Infant Care and Feeding

Philippine Midwifery Licensure Examination

Infant Care
and Feeding
Philippine Midwifery Licensure Examination
Infant Care and Feeding
Philippine Midwifery Licensure Examination

GROWTH & DEVELOPMENT  Environment as bases for growth &

Growth Development development
o Tabula Rasa
Body Skills
 by John Dewey
 A child is a blank sheet, and its growth &
development is influenced by “teachers”.
Measurable Observable
 Infant and children learn by doing and
observing, with the most effective being learning
Anthropometrics
(Ht., wt.,
circumference)
Qualitative Stage by doing.

Quantitative
"Maturation"
Change

PRINCIPLES OF GROWTH & DEVELOPMENT

TIME
 Starts at fertilization/conception
o Sequence: Ovum – Zygote (first human cell) –
Morula (16 cells) – Blastocysts – Implantation –
Embryo (8 weeks) – Fetus
o Implantation occurs on the upper posterior
location of the uterus.
 Ends with death which is the cessation of
cardiopulmonary and circulation, including function of
brain and brain stem.
ORDERLY SEQUENCE
 Cephalocaudal
o Head to toe
 Normal HC: 13-14 in./33-35 cm.
 Normal AC/CC: 12-13 in./31-33 cm.
 Proximodistal
o Nearer parts develop first than far body parts (e.g.,
elbow flexing develops first than pincer grasps).
 Gross to refine.
o Use of larger muscles to smaller muscles.
 Mass to specific
OPTIMUM TIME
 There is a specific timeline for the appropriateness of
an infant or child’s milestones.

INDIVIDUAL DIFFERENCES
 Each child grows at different rates BUT the milestones
are predictable.
 Theories for individual differences
o Epigenetics
 Genes as bases for growth & development.
o Sociocultural
Infant Care and Feeding
Philippine Midwifery Licensure Examination

NEONATAL REFLEXES motion

FEEDING REFLEXES (Abduction
&
adduction)
Disappear Loud noise
Reflex Stimuli Response Jerky
by Startle or jarring 4-6 mos.
extension
Turn head of crib
and inhibit Stroking
Rooting Cheek 4 mos.
sucking of the sole Fanning of
Babinski 6-12 mos.
reflex in inverted toes
Extrusion/ Anterior “J” pattern
Spit 4 mos.
Spitting tongue Touching Toes curling
Plantar Grasp 8-10 mos.
Posterior the sole inward
Swallow Swallow 4 mos.
tongue Feet
Sucking Lips Suck 4 mos. touches
 The extrusion/spitting reflex doesn’t promote hard
Stepping/ surfaces Alternating
breastfeeding but protects baby from poisoning. 2-3 mos.
Dancing when steps
PROTECTIVE REFLEXES infant is
held
 Protects neonates and infants.
upright
Reflex Protection from Darwin/Palmar Touching
Grasp 2-3 mos.
Sneezing Respiratory infections Grasp the palm
Coughing & gagging Aspiration Stroking
Yawning Hypoxia of the
Eye injuries such as: lateral
o Blepharitis – portion of
Before 1
Gallant the spine Turn to side
inflammation of the yr.
when the
eyelids
baby is in
o Keratitis -
prone
inflammation of the
position
cornea
If infant is
o Iritis - inflammation
Blinking facing right,
of the iris Supine right
o Scleritis - Tonic Neck/ position extremities
inflammation of the Fencing/ with the are 5-6 mos.
sclera Boxing head turn extended
o Conjunctivitis - to side with the
inflammation of the of opposite
the conjunctiva side flexed
In prone
 These reflexes become involuntary by 4 mos. position
and Forward
Parachute/
suddenly extension of 1-2 y.o.
Landau
lowered both arms
toward flat
surface
NEUROLOGICAL REFLEXES
In supine
position,
Disappear extend one NB raises
Reflex Stimuli Response leg and opposite leg
by
rub the and extends
Moro Falling Extension 4-6 mos. Cross Extension 4-6 mos.
sole of the it as if
sensation of
opposite trying to
extremities
leg with push away
&
sharp
embracing
object.
Infant Care and Feeding
Philippine Midwifery Licensure Examination

 The gallant reflex is a test for the spinal cord function.

Infant Care and Feeding
Philippine Midwifery Licensure Examination

APGAR SCORING  Suction mouth first then nose.

 APGAR Score was developed by Virginia Apgar,  7-10
which is a method for assessing newborn viability. o Good (expected)
 APGAR scoring is done twice: o Routine newborn care
o 1 min. after delivery to determine how well the
baby tolerated the labor process.
o 5 min. after delivery to determine how well the PHYSICAL ADJUSTMENT TO
baby is adjusting to extrauterine life. EXTRAUTERINE LIFE
 In APGAR scoring, take note of the following:  First Period (First 15-30 min.)
o Pulse/heart rate o Alert
 The most important APGAR score o Rapid HR and RR
o Appearance o Sucking sounds
 Least important APGAR score  Resting Period (30-120 min.)
o Respirations o Slow HR and RR
 First to be assessed o Sleeps for almost 90 min.
 Infants with no problems will have long, loud,  Second Period (2-6 hr,)
lusty cry. o Wakes again
 During the first 3 mos., they will have no o Alert
tears as their tear ducts are still immature.
o Responsive
APGAR SCORE CHART o Mucus at the mouth
 May exhibit gagging or choking sounds.
2 1 0
Bluish/pale
A Pinkish all extremities but
Blue or pale
Appearance over pink trunk
(acrocyanosis)
P
> 100 bpm <100 bpm Absent
Pulse
Loud cry
G Minimal
with facial Absent
Grimace grimace
grimace
Good
flexion,
A No
recoil, and Poor flexion
Activity movement
active
movement
Shallow or
R irregular
Strong cry Absent
Respirations breathing, weak
cry

Interpretation:

 0-3
o Severe
o Needs resuscitation
o When this occurs, midwife must refer the infant to
the NOD or ROD.
 4-6
o Fair/moderate
o Needs suctioning + 02
Infant Care and Feeding
Philippine Midwifery Licensure Examination

