Presented By, Candice Sullivan, Erica Cockrell, & Deirdre Arroyo (Nurse Practitioner) (Counselor) (Nurse Practitioner)

Objectives and Overview

To work as a cohesive team with members of different

professions.
To provide information to our classmates on the health

maintenance of the infant up to the age of two years.

To develop screening tools to assess infant health, both

physically and neurologically.

To provide information for parents and the public at large

on community resources and the referral process.

Implications for Health Promotion

Working with multiple disciplines.
Social, family and developmental issues. Employing approaches to infant health promotion that

can be used universally.

Working with families as a unit.

Assessment: Growth
Assessing growth in children is important in monitoring health status. Detection of poor growth in childhood allows for early intervention for adverse consequences including: poor cognition and educational performance, low adult wages, lost productivity and, when accompanied by excessive weight gain later in childhood, increased risk of nutrition related diseases Below are links to the World Health Organization standards for physical growth in children 0-2yrs. Length/height for age - Girls 0-2yrs Length/height for age - Boys 0-2yrs Weight for age - Girls 0-2yrs Weight for age - Boys 0-2yrs Head circumference - Girls 0-2yrs Head circumference - Boys 0-2yrs
WHO. (2014). World Health Organization. Child Growth Standards. Retrieved February 05, 2014, from http://www.who.int/childgrowth/standards/motor_milestones/en/index.html (Onis,M., Onyango, A., Borghi, E., Siyam, A., Blossner, M., & Lutter, C. (2012). Worldwide implementation of WHO growth standards. Public Health Nutrition, 2, 1-8.

Assessment: Gross Motor Development

Activity Sitting without support Standing with assistance Crawling Walking with assistance Standing alone Walking alone

Age
4 to 9 months 5 to 11.5 months 5 to 13.5 months 6 to 13.5 months 7 to 16.5 months 8 to 17.5 months

WHO. (2014). World Health Organization. Motor Development Milestones. Retrieved February 05, 2014, from, http://www.who.int/childgrowth/standards/motor_milestones/en/index.html

Assessment: Cognitive Development

Language develops: Crying (begins at birth) Cooing (begins 1-2mos) Babbling (begins 6mos) Gestures (begins 8-12mos) First words (begins 13mos) Piagets six sub-stages of infant development 1. reflexive activity 2. primary circular reactions 3. secondary circular reactions 4. coordination of secondary schemes 5. tertiary circular reactions 6. beginning of representational thought.

Oswalt, A. (2014). Infancy Cognitive Development, in Seven Counties Services Inc., Retrieved on February 5, 2014, from, http://www.sevencounties.org/poc/view_doc.php?type=doc&id=10113&cn=461

General Assessment
Posterior fontanelle closes by 2-3mos
Anterior fontanelle closes by 18mos Reflexes present: Babinski, blinking, grasping, moro,

rooting, sucking, stepping, swimming, tonic neck Vital signs (normal for age 1mos-1yr)
Heart rate 80-160bpm BP 95/58 Temperature 97-99 degrees

Hearing and Eyesight development within normal range for

age.
National Institutes of Health. (2014). Medline Plus, in NIH. Retrieved on February 5, 2014, from, http://www.nlm.nih.gov/medlineplus.

Video on Infant Health Maintenance

Screening Tool Ideas

The Rourke Baby Record (RBR) is an evidence-based tool for

practitioners of children in early life. The RBR has guidelines for well baby care including:

growth and nutrition monitoring developmental surveillance physical examination parameters Immunizations anticipatory guidance on safety, family, behavior and health promotion issues

The RBR encourages a team approach to care with implications

for Nursing, Counseling, Nutrition & Dental care. The screening tool has guidelines for ages 0-5yrs. The Rourke Baby Record

Rourke, L. (2011). Rourke Baby Record. Evidence-Based Infant/Child Health Maintenance Guide. Retrieved on February 5, 2014, from, http://www.rourkebabyrecord.ca/

Screening Tool

Screening History Questions???

How often does your infant eat? What is your infant eating?

When does your infant sleep and for how long?

Is your infant meeting age appropriate goals? How well does your infant socialize? As a new parent, do you have any concerns? What kind of support network do you have at home?

Physical Tests
In order to track appropriate growth and development

during the first two years of life, several physical tests are used to measure expected motor and cognitive milestones. These include:1. Length and Weight 2. Head Circumference 3. Hearing Tests and Visual Screening 4. Emotional Development and Attachment 5. Heart screening 6. Blood Tests Hemoglobin, hematocrit, phenylketonuria

Psychological Tests
Ages and Stages: Social-Emotional
Brief Infant Toddler Social Emotional Assessment Carey Temperament Scales Greenspan Social-Emotional Growth Chart

Temperament and Atypical Behavior Scale

Grant, R., Gracy, D. & Benito, A. Developmental and social-emotional screening instruments for use in pediatric primary care in infants and young children. Retrieved from http://www.childrenshealthfund.org/sites/default/files/dev-andmental-health-primary-care-screening-tools.pdf

