Health Promotion and

Maintenance- Infants
through Adolescence
N380 Fall 2019
  Health maintenance-activities that
preserve an individual’s present state of
health and that prevent disease or injury
occurrence.

 Health supervision (in children)-provision

of services that focus on disease and
injury prevention, growth and
developmental surveillance, and health
promotion at key intervals during the
child’s life.
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 Begins during hospital stay/birthing center
Newborn usually seen at about age 5 days
Support health of infant and family unit
Newborns/Infants Assess protective factors
Assess risk factors
Growth and development
Physical assessment
Nutrition

Assess current eating patterns

requires 110-115kcal/kg/day. 50% comes from fats
Birth-1 month infants feed about q 2-3 hours (2-3 oz)
2-4 months- feed q 3-4 hours (3-4 oz)
By age 12 months baby usually taking 6-8 oz each feed
Physical activity
 Allow time to kick legs, practice
head control, reach for objects
 Supervise play on stomach

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Oral health
 Wipe gums
 No feeding while sleeping
 no at will bottles during the day
 First teeth at 6 months
 Discuss teething pain
 1st trip to dentist at 6 months of age
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Mental/spiritual Evaluate growth
Observe
parent/child
Stranger
anxiety/separatio
health interaction n anxiety
  14-18 hours/day until age 6
months; then 12-13 hours/day
with naps
 Night awakenings
common/variable
Sleep  Assess infant’s ability to self-
soothe
 Establish routine
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  Metabolic screening
 Hearing screening
 Immunizations
Disease  Minimizing exposure to smoke
prevention  Minimizing exposure to disease
 Hand hygiene
 Safe sleeping
  Car seat safety
 Falls
 Burns
Injury  Chocking
prevention  Drowning
 Suffocation
 Shaken baby syndrome
  When to call provider
 Axillary temp over 99.3
 Seizure
 Rash- petechiae, pupura
 Unusual irritability/lethargy
Other concerns  Refuses to eat
 Vomiting/diarrhea
 Dehydration
 cough

 colic- when a baby cries and fuss out

Toddlers

 Health visits at 12, 15, 18, 24 and 30 months then ages 3, 4, and 5 years
 Measure growth
 Child able to stand for height
 BMI at age 2 years
 Head circumference until age 2 years

 Screening for BP, Vision and Hearing, and autism

nutrition
 Support breastfeeding mom
 Wean from bottle by age 1 year
 Cow’s milk after age 1 year (use whole milk)
 Toddlers need 16-24 oz milk/day (no more than that)
 Limit fruit juice to 4-6 oz/day
 Food jags normal (picky eaters)
 “500 mg calcium a day” = “5 a day”

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  Physical activity
 Play more social
 60 min unstructured play
daily
Physical  60 min structured play daily
Activity  Max 60 min sedentary
behavior at any one time
(except sleep of course!)
Oral health
 Discontinue pacifier
 Discourage thumb sucking by
age 4 years.
 Brush teeth (toothpaste ok)
 Limit sweets
 Regular dental visits
 • Maintain/establish routine
Sleeping • Advise against co-sleeping
• Nightmares vs night terrors

Spiritual/mental Non-social • Temper tantrums

health behaviors • Hitting and biting

• Distraction
Discipline • Time out
• Consistency!!
  Immunizations (catch-up if
needed)
 Car seat safety
 Falls
Disease/injury  Poisoning
prevention  Bruns
 Drowning
 MVA (car and pedestrian)
 Risks at other homes
Potty training
Lots of variability
Establish readiness
Use potty chair regular intervals
Positive reinforcement
If unsuccessful wait and try again later
Not predictive of future development
Hospitalization may cause regression

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 Preschoolers and
School age
 Most kids are relatively healthy
 Lots of minor injuries
 Provider visits sporadic but
recommended yearly
 Some screening done by school nurses
 Lipid screening at age 10 years

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Nutrition/physical
activity
 Kids making own food choices
 Influenced by friends and media
 Limit fast food
 Forming habits that last a lifetime
 Starting organized sports-safety gear!
 60 minutes/day exercise
 Limit screen time to 2 hours/day

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Author
Photo
is licensed
by Unknown
under
Author
CC BY-SA
is licensed under CC BY
 Lose first baby tooth at age 6

All 20 teeth will be lost during school age years

Regular dentist appts.

Oral health Ask about sealants

Observe for malocclusion

Orthodontia

Dental injuries
 Self- esteem Sexuality

 school age child developing

sexuality
Mental/spiritua  Answer ? Honestly
 Some education in grade 4
l Health
 Books should be available in
the home
 Encourage parents to discuss
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Unknown Author is inappropriate touching
licensed under CC
BY-SA
Disease/injury prevention

 Catch up on immunizations. HPV series at age 9. Meningococcal at age 11

 Ask about medications child takes routinely
 Many injuries preventable with protective gear
 Car seat safety- booster seat in back. Lap/shoulder belt ok if it fits snugly. Best to
keep kids in backseat until age 13.
 Other hazards- firearms, burns (teach stop, drop and roll), assault
Adolescents
 Health care visits sporadic (still
recommended annually)
 Growth measurement still important
 Scoliosis screening
 Breast/testicular exam
 Testing for STI (if sexually active)
 Pelvic exam and pap smear for
sexually active females
nutrition

 Need 2,000 kcals/day to support growth

 most teens don’t eat well
 Eating disorders may develop
 Assess diet- vegetarianism, supplements
 Pregnant or breastfeeding teens have special dietary needs
  Mental health screening important
 Identify risks- changes in weight, mood, or school
performance. Increased physical complaints, or
thoughts of suicide.
 Encourage questions
Spiritual/mental  Assess need for contraception, discuss STI
health  Offer support if teen is confused about sexuality
 If gay, encourage conversation about safe sexual
practices.
 Teens still need/want guidance from parents
 Need rules that are consistently reinforced!!
Typically healthy Health issues Disease
Acne prevention
Body piercing
Tattoos
Sleep deprivation
Overuse injuries
 Injury prevention
 MVA and other motorized vehicles
 Firearms
 Drowning
 Sun exposure
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 Abuse
QUESTIONS?