TIME-BOUND INTERVENTIONS  Because of breastfeeding, the baby intakes

 The World Health Organization (WHO) developed the colostrum, which provides them natural
ENC protocol (formerly known as EINC) to decrease the passive immunity.
rate of Infant Mortality and Maternal Mortality. This is  IgA is the type of antibody passed from the
then known as the “Kangaroo Mother Care”. mother to the newborn via breastmilk.
 The local equivalent of WHO in the Philippines which o Promotes eye-to-eye contact.
is the Department of Health (DoH), adapted the ENC 3. Properly timed cord clamping and cutting
protocol and named it the “Unang Yakap” campaign o The average cord length is 50-55 cm.
through AO 2009-0025. The ENC campaign provides o Delayed cord clamping is done to prevent anemia.
specific details on newborn’s care during birth until first  This gives NB 80-100 mL of blood.
six hours of life. o Remove first glove before clamping cord.
UNANG YAKAP (FIRST EMBRACE) o Ideally, the cord must be cut after the pulsation
1. Dry the baby stops.
o Done during the first 30 sec. after delivery. o If pulsation does not stop, the cord may be
o Its purpose is to prevent hypothermia or heat loss. clamped and cut after 1-3 mins.
 Brown fat controls the NB’s temp. o First clamp must be placed 2 cm (0.79 in.) above
 This conserves heat or produce body heat the umbilicus, and the second clamp must be placed 5
by increasing metabolism. cm (1.97 in.) above the umbilicus.
 Preterm infants have less brown fats or o Check umbilical cord for the two arteries and one
brown adipose tissue, which puts them at a vein.
higher risk for hypothermia.  Rate of blood flow at term is rapid at 300-350
o Types of heat loss: mL/min.
 Conduction o Milking is NOT allowed.
 Contact to cold objects or surface. 4. Non-separation
 Radiation o Also called rooming-in
 Proximity to cold objects or surfaces. o Must be done within the first 90 mins.
 Convection o Do not immediately initiate breastfeeding; wait for
 Exposure to room air. feeding cues in which the first feeding cue will be
 Evaporation drooling.
 Wet body parts  This can occur 20-60 mins. after delivery.
o Ideal temperature of the delivery room during
NON TIME-BOUND INTERVENTIONS
delivery is 25-28°C.
 Anthropometric measurements (i.e., wt., ht.,
2. Early skin-to-skin contact
circumference)
o First 1 min. or 60 sec. after delivery
 Vitamin K injection
o Prevents HHI:
o This is important for the clotting factor formation.
 Hypothermia
o Newborns have physiologic hypothrombinemia
 The baby gains heat due to body contact
which requires them to have the vit. k shot.
with mother.
o Dose:
 Hypoglycemia
 This prevents hypoglycemia because when  1 mg (0.1mL) for 1.5 kg
the baby is placed in a prone position, the  0.5mg (0.05 mL) for <1.5 kg
montgomery’s ducts secretes pheromones  Hepatitis B vaccine
that is attractive to the baby, hence the  BCG (bacille Calmette-Guerin) vaccine
“nudging” towards the breast for o For prevention of tuberculosis
breastfeeding.  CA:
 Infection  Mycobacterium tuberculosis or Koch’s
bacillus
Infant Care and Feeding
Philippine Midwifery Licensure Examination

 Directly Observed Treatment, Short-Course

(DOTS)
 International program for screening and tx
of TB pt.
 Crede’s Prophylaxis
o This is done to prevent opthalmia neonatorum
and gonorrhea conjunctivitis.
 Opthalmia neonatorum is caused by the
following STIs:
 Gonorrhea (Neisseria gonorrheae)
 Chlamydia (Chlamydia trachomatis)
o The following medications may be used:
 Tetracycline
 Silver nitrate 1%
 This can cause eye redness which is self-
limiting.
 This is not used anymore.
 Erythromycin
 2% Povidone Iodine
AVOID THE FOLLOWING!

 No routine suctioning of secretions

 Early bathing (>6 hrs. after delivery)
 Wiping out or removal of vernix when present (only
spread)
 Buttocks slapping, foot slapping, foot printing
 Offering baby prelacteal feedings, or sugary water
before breastfeeding
 Rubbing oil to baby’s skin
 No squeezing of the chest and hanging the baby upside
down
 Putting anything in the cord stump
o This may cause tetanus neonatorum.
o Omphalitis
 Inflammation of the cord stump.
o The cord stump will fall within a week and may
fall as early as 2 days.
Infant Care and Feeding
Philippine Midwifery Licensure Examination

ASSESSMENT  Frontal Suture

HEAD  Between the two frontal bones.
Assess for the following:  Coronal Suture
 Normal HC: 33-35 cm./13-14 in.  The line between the two frontal bones and
 Head circumference >35 cm parietal bones.
o This can be a sign of hydrocephalus.  Saggital Suture
 Hydrocephalus may cause an increase in the  Running midline between two parietal
ICP (normal: 0-15 mmHg). bones
 Watch out for (WOF):  Lamboid
 Bulging of the anterior fontanelle (bregma)  The line between the two occiput bones.
 Shrill cry (high-pitched cry) o Craniosynostosis
 Convulsions/seizure  Premature closure of the suture lines.
 Unable to breastfeed  Fontanelles
 Projectile vomiting o Anterior Fontanelle (Bregma)
 Abnormal sleeping (lethargy)  Diamond or kite shape
 Head circumference <35 cm  2-3 cm wide, 3 cm long.
o The danger of a small head circumference is o Posterior Fontanelle (Lambda)
mental retardation (low IQ)  Triangle shape
 Normal: 90-110  0.5-1 cm length
 Stages of MR
 Profound (IQ <20)
 Infant to toddler
 Severe (IQ 20-35)
 Preschooler
 May play with other children.
 Moderate (IQ 36-50)
 Grade 2
 Knows simple English and
Mathematics.
 Mild (IQ 51-70)
 Grade 6
 Knows complex English and
Mathematics and can attain high school  Abn.:
level and vocational courses. o Craniotabes
 Borderline (IQ 71-80)  Softening of the skull bones.
 Dullness (81-90)  Usually due to vit. D deficiency in utero.
 Check for caput succedaneum and cephalhematoma.
o Caput succedaneum will resolve in 2-3 days. EYES
 This occurs in the parietal bones.  Vision is 20/150 – 20/190;
o Cephalhematoma will resolve in 3-6 wks. o Myopic
 Does not cross suture lines.  No tears are produced due to immature tear ducts.
 Suture lines  NB can see from 9-12 in. only.
o Molding  Optimal field of vision is achieved by 12-18 mos., and
 When the head becomes narrow and longer. fully develops at the age of 6.
 Overlapping of sutures.  The iris will not assume its permanent color until
 Accounts for diminution of the biparietal between 3-12 mos. of age.
diameter and suboccipitobregmatic diameters by  Normal:
0.5-1 cm. o Strabismus or Nystagmus
o Types of sutures:
Infant Care and Feeding
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 This is normal for the NB’s eyes to wander or