Psychological Findings
Infant Mental Health includes:
Emotions Relationships

Exploration

Proper environment and interaction are key Important to look at both the parents and the

infant
Nelson, F. & Mann, T. (2011). Opportunities in public policy to support infant and early childhood mental health: The role of psychologists and policymakers. American Psychologist, 66(2), 129-139. doi: 10.1037/a0021314

Important Psychological Issues

Mental health problems CAN be present even in infancy!
Attachment is important to look at for signs of mental health

issues Poor attachment Sleeping/feeding problems Over/under-response to environment Parental risk factors can also be indicators of the presence or high potential of infant mental health problems
Kelty Mental Health Resource Centre. Infant mental health. Retrieved from http://kelty mentalhealth.ca/ mental-health/disorders/infant-mental-health#view-tab-2

Incidence of Infant Health Problems

Infant mortality rate 6.15 deaths per 1000 live births The top 5 causes of infant deaths in 2010 (57% of all

infant deaths)
birth defects (5,819)

Heart defects Orofacial Defects Spina Bifida

low birth weight and prematurity (4,841) SIDS [Sudden Infant Death Syndrome (2,323)

maternal complications (1,683)

accidents/unintentional injuries (1,147)
Centers for Disease Control. (2014). CDC features, Retrieved on February 5, 2014, from http://www.cdc.gov/features.

Impact of Ethnicity
American Indian / Alaskan Native: The effects of poverty, inadequate education, discrimination in the delivery of health care services, and cultural differences among American Indians have led to: lower life expectancies poorer living conditions reduced general health of infants lower potential well-being throughout life.
The pre-term birth rate is 13.6% Infant mortality rate is 8.5/1000 live births
CDC (2013). Infant mortality statistics from the 2009 period linked birth/infant death data set. National Vital Statistics Reports. Retrieved February 9th, 2014 from http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_08.pdf

Impact of Ethnicity
Hispanic: Pre-term birth rate is 11.8% Infant mortality rate ranges from 4.5 to 7.2/1000 live births Hispanic children have been found to be at risk for low cognitive achievement. Low socio-economic status and language barriers put this population at greater risk for poor health care and adverse health outcomes.

CDC (2013). Infant mortality statistics from the 2009 period linked birth/infant death data set. National Vital Statistics Reports. Retrieved February 9th, 2014 from http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_08.pdf

Impact of Ethnicity cont.

African American: Pre-term birth rate is 17.1% Infant mortality rate is 13.9% Non-Hispanic black children are twice as likely to be small for gestational age (SGA) compared to their white counterparts. These infants have the highest likelihood of experiencing chronic conditions and diminished health potential. Poverty and low birth weight among this population are leading causes of low educational achievement and developmental delay.
Nepomnyaschy, L. (2009). Scoioeconomic gradients in infant health across race and ethnicity. Maternal Child Health Journal. 13:720-731 Ngozi, A. (2006). Racial and ethnic disparities in infant and maternal mortality. Ethnicity and Disease. 16:71-76

Community Resources

Mobile Health Centers HealthyChildren.org Women, Infants and Children (WIC) program Baby Care Program of VA Department of health Family Planning Programs Community Vaccination Programs Bright Smiles For Babies

United States Department of Agriculture. (2014). Women, Infants, and Children (WIC). Retrieved on February 8, 2014, from, http://www.fns.usda.gov/wic/women-infants-and-children-wic. Virginia Department of Health. (2013). Baby Care Program. In Community Resources, Retrieved on February 8, 2014, from, https://www.vdh.virginia.gov/lhd/portsmouth/Community.htm.

The Referral Process

Identification of special needs
Listen carefully to parental concerns

Be knowledgeable about specialists in the surrounding area

Work in collaboration with other specialties

Provide continuity of care throughout childhood and into

adulthood

References Cont.
Oswalt, A. (2014). Infancy Cognitive Development, in Seven Counties Services Inc., Retrieved on February 5, 2014, from, http://www.sevencounties.org/poc/view_doc.php?type=doc&id=10113&cn=461 Rourke, L. (2011). Rourke Baby Record. Evidence-Based Infant/Child Health Maintanence Guide. Retrieved on February 5, 2014, from, http://www.rourkebabyrecord.ca/ United States Department of Agriculture. (2014). Women, Infants, and Children (WIC). Retrieved on February 8, 2014, from, http://www.fns.usda.gov/wic/women-infants-and-children-wic. Virginia Department of Health. (2013). Baby Care Program. In Community Resources, Retrieved on February 8, 2014, from, https://www.vdh.virginia.gov/lhd/portsmouth/Community.htm WHO. (2014). World Health Organization. Child Growth Standards. Retrieved February 05, 2014, from http://www.who.int/childgrowth/standards/motor_milestones/en/index.html WHO. (2014). World Health Organization. Motor Development Milestones. Retrieved February 05, 2014, from, http://www.who.int/childgrowth/standards/motor_milestones/en/index.html