the doors to all household appliances shut at
all times.
 As soon as children are old enough to crawl, make
sure the floor of the home and any area that is
within children's reach is free of small objects that
can fit into children's mouths.
 Don't feed infant while he is lying.
 Take an infant/child CPR course.
Poisoning
 Keep all toxic materials, including household
cleaners, medications, and chemicals out of the
reach of children.
 Throw out all medication, household cleaners, and
other toxic substances that have not been used.
 When giving medication to a child, avoid calling it
candy or making a game of it.
 Never store chemicals or cleaners in food
containers.
 Make sure that all paint in the home is lead free.
 Many house plants are poisonous. Keep them out of
the reach of children.
Scalds and Burns
 Keep children away from all hot appliances as
stoves, portable heaters.
 Do not leave cups of hot liquid (coffee, tea, soup)
within the reach of children.
 Never carry children while pouring or carrying a
cup of hot liquid.
  Always check the temperature of bath water before
bathing children.
 Make sure all matches and cigarette lighters are
kept out of the reach of children.
Drowning:
 Infants should always be supervised in a bath-tub.
 Keep bathroom door closed.
 Tub should be emptied completely after each use.
 Children shouldn't be left unattended in tub bath.
Bodily damage
 Avoid giving sharp object as scissors or knife
especially when walking or running.
 Store all dangerous tools, garden equipment out of
reach.
 Be alert to danger of animal including household
pets.
 Play equipment should be kept in safe condition.

Reference

 Hockenberry.M.J, Wong's Nursing Care of Infants

and Children (2007), eighth edition, Mosby, New

 York, p.p (525-561)

 http://www.parenting-ed.org/
 Arrow, P., Raheb, J.& Mille, M. (2013). Brief oral health
promotion intervention among parents of young children to
reduce early childhood dental decay. BMC Public Health
2013, 13:245 doi:10.1186/1471-2458-13-245. Retrived from
BMC Public Health 2013, 13:245 doi:10.1186/1471-2458-
13-245 at 15/11/2014.
 http://www.cdc.gov/mmwr/preview/mmwrhtml/
mm5751a5.htm at 16/11/2014.