cross occasionally due to immature eye muscles
coordination. This is usually resolved around 4-6
mos.
o Subconjunctival Hemorrhage
 The bursting of blood vessels in the sclera,
which is normal and due to birth trauma. This is
reabsorbed in 2-3 wks.

 Abn.:
o Coloboma o Sunset Eyes
 Irregularly shaped pupil.  Indicates hydrocephalus or increased ICP.
 H.S.:
 Macewen Sign
 Crack pot sound

o Pink Iris
 Sign of albinism

o Brushfield Spots
 Indicates down syndrome

o Opaque Pupils
 Congenital cataract which occurs if the mother
has hx. of rubella during pregnancy.

o Purulent Discharges
 Opthalmia neonatorum or conjunctivitis
Infant Care and Feeding
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 Caused by Candida albicans.

o Cleft Lip & Cleft Palate

Cleft Lip Cleft Palate

Common in males Common in females
Causes: Causes:
Hereditary Hereditary
Teratogens Teratogens
B9 Deficiency B9 Deficiency
Has impaired sucking Aspirates easily than
EARS reflex cleft lip
 Ears should be above the outer cantus of the eye. Use dropper or feeding
 Abn.: Use dropper or syringe
bottle with large nipple
in feeding
o Low set ears can indicate down syndrome. in feeding
Delayed repair
Use of Malek protocol:
Needs early repair (1-2 Soft palate repair @ 3
mos.) mos.
NOSE Surgery: Cheiloplasty Hard palate repair @ 6
 Abn.: mos.
o Choanal Atresia Surgery: Palatoplasty
 Abn. blockage of nasal canal Surgery is done to save Surgery is done to save
the sucking reflex the speech

o A small with flattened nose bridge can also

indicate down syndrome in an infant.
MOUTH
 Neonatal Tooth/Natal Teeth (Precocious Teeth)
o This tooth is present when the infant is born. The
teeth are often not fully developed and have weak
roots. This is a rare occurrence.  Vitamins & minerals essential in pregnancy to
o The cause is unknown. avoid deformities or abnormalities:
 Epstein’s Pearl  Iron
o Whitish-yellow cysts that forms on the gums and  40 mg/day
roof of the NB’s mouth. This disappears within 2  1000 mg reserve for entire
wks. pregnancy.
o Caused by calcium deposits.  500 mg goes to the fetus
 Abn.:  300 mg goes to the placenta
o Excessive mucus  200 mg is waste
 May indicate esophageal atresia or tracheal  Folic Acid/Folate
esophageal fistula.  400 mcg/day
o Thrush  Calcium
 Grayish white milk curd plaques at the tongue  1000 mg/day
and buccal cavity.
Infant Care and Feeding
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Pre and Post-Op Care:  Back

 Pre-op o Abnormalities can be seen by a protrusion, which
 The following must be checked: may indicate spina bifida. These are the types of
 Rule of 10’s: spina bifida:
 Hemoglobin – 10 g/dL  Occulta
 WBCs – 10,000 (normal 4,000-  Dimpling
11,000)  Abn. tufts of hair
 At least 10 lbs.  Discolored skin
 At least 10 wks.  Meningocele
 Post-op  Protrusion of sac with CSF + meninges.
 The baby must be placed in a prone  Myelomeningocele
position to avoid aspiration.  Protrusion of sac with CSF + meninges +
 Elbow restraints will also be used and cord.
should be practiced on the baby before o Spina bifida is mainly cause by B9 (Folic Acid)
surgery. deficiency during the 1st trimester.
o Ankyloglossia (Tongue-tie)
EXTREMITIES
 Abn. restriction of the tongue caused by an
 Arms
abn. tight frenulum.
o Amelia
NECK  Absence of extremities
 Check the integrity of the sternocleidomastoid muscle o Pocomelia
(SCM) or the neck muscle, as a weak SCM may indicate  Incomplete or short arms
torticollis or wry neck.  Hands
 In NB whose membranes were ruptured for >24 hrs., o Syndactyly
nuchal rigidity could be a beginning sign of meningitis.  Fusion of fingers
o Polydactyly
CHEST
 Excess digits
 Assess for chest retraction or indrawing (inward
movement of the chest when breathing in) as this may
indicate RDS.
 Congenital Hip Dysplasia/Subluxated Hip
TRUNK o S/Sx:
 Nipples  Galeazzi sign
o Witch’s Milk  When thighs are flexed at a 90° angle
 White discharge from the nipples due exposure toward the abd. and one knee is lower than
of the hormone prolactin. the other.
 Umbilicus  Ortolani sign
o The NB’s abdomen is protuberant.  “Clunk” sound heard during abduction of
legs.
 Barlow sign
o Abnormalities can be seen in any protrusion.  Femur felt slipping in and out of socket
 Omphalocele during adduction.
 Infant’s organs stick outside the belly  Asymmetry of skin folds
enclosed in a sac.  Prominence of the trochanter on the right side.
 NGT is used.  Legs
 Needs surgery within 24 hrs. o Genu Varum
 Gastroschisis  Bow legged
 Infant's organs stick outside the belly. o Genu Valum
 Avoid putting the baby in a prone position  Knock knees
for both cases.  Feet
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o Club foot (Equinovarus) o This stabilizes within 4-12 hrs.

