Health Problems of Infants

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Nutritional Disorders

Vitamin imbalances:

Vitamin D deficiency rickets Complementary and alternative medicine (CAM) Review Table 11-1 Esp. iron, calcium, zinc, phosphorus, magnesium Phytates, oxalates Review Table 11-2 Need to watch for deficiencies in protein, calories, vitamins, minerals
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Mineral imbalances

Vegetarian diets

Protein-Energy Malnutrition

Kwashiorkor deficiency of protein with adequate calorie supply; may result from interplay of nutrient deprivation and infectious or environmental stresses; causes thin, wasted extremities and prominent abdomen from edema (ascites) Marasmus results from general malnutrition of both calories and protein; causes gradual wasting and atrophy of body tissue; child appears very old with loose, wrinkled skin
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Nursing Care Management

Initial nursing goal is identification of nutrient intake which requires assessment based on a dietary 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 of Agriculture: 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 -- Immunoglobulin E (IgE)mediated immune response Example: cows milk allergy Food intolerance -- Non-IgEmediated immune response 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 an allergen, 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, unresponsiveness
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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 primary strategy for avoiding atopy in families with known food sensitivities

BF mother encouraged to avoid foods such as peanuts, tree nuts, fish, shellfish during first 6 mths of BF
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Epi-Pen!!!

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 an otherwise healthy infant

Diagnostic tests include stool for heme, serum IgE levels, skin-prick/scratch testing, radioallergosorbent test (RAST) Management includes prevent/reduce exposure 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 or digestion of lactose in the small intestine Primary/Secondary/Developmental lactase deficiency Primary symptoms include abd pain, bloating, flatulence, and diarrhea after ingestion of lactose Treatment reduce/eliminate the offending dairy product; probiotics; lactase tablets
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Feeding Difficulties

Regurgitation and spitting up

Not to be confused with vomiting Frequent burping and proper positioning during/after feeding will help R/O GERD if regurgitation is persistent

Colic paroxysmal abd pain or cramping manifested by loud crying and drawing legs up to abdomen

Multifactorial in nature; no single treatment will be effective 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 common parameter is weight that falls below the 5th percentile for the childs age Three general categories:

Organic result of physical cause (microcephaly, GER, congenital heart defect, etc.) Nonorganic unrelated to disease; most often result of psychosocial factors (deficiency in maternal care, inadeq. nutritional info, separation issues Idiopathic unexplained by the usual etiologies

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Nursing Care Management

Four primary goals of nutritional mgmt;

Correct nutritional deficiencies and achieve ideal weight 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 requirements
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Positional Plagiocephaly

Since the infants sutures are not closed, the skull is pliable and, when the infant is placed on the back to sleep, the posterior occiput flattens over time; mild facial asymmetry may develop 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 Since 1992, incidence of SIDS in US decreased by 53% to all-time low of 0.57 per 1000 live births

Back to Sleep campaign

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 prone sleeping position in infants from birth to 6 mths, 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 respiratory pause of 20 sec. or more, or pauses less than 20 sec. accompanied by pallor, cyanosis, bradycardia, or hypotension in the term infant ALTE event that is sudden and frightening to the observer, in which the infant exhibite a combination of apnea, change in color, change in muscle tone, choking, gagging, coughing, and which usually involves a significant intervention and even CPR by the caregiver who witnesses the event
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Treatment/Management

Usually involves continuous home monitoring of cardiopulmonary rhythms and, in some cases, the use of methylxanthines (theophylline, caffeine) Education/support of family regarding use of home monitoring systems and anxiety that goes 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 small infants, one fingerbreadth may be used.

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