o Flat footed o Site: Axilla
 HR: 120-160 bpm
GENITALS
o Best determined at the apical site.
 Female
o Femoral pulses should be checked as absence
o Pseudomenstruation
could indicate coarctation of the aorta.
 This is a normal occurrence as this happens
due to large amounts of exposure to the hormone  RR: 30-60 cpm
estrogen. o NB are obligatory nose breathers.
o Abn.: o They are also abd. breathers.
 Pseudohermaphroditism o Respiratory may be irregular with short periods of
 This is an abnormal condition in which the apnea (<15 sec.), or also called periodic respirations.
baby has another external genitalia o Abn.:
superficially resembling those of the other  Transient Tachypnea of the NB
sex. This is caused by congenital adrenal  RR >60 cpm.
hyperplasia (CAH).  Occurs as a direct result of retained lung
fluid.
 Common in babies born via CS.
 BP: 80/45 mmHg
o Recording of BP starts at 3 y.o.
 Male o If the NB has a congenital heart defect, this will
o Abn.: be monitored routinely.
 Phimosis
 Unretracted foreskin SKIN CONDITIONS
 Paraphimosis  Ruddy Complexion
 Inability to replace the prepuce over the o Normal complexion
glans once it has been retracted.  Acrocyanosis
 This is an emergency. o Reddish/pink trunk, blue extremities
 Cryptorchidism  Harlequin’s Sign
 Undescended testicles o Dependent side appears red.
 Tx:  Cutis Mamorata
 Short course HCG for 5 days o Mottling of the NB’s skin upon exposure to cold
 Surgery air.
 Orchiopexy is the surgery used to  Desquamation
treat cryptorchidism. o Peeling of the skin within 1st week of life.
 Epispadias o Also seen in post-term infants.
 Urethral orifice is located on the upper
 Milia
portion of the penis (dorsal).
o Pinpoint white papules because of blocked
 Hypospadias
sebaceous glands
 Urethral orifice is located at the bottom
o This disappears within 2-4 wks.
portion of the penis (ventral).
 Miliaria
LENGTH o Clear vesicles on face, scalp, and perineum
 Normal length: 45-55 cm. (17.7-21.7 in.)  Erythema Toxicum Neonatorum
 An infant will grow at the following rates: o Flea bite rash which is harmless
o 1 in/mos. (1-6 mos.)  Mongolian Spots
o 1.5 in/mos. (7-12 mos.) o Blue or gray patches over the buttocks
VITAL SIGNS o This will disappear over time (within 2 yrs.)
 Temp.: 36.5-37.5°C (97.6-98°F)
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 Intertrigo
o Redness due to friction in the skin folds.
 Port-wine Stain (Nevus Flammeus Firemark)
o Red like stains common in the face, scalp, and
arms.
o This usually persists.
 Strawberry Mark (Nervous Vasculosis/Infantile
Hemangioma)
o Capillary hemangioma
 Stork Bite Nevi (Telangiectic Nevi)
o Capillary dilatation in upper eyelids, forehead, and
nape
 Salmon Patch (Angel’s Kiss)
o Pink or red flat, irregularly shaped patches on the
baby’s face
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STAGES OF STOOL
 Meconium
o Tar, sticky, blackish green, odorless.
o Must be passed within 24 hrs.
 Transitional
o Green, slimy.
 Breast-fed Stool
o Golden yellow, soft, mushy, sour
 Bottle-fed Stool
o Light yellow, formed, hard, offensive odor
 Abn.:
o Ribbon-like
 Hirschpsrung’s Disease
o Currant jelly stool
 Intussusception
o Fatty or foul smell
 Steatorrhea or malabsorption syndrome
o Black stool
 GI hemorrhage
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PHYSIOLOGIC CHANGES IN NEWBORN 28 wks. AOG if the mother becomes

 Physiologic change is normal and is to be expected in pregnant for the second time.
newborns. o Difficulty in labor
 Pathologic change, however, is abnormal and must be o In pathological jaundice, bilirubin is higher
referred to the NOD or ROD. (normal: 6 mg/dL). This may cause acute bilirubin
encephalopathy or kernicterus, which is a type of
PHYSIOLOGIC WEIGHT LOSS
brain damage cause by high bilirubin levels.
 This occurs during the first 10 days. About 5-10% of
 S/Sx:
the birth weight (BW) is lost (normal: 2500-3500 g/2.5-
 Severe jaundice
3.5 kg; ave. for Filipino infants is 3000 g/3 kg)
 Seizures
o By 6 mos., weight must be twice the BW.
 Sleeping abnormally (normal: >16 hrs. of
o By 12 mos., weight must be thrice the BW.
sleep)
o By 24 mos., weight must be quadruple the BW.  Sucking reflex is weak
 Due to withdrawal of maternal hormones and voiding.  Mgt.:
o NB voids 6-8x/day.  Phototherapy (UV light exposure)
o 2-3 bowel movements.  Expose as much skin as possible while
covering the eyes and genitals.
PHYSIOLOGIC FEVER
 Expect green colored stools.
 A temperature between 37.6-39°C.
 Eyes should be covered to avoid
 This occurs due to the hypothalamus’ response to
neonatal blindness, and genitals as well
thermoregulation.
to avoid priapism.
 Stabilizes after 4-12 hrs.
PHYSIOLOGIC ANEMIA
PHYSIOLOGIC JAUNDICE  This happens at 4 mos.
 This is a type of jaundice that occurs 24 hrs. after
 This is caused by more iron needed secondary to
delivery. This is due to the liver immaturity.
growth.
 Glucuronyl Transferase o Infancy has the fastest growth.
o Enzyme that converts indirect bilirubin to direct
o Adolescence has growth spurt.
bilirubin.
o Preschool/grade school has uniform growth.
o Comes from the liver.
 Decrease in serum Fe lvl. is expected at 6-9 mos. as the
 Mgt.:
last of the iron stores is used.
o Early morning sunlight exposure
 S/Sx:
o Increase breastfeeding.
o Pallor
 If the jaundice occurs within 24 hrs. after delivery, this  It is ideal to check at the conjunctiva and the
is what we call pathological jaundice. This is caused nail beds, except in severe cases where pallor is
by: seen at the palms.
o ABO incompatibility (for blood groups A and O)  Easy fatigability
 This results in hemolysis, which is the  Dizziness
destruction of RBC.  Mgt.:
o Start complimentary feeding.
o RH (Rhesus factor) incompatibility
 This occurs when the mother’s RH factor is
negative, while the baby’s RH factor is positive.
 First baby is SAFE from hemolysis or
isoimmunization. However, the second baby will
suffer from hemolysis if the mother does not
receive treatment, which is the RhoGAM.
 RhoGAM must be given within 72 hrs.
after the delivery of the first baby, and at
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BREASTFEEDING  44.5%
 The mother must breastfeed 8x within 24 hrs., with 2-3 o CHON
hrs. of interval in each feeding.  8.4%
o Feed as long as baby wants and never interrupt. o Fats
 Breastmilk production is affected by the following  43.9%
factors:  Other components of BM:
o Depression o Lauric Acid
o Dehydration  The type of acid found in breastmilk that
o Fatigue prevents acne.
 To increase breastmilk production, intake of  Anti-aging property of BM.
galactagogues rich food must be done (e.g., malunggay) o Linoleic Acid
 There are 10 steps to successful BF.  Essential fatty acid which is necessary for
o Hospital must have a written policy. brain growth and skin integrity in infants.
 BM has app. 20 kcal/oz. o Pregnanediol
o A NB needs 110-120 kcal/kg (50-55 kcal/lb) every  Can be found in BM that suppresses the
24 hr. for the first 2 mos. glucoronyl transferase (liver) that leads to milk
o After 2 mos., an infant needs 100 kcal/kg (45 jaundice (rare case of jaundice).
kcal/lb).  Low in iron but high in vit. a.
o For formula feeding, a quick rule of thumb to  Types of BM:
determine how much an infant drink is age in months o Colostrum “Gintong Gatas”
+ 2 or 3.  Occurs during the first 5 days after delivery.
 Advantages of BF:  High in CHON and fat-soluble vit., low in fats
o Lactoferrin and CHO.
 Iron-binding protein that interferes with the  Has a purgative effect.
growth of the bacteria.  Aids in physiologic jaundice.
o Antibody IgA  Breastfed babies have golden yellow, soft
 Antibody passed by the mother to the infant stools, and defecates 3-4x/day.
via BF.  Formula fed babies have green or brown,
o Bifidus Factor semi-formed stools, and defecates 2-3x/day.
o Hind milk
 Lactobacillus bifidus
 Interferes with the colonization of  Fatty milk
pathogenic bacteria in the GI tract, thus  The milk that makes a breastfed infant grow
reducing the incidence of diarrhea. rapidly.
o Lactose  Type of milk at the end of feeding.
o Fore milk
 Easily digested sugar and for rapid brain
growth.  watery milk
 Formed after the let-down reflex.
o Lysozyme  Type of milk at the start of feeding.
 Destroys bacteria by lysing.  Expressed milk storage:
o Interferon o Room temp.
 Interfere virus growth.  4 hrs.
o Body of refrigerator
 Proteins in BM:
o Lactalbumin  24 hrs.
o Frozen
 60%
o Casein  30 days
o Deep Freezer
 40%
 6 mos.
 Macronutrients of BM:
o CHO HORMONES
Infant Care and Feeding
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contraindication. Mother must continue to breastfeed

when this happens.
Hormone Function Produced by  BF for 10 min. each breast.
Adenohypophysis
Milk
Prolactin (anterior pituitary FEEDING CUES
Production
gland)  Opening of the mouth
Let down  Licking
Neurohypophysis
reflex and  Tonguing
Oxytocin (posterior pituitary
ejection of
gland)  Movement of arms & fisting
milk
 Rooting
 Crying (late sign)
CONTRAINDICATIONS IN BREASTFEEDING o Hand to mouth reflex is not a feeding cue.
 HIV/AIDS
o But according to WHO, women can BF as the SIGNS OF GOOD ATTACHMENT
benefits of BM outweighs the risk of transmitting  More areola is visible above.
HIV.  Mouth is wide open,
 Chin touching the breast.
 Nose is not obstructed.
 Psychotic  Body is closer to the mother.
o You can determine if the mother is undergoing  Deep, slow sucking with pauses.
through post-partum psychosis if there are  When BF, allow baby to touch breast to stimulate the
hallucinations. release of oxytocin.
 Cancer pt. undergoing chemotherapy and radiation BENEFITS OF BREASTFEEDING TO MOTHER
therapy.  Maternal postpartum hemorrhage prevention.
 Women taking COC pills  Ovarian and breast CA prevention.
o COC pills contain estrogen which decreases milk
 Type II DM risk reduction.
production.
 Helps mother to burn more calories which in turn helps
o This will also affect LAM, as it has three
mothers lose weight.
components for it to be successful (AGE):
 Economical, saves time, and money.
 A – amenorrhea
 Reduces the risk of postpartum depression.
 G – 6 mos.
 Suppress ovulation due to elevated levels of prolactin.
 E – exclusive breastfeeding
 Active TB WEANING
 Herpes lesion on nipples  This process is the gradual introduction of solid foods.
 Women addicted to drugs.  Signs of readiness:
 False contraindication: o Sits erect and has head control.
o Mastitis o Spitting/extrusion reflex disappears.
 Inflammation of the breast. o Shows interest in table foods.
 Caused by Staphylococcus aureus.  Remember the following in weaning:
 From the baby’s mouth. o Wean the child gradually.
 This is characterized by pain, redness, o Earliest age of giving solid food is 4 mos.
swelling, and warm to touch. o Always serve newly prepared/cooked food.
 BF should be continued if possible because o No added salt or sugar.
keeping the breast emptied of milk helps to
o Introduce one kind of food at a time.
prevent growth of bacteria.
 Wait 5-7 days before giving new foods to
 Tx:
observe for any allergic reaction.
 Antibiotics and anti-inflammatory drugs
o Never mix solid food with milk in a feeding bottle.
o Engorgement of the breast, which is only
o Give the food before breast feeding.
characterized by swelling of the breast, is not a
Infant Care and Feeding
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 The common allergens are eggs and nuts.  Vegetable oil

 These are the order of foods to be introduced: o Vitamin C
o Cereals  Citrus fruits
o Vegetables  Melons
o Fruits  Mango
o Soft meat
o Fish
o Egg yolk (before 1 y.o.)
o Egg white (after 1 y.o.)
 Guide in feeding:
o At 6 mos.:
 Carbohydrates is the first nutrient (2-3 tbsp.,
2x/day).
 Iron fortified cereals
o At 7 mos.:
 Fruits and vegetables should be pureed or
mashed.
 Thick porridge or soft rice.
o At 8 mos.:
 Same food at 6-7 mos.
 Minced/finely chopped meat
 Can be served 2-3 meals
o At 9 mos,:
 Same food at 6-8 mos.
 Fish flakes and egg yolk
o At 10-12 mos.:
 Chopped, coarsely, or whole tender foods can
be given
 Biscuits and finger foods
 Table foods (given at 1 y.o.)
 3 meals a day
o Allergen Foods
 Wheat
 Tomatoes
 Fish
 Egg white
 Peanut
 Essential nutrients for the baby and their sources:
o Iron
 Meat
 Chicken liver
 Dark green leafy vegetables
 Legumes
o Vitamin A
 Squash
 Papaya
 Yellow sweet potatoes
 Mango
Infant Care and Feeding
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DEVELOPMENTAL MILESTONES Clapping of hands

Plays games (e.g., peek-a-boo, patty
cake)
Month Milestones Wave
Head sag Bye
Fisted Hands Cruising – walking by holding to
Throaty sounds furniture
1 month 11 mos.
Enjoys the smells of breastmilk Uses spoon and fork
Near sighted (Myopia); Midline vision Can eat with family at the table
Messy look Walk with support
Temporarily raise head Birthweight triples
12 mos.
Handle rattle Stands alone
Social smile Can feed themselves well
2 mos.
Cooing sounds Walks without support
Binocular vision (follows objects) 15 mos. Walk backwards
Open fisted hands Can creep & crawl upstairs
Laugh out loud Can creep & crawl downstairs
Hand to mouth coordination Start of bladder & bowel control
Thumb sucking (Do not discourage as Start of temper tantrums
3 mos.
the baby may develop oral fixation) Mgt.:
Can raise head well 1. Ignore but ensure safety
Follows object beyond midline vison Start of negativism
Sideways roll (back to front) Mgt.:
Disappearance of feeding reflexes 1. Offer choices
Earliest time to start complimentary Dawdling or ritualistic
4 mos. feeding Mgt.:
Thumb opposition begins 18 mos. 1. Let toddler finish ritual
Can recognize mother Temper tantrums, negativism, and
Can reach objects dawdling are important for autonomy
Roll over (prone to supine) development
Learned crying Separation anxiety is also developed at
5 mos. this age.
Hand regard (Can handle cups with
Mgt.:
hands together)
1. Avoid sneaking (develops sense of
Earliest time to develop stranger anxiety abandonment)
Can roll easily 2. Firm goodbye
Birthweight doubles 3. Make promises that you can keep
Head and chest is equal in size 4. Give security object
6 mos. Sits with support 24 mos. Open doorknobs
May say “oh-oh” 36 mos. Can undress themselves (except
Eruption of first tooth, which is the (3 yrs.) buttons)
lower central incisors (mandibular
Can play with toys well and other
incisors)
children
Average time to develop stranger Ride a tricycle
anxiety
7 mos. 60 mos.
Toes to mouth Can tie shoelaces
(5 yrs.)
Transfers objects hand to hand
Peak of stranger anxiety
Sits without support TEETH
8 mos.
Eruption of upper central incisors  Primary detention teeth
(maxillary incisors)
o 20 teeth
Disappearance of stranger anxiety
Creep and crawl
o All erupted by 2-3 y.o. (Ave. 30 mos.)
9 mos.  Secondary detention teeth
Says first word (dada)
Attempts to stand o 32 teeth
10 mos. Pincer grasp o First to appear: Molar
Infant Care and Feeding
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o Last to appear: 3rd Molar (wisdom tooth) with caregiver

 Dental visit and brushing start on the rupture of the Dark, ghosts, punishments,
Pre-schooler
first deciduous teeth mutilation, hospitalization
 Signs of teething: Bully, loss of honor roll, defeat,
School Age
o Drooling school rejection
Friend rejection, break-up,
o Discomfort Adolescence
acne, body odor, obesity
o Irritable
o Slightly feverish
o Chewing on objects MOST IMPORTANT PERSONS
o Sucking on hands Infant Mother
Toddler Mother and father
o Not eating well
Pre-schooler Parents and siblings
 Mgt.: Teacher, parents, and other
o Cool teething ring School Age
family members
o Cool damp cloth to relieve inflammation. Boyfriend/girlfriend, circle of
Adolescence
friends
Deciduous Teeth Lower Teeth Upper Teeth
Central Incisors 5-7 mos. 6-8 mos.
Lateral Incisors 12-15 mos. 8-11 mos.
Canines 16-20 mos. 16-20 mos.
First Molars 10-16 mos. 10-16 mos.
Second Molars 20-30 mos. 20-30 mos.

TYPES OF PLAY
Infant Solitary
Toddler Parallel/Side by side
Pre-schooler Cooperative/associative
School Age Competitive
Adolescence Outdoor, team sports, reading
AGE APPROPRIATE TOYS
Mobile, music boxes, stuffed
1-2 mo.
animals, and rattle.
3 mo, Small blocks, small rattles
Plastic ring, blocks, squeeze
4-6 mo. toys, clothespin, rattles, plastic
keys
Cloth textured toys, splashing
7-9 mo.
bath toys, large blocks, balls
Durable books w/ large
10-12 mo. pictures, large building blocks,
push-pull toys.

TYPES OF FEAR
Infant Stranger anxiety
Toddler Separation anxiety
Stages:
Protest – cry
Despair – sad
Denial – adjustment, coping
mechanism; avoids interaction
Infant Care and Feeding
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THEORISTS  Perfectionist, OCPD

SIGMUND FREUD  Lax discipline
 Father of modern psychology  Disorganized
 Theory: Psychosexual/Psychoanalytical  Phallic Stage (Preschool: 3-6 y.o.)
o Libido (sexual drive) is the basis for behavior  Libido is focused on the genitals
o This theory has three levels: ID, Ego, Superego (curiosity)
 Oedipal Complex
ID  Attachment of the child to the parent of
(Instinctual Ego Superego
Drive)
the opposite sex, and rivalry to the
Developed Developed Developed parent of same sex (son to mother).
during infancy during toddler during preschool  Electra Complex
Focus on  Attachment of the child to the parent of
Focus on wants Focus on self
conscience the opposite sex, and rivalry to the
Pleasure Morality parent of same sex (daughter to father).
Reality principle
principle principle
 Touching of genitals
o Stages of Psychosexual Development
 Parents must divert the child’s attention
 Oral Phase (Infancy: 0-18 mos.)
when this happens.
 Libido is focused on the mouth (hand to
 Exhibitionism
mouth reflex).
 Latency Stage (School Age: 6-10 y.o.)
 Toys must be lead free and washable.
 Libido is dormant due to diversion to
 Satisfy breastfeeding, use pacifier, and do
school activities.
not discourage thumb sucking.
 Genital Stage (Adolescence: 12-18 y.o.)
 Anal Phase (Toddler: 18-36 mos.)
 Libido is full blown.
 Libido is focused on the anus.
 Two types of attachments during this
 Satisfy anal satisfaction through toilet
phase:
training.
 Emotional
 Toilet training can be initiated as early
 Same sex
as 18 mos. and must be finished before
 Sexual
preschool.
 Opposite sex
 18 mos.-2 1/2 y.o.
 Bowel training ERIK ERIKSON
 2 1/2 – 3 y.o.  Theory: Psychosocial Theory
 Daytime bladder training o Infancy (0-18.mos.)
 3 – 4 y.o.  Trust vs. mistrust
 Nighttime bladder training  Low trust
 Enuresis  Results to paranoia
 Bedwetting  Increased trust
 Encopresis  Results to being gullible
 Uncontrolled bowel o Toddler (18 mos. – 3 y.o.)
 Toilet training readiness must be assessed  Autonomy vs. shame and doubt
through the following: o Preschool (3-6 y.o.)
 Physiological  Initiative vs. guilt
 Most important factor. o School Age (6-12 y.o.)
 Able to sit, walk, and squat.  Industry vs. inferiority
 Psychological o Adolescence (12-18 y.o.)
 Able to verbalize the need for toilet  Identity vs. role confusion
training. o Young Adults (18-40 y.o.)
 During toilet training, discipline must be
 Intimacy vs. isolation
CONSISTENT and FIRM.
o Middle Adults (40-60 y.o.)
 Strict discipline
Infant Care and Feeding
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 Generativity vs. stagnation

o Late Adults (>60 y.o.)
 Integrity vs. despair
JEAN PIAGET
 Theory: Cognitive Theory of Development
o Sensory motor stage (infancy)
 Eye to hand
 Developing object permanence
o Pre-operational stage
 Toddler (2-3 y.o.)
 Pre-logical reasoning
 Preschooler (4-7 y.o.)
 Magical thinking/animistic
 Centering
 Assimilation
 No awareness to reversibility
o Concrete operational
 Uses memory and logic.
 Uses inductive reasoning (specific to general)
o Formal operational
 Highest mental development
 Abstract thinking
 Deductive reasoning (general to specific)
LAWRENCE KOHLBERG
 Theory: Stages of Moral Development
 Infancy is not included as it is considered pre-religious.
o Stage I – Pre-conventional
 Toddler (2-3 y.o.)
 Punishment-obedience orientations
 Preschool (4-7 y.o.)
 Reciprocity
o Stage II – Conventional
 School Age
 Good boy/girl orientation
 At this stage, the child seeks social
approval.
o Stage III – Post-conventional
 Early adolescence (10-12 y.o.)
 Follows social norms.
 Adolescence
 Internalized conduct
 Can decide what is right or wrong.
Infant Care and Feeding
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PROBLEMS WITH INFANTS  Can be assessed through the Silverman-

PRETERM Andersen reflex.
 Preterm is a live born between 20-37 wks. AOG.  Score interpretation:
o 20 wk. is the age of viability or when extrauterine  0
life is viable.  No RDS
o Assessment of AOG can be done by Ballard  1-3
scoring.  Mild distress
 Risk factors (PRETERMS):  4-6
o Poor, poor nutrition, poverty  Moderate distress
o Race (African-Americans have the highest  7-10
preterm rates)  Severe distress
o Exposure to tobacco  Mgt.:
 Smoking exposure leads to SGA  Give surfactant.
o Teenage pregnancy (>18 y.o.)  This is developed in the womb during
o Early induction of labor (high oxytocin levels) 28-36 wks. AOG.
 Corticosteroids for lung maturity (e.g.,
o Recent or history of preterm delivery
dexamethasone, betamethasone,
o Multiple pregnancies
hydrocortisone).
 Uterine stretch theory is believed to be the  Betamethasone can be given in two
cause for early labor and delivery in women with doses of 12-12.5 mg IM, 24 hrs. apart.
multiple pregnancies  It takes about 24 hrs. for the drug to
o Stress begin its effect and can last about 7 days.
 Assessment:  To hasten fetal lung maturity.
o Thin, reddish skin  Phenobarbital is also given to
o Prominent veins hasten liver maturity.
o More lanugo  Intubation + mechanical ventilation
 Lanugo only starts to fall intrauterine at 32  Positive End Expiration Pressure
wks. (PEEP) reverses atelectasis.
o More vernix caseosa (do not remove)
o Has only 1 or 2 sole creases o Heart Failure
 NB who has simian crease indicates down  Low contractility
syndrome. o Kernicterus
o Very short/little nails  This is brain damage secondary to high
o Low birthweight bilirubin levels.
 Low birthweight - >2500 g  The accumulation of unconjugated bilirubin
 Very low birthweight - >1500 g into brain cells.
 Extremely low birthweight - >1000 g  Sites to check for jaundice is the palm and
 Dangers: soles, but the BEST site is the nose
o Respiratory Distress Syndrome (RDS) or  Mgt.:
Hyaline Membrane Disease  Phototherapy/Bili light
 Problems is SHA:  Light must be 18 in. or 1 1/2 ruler away
 Severe pulmonary edema to prevent burns.
 Hypoxemia  1st time exposure to UV light will cause
 Atelectasis bronze baby syndrome.
 S/Sx: o Anemia
 Chest indrawing or chest retractions  Low RBCs and Hgb
 R/f:  This is due to kidney and bone marrow
 Atelectasis immaturity.
 Collapsed lung.  Mgt.:
Infant Care and Feeding
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 Administration of epogen (epoetin alfa)  MOT: Contact and droplets

o Hypothermia  CA: Bordetella pertussis
o Retrolental Fibroplasia or Retinopathy of  Incubation period: 5-21 days
Prematurity  Period of communicability: During catarrhal
 Occurs in premature NB due to excessive O2 (respiratory illness) stage
administration.  H.S.:
SUDDEN INFANT DEATH SYNDROME (SIDS) o Whooping cough
 The cause of SIDS is unknown.  Evident during the paroxysmal stage.
 Risk factors:  S/Sx:
o Sleeping in a room with no air movement o Fever
o Inadequate surfactant o Loss of appetite
 This is common in pre-term infants and may o DOB or SOB
cause atelectasis.  Complication:
o Drug dependent mothers o Pneumonia
 Those who are addicted to opioids or narcotics  Mgt.:
(downers) o Eryhtromycin
 Drug addiction o Azithromycin
 “I want more.”
 Drug dependency TETANUS
 This is a CNS infection
 “I can’t live without this.”
o Sleeping or placing the baby in prone position.  CA: Clostridium tetani
o Sudden laryngospasm  H.S.:
o Risus sardonicus (sardonic smile)
 Triggered by:
 Obnoxious smells  This is secondary to lock jaw.
 Mgt.:  S/Sx:
o Autopsy o High grade fever
 To ease the doubt of the parents. o Trismus (lock jaw)
o Opisthotonus (abn. arching of the back)
DIPTHERIA  Cause of death: Laryngospasm
 This is a type of respiratory infection that involves the  Mgt.:
nose and throat. o Abx for 7 days
 MOT: Droplets and contact
 Diptheria, pertussis, and tetanus can be prevented by
 CA: Corynebacterium diptheriae the DPT vaccine.
 Incubation period: 2-6 days
 H.S.: HEART PROBLEMS
o Pseudomembrane TETRALOGY OF FALLOT
 Gray spots in the throat.  This is a cyanotic heart disorder, commonly referred to
 S/Sx: as “blue baby”.
o Sore throat (pharyngitis)  Dx:
o Echocardiogram
o Swelling of the neck
 Visualization/imaging study of the heart (2D
o Rinorrhea (nasal discharges)
Echo).
o Cough (late sign)
 Problems:
 Complication:
o Pulmonary Artery Stenosis
o Pneumonia
o Right Ventricular Hypertrophy
 Mgt.:
o Ventricular Septal Defect (VSD)
o Abx for 7 days
o Aorta overriding the VSD
PERTUSSIS  Reason for the cyanosis
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 H.S.:
o Tet spells
 Increased cyanosis when crying.

 S/Sx:
o Easy fatigability
o Fast breathing
o Cyanosis

 Danger:
o The average life expectancy is 30 y.o.
o Heart failure
 Squatting relieves the symptoms as it promotes the
trapping of unoxygenated blood in the legs; for infants,
the knee-chest or genupectoral position is used.
 Mgt.:
o Surgery

CYSTIC FIBROSIS
 This produces sticky secretions.
 CF is hereditary (autosomal recessive).
 Problems:
o Lungs
 Pneumonia
o Skin
 Salty sweat
o Pancreas
 Pancreatitis
o Live
 Gallstones
o Intestines
 Adhesions that may lead to intestinal
obstructions.
 Meconium ileus
 Obstruction of the intestinal lumen by
hardened meconium.
 Mgt.:
o Mucolytics
 To loosen secretions
o Reverse isolation
 Average lifespan is 36 y.o.
Infant Care and Feeding
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NEWBORN SCREENING (NBS) o Maple syrup urine odor

 R.A. 9288 (Newborn Screening Act of 2004)
 NBS is used to detect childhood metabolic problems. CONGENITAL ADRENAL HYPERPLASIA
(CAH)
 The goal is to reduce infant/neonatal mortality rate.
 This causes pseudohermaphroditism (female)
 This is done 2-3 days/48-72 hrs. after birth.
 CAH also causes dehydration.
 Specimen used is blood, which is obtained from a heel
 Tx:
prick.
o Steroids
 Premium NBS detects 26 diseases, while the NBS
package from PhilHealth only detects six diseases. GLUCOSE 6 PHOSPHATE DEHYDROGENASE
(G6PD) DEFICIENCY
SIX DISEASES  G6PD is the enzyme responsible to make RBCs last
CONGENITAL HYPOTHYROIDISM
120 days.
 Problem:
 G6PD Deficiency causes anemia and pathologic
o Low T3 and T4 hormones
jaundice in infants.
 T3
 Most common metabolic disorder in the PH.
 Responsible for the brain, heart, and GI
function
 When not regulated, child may be mentally
and physically challenged.
 T4
 Responsible for the regulation of body
temp.
 Abnormalities will lead to hypothermia.
o Cause:
 Mother has hyperthyroidism during pregnancy
(e.g., toxic goiter)
o Tx:
 Levothyroxin
 This medication must be mixed with milk
and given within 2 wks.
GALACTOSEMIA
 Infants who have galactosemia are lactose intolerant.
 This can also cause cataracts (cloudy lens).
 Breastfeeding is contraindicated in infants with this
disease. They are formula-fed with lactose free milk
(e.g., Nutramegen).
 Can lead to blindness if untreated.
PHENYLKETONURIA (PKU)
 This is the inability to metabolize phenylalanine.
 Dx:
o NBS
 Because of severe pain, infants also manifest
opisthotonos with convulsions
 Infants with PKU is also formula-fed with Lofenalac.
MAPLE SYRUP URINE DISEASE (MSUD)
 This is a rare genetic metabolic disorder.
 H.S.: