DR

Hind Mohammad Emara

Lecturer of pediatric Nursing
Faculty of nursing
Menofia university
 By the end of this module the third year
student should be able to identify, assess and
specify the role of pediatric nurse in
maintaining infant health during wellness.
Domain No 1: PROFESSIONAL AND ETHICAL PRACTICE
Competency Key elements Course Subject Subjects' objectives

Demonstrate 1.1.1 - - Health 1-Assess infant and

knowledge, Demonstrate Maintenance of child for daily care.
understanding, utilizing of the Infant. 2- Apply general
responsibility and legislative Assess measures for weaning
accountability of the framework and Eygption process.
legal obligations for the role of the schadual of 3- Carry out skills for
ethical nursing nurse infant health education,
practice and its regulatory immunization counseling and parents
functions. supports in response to
child vaccination.
4- Carry out prober
care for side effects of
vaccination
 Domain No 2: Holistic Patient-Centered Care
Competency Key elements Course Subjects Subjects objectives

2.1Provide 2.1.1Provide  Definition of  Discuss the vaccination

holistic and holistic nursing infantial period schedule in Egypt.
evidence- care that  Types of  Identify the particular
based nursing addresses the vaccination for safety measures related to
care in needs of infant. each child age group.
different individuals,  Identify the  Compare between
practice families and weaning periods importance and
settings. communities  Assess proper contraindications of
across the life weaning food. breast feeding
span.  Safety and injery  Differentiate between side
prevention effect of vaccination
 Design appropriate care
for an immunized infant
 Select appropriate clothes
for an infant.
 Routine Checkups.
 Dressing the infant.
 Dental care.
 Handling and holding the infant
 Caring for the diaper area.
 Breast-feeding.
 Vaccination.
 Weaning of children.
 Safety concern
 Nursing management
 Follow up activities
 After the newborn period, the baby enters a
period termed infancy period, which consider as
the first year of life. This is a year of extremely
rapid growth and development in all
dimensions. He learns trust through meeting
basic physiological and psychological needs .
 During the first year of life, at least six visits to
the health care facility are recommended.
 Usually occur at 2 weeks, 2 months, 4 months,
6 months, 9 months, and 12 months. During
these visits, the nurse assesses the infant's
growth and development, nutritional condition,
sleeping patterns, immunization and any
potential problems.
 Dressing the infant can sometimes create

dilemma, especially for the first-time caregiver.

Sometime, it is difficult just to get the clothes on

the baby, so the easiest way is to put an infant's

arm into a sleeve while holding the infant tightly.

 Clothes should be not too tight to allow freedom of
movement.

 Clothes should be appropriate to weather.

 Over dressing in hot weather cause over heating and

prickly heat rash.

 Dressing infant head covering when go to outdoors in

cold weather.

 Infants don't need hard shoes to allow appropriate

foot development.
 Teething begins in the second half of the first
year. The caregiver can start practicing good
dental hygiene through rubbing the gums and
newly erupting teeth with clean damp cloth
while holding the infant in the mother’s lap and
gently cleanse with plain water .
 Toothpaste is not recommended at this stage
because the infant swallow it .
 The new baby needs to be held but not to be handled
frequently. (excessive wrestling cause fretfulness, and
regurgitation of food).
 On the other hand, they need the comforting security
that come from being held while eating In handling
the infant, the head must be supported until the infant
is strong enough to do so unaided.
 The skin of the diaper area has special
needs for protection from the irritating
effects of urine and feces and prevention
of diaper dermatitis. These needs such
as diapers that absorb the excreta, as
well as products for cleansing and
conditioning the skin.
Factor may development of
diaper dermatitis
Prolonged exposure to excreta,
alterations in skin pH or
increased hydration, and changes
in skin microbial flora.
• Change wet or soiled diapers frequently to decrease
moisture on the skin.
• Gently clean the diaper area with water and a soft
washcloth.
• Pat dry baby’s skin. Do not rub. Allow the area to air dry
fully.
•
 Gently apply a thin layer of protective
ointment or cream with zinc oxide and/or
petroleum.
 Keep skin dry with a soft, absorbent, high
quality diaper that locks wetness away.
 Make sure diapers aren’t too tight so wetness
stays away from the skin
 A rash is severe, blistering or bleeding.
 The rash looks unusual.
 The rash doesn’t get better even with extra
care.
 1.Composition: breast milk is nutritionally
superior to any alternative and is easily
digestible.
 2.Convenience: it is ready to serve anytime
and any where, always fresh and supplied at
the proper temperature.
 3.Sterility: always sterile and has antinfective
properties as A immunogloblins A (IGA) which acts in
the gut against bacteria and viruses .
 B-lysozyme C- lactoferrine D-interferon
E-lactobilfidus bacteria

 4.Anti-allergic: allergy to breast milk is practically

nonexistent , it gives partial protection against some
allergic conditions/as infantile eczema .
Advantage to the mother:
1. Inexpensive.
2.Emotionally satisfying: for both mother and infant,.
3. Contraceptive effect: exclusive breast feeding inhibits
ovulation for the women, while, its not sure a contraceptive
method.
4. Cancer breast: the risk may be diminished particularly if
breast feeding is prolonged and repeated.
Contraindications or mothers.
 1. Mothers receiving a medications known to be
harmful on their infants.
 2. Severe debilitating disease e.g. chronic renal
failure, malignancy .
 3. Severe acute infection e.g. septicemia (temporary
contraindication).

 4. Local breast condition e.g. severe inverted

nipple, breast abscess until recovery.
 Obstacles in the baby:
 l- Congenital abnormalities.
 2. Nasal obstruction.
 3. Painful condition in the mouth.
 4. Birth trauma.
 5. Prermaturity.
 6. Pneumonia and other causes of respiratory
distress.
 Vaccine is an antigen which resulting
immunity against particular disease
Vaccines are prepared from
1. Live attenuated organism: as BCG,
Oral Polio Vaccine (sabin), measles,
rubella, and mumps.
2. Killed organism: as Cholera, Typhoid,
IM Polio Vaccine (salk)
3. Toxoids: eg Diphtheria and Tetanus
toxoid .
4. Genetically engineered: eg Hepatitis B
vaccine.
 Age Name of vaccine Type Dose and Rout

At birth 1-Oral Polio vaccine Live attenuated - 2drops orally

2-BCG Live attenuated Bovine 0.1ml, intradermal on the
Strain left deltoid
3- Hepatitis B HBV Genetic engineerin
2nd month 1-Oral Polio vaccine 1-Live attenuated (Sabin) - 2drops orally
2-Penta vaccine (Dephetria, Pertussis, 2-D&T (Toxoid), P (Killed) - 0.5 ml IM injection
Tetanus, HBV, haemophilus influenza HBV Genetic engineering

4th month & 6th month As the Second month As the Second month As the Second month

9th month Oral Polio vaccine

Vit A cap
12 months 1-Oral Polio vaccine 1-Live attenuated 1- 2drops orally
2-Measles, mumps, rubella (MMR) 2-Live attenuated 2-0.5ml subcutaneously
3-Vit A cap

18 months 1-Oral Polio vaccine Live attenuated 1-2drops orally

2- MMR Live attenuated 2-0.5ml subcutaneously
3- DPT D&T (Toxoid), P (Killed) 3- 0.5ml IM injection
4-Vit A cap
 It is a freeze dried vaccine containing
live attenuated bacilli (Bacillus
Chalmette–Guérin ) it should be given
in the first 3 months of life or it may
be given on the day of birth.
 The vaccine is injected intradermally,
the angle between the skin surface
and needle should not exceed than 15
degree in the middle of the left deltoid
region in dose of 0.1 ml.
 A satisfactory reaction produces a wheel about 5
mm in diameter which rapidly disappears, After 2-
3 weeks, the swelling becomes small abscess
which become a discharging ulcer about 10 mm
across. Then, ulcer heals by leaving a permanent
scar about 5 mm across.
 Mother should informed about the reaction and
advise her not to put any medicine on the ulcer.
 There are two types of vaccine that
protect against polio: inactivated
poliovirus vaccine (IPV) and oral
poliovirus vaccine (OPV). IPV is given as
an injection in the leg or arm, depending
on the patient's age. Polio vaccine may
be given at the same time as other
vaccines.
 Children get 4 doses of IPV at these
ages: 2 months, 4 months, 6-18
months, and a booster dose at 4-6
years.
 For oral polio vaccine 2 drops are given orally
each time Keep the vaccine in a cup containing
ice during the vaccination session and throw
away the vaccine that remains in the vial.
 Repeat the dose if the child spit out the drops.
 Breast feeding has no effect on the vaccine.
 If the infant has diarrhea do not post pane
vaccination and give extra 4th dose 4-8 weeks
after the 3rd dose.
 The 5-in-1 vaccine Dephetria, Pertussis,
Tetanus,( (DPT) hepatitis B vaccine
(HBV), haemophilus influenza is very safe
but, as with all medicines, a few infants
will have side effects. In general, side
effects are mild and short-lived. Most
infants won't have any problems at all.
 Pain, redness and swelling at the injection
site
 Fever
 Vomiting
 Abnormal crying
 Irritability
 Loss of appetite
 High fever (more than 39.5C)
 Fits or seizures
 making sure they don't have too many layers
of clothes or blankets on
 giving them cool drinks
 You could also give them
infant paracetamol to reduce their fever. Read
more about medicines for children.
 Call the doctor immediately if, at any time,
your baby's temperature gets higher
than 39C.
 MMR is made up of three different vaccines
(measles, mumps and rubella) and these can
each cause reactions at different times after the
injection.
Reaction after MMR vaccine
 After six to ten days, the measles vaccine starts to
work and may cause a fever, a measles-like rash,
and loss of appetite. Infants with vaccine-
associated symptoms are not infectious to others.
 Two to three weeks after the injection, the
mumps vaccine may cause mumps like
symptoms in some children (fever and swollen
glands).
 The rubella vaccine may cause a brief rash and
possibly a slightly raised temperature, most
commonly around 12 to 14 days after the
injection, but a rash may also rarely occur up
to six weeks later.
 It is a system of storage and transport of
vaccines at low temperature to preserve their
potency this is require at the health center
refrigerator, cold box, vaccine carrier and ice
packs.
 The term weaning means the gradual
introduction of semisolid and solid foods to
the infant gradually until he is accustomed
to the regular family diet.
 Exclusive breast feeding is sufficient for the
first 6 months. After that, the infant needs.
 1. Extra source of energy to maintain growth.
 2. Foods rich in iron to replace the deficiency.
Therefore prolonged breast feeding without
supplements will lead to poor growth rate, wasting
and iron deficiency anemia.
 Nutritious with high concentration of energy
and nutrients : protein, iron and vitamins.
 Semisolid with gradually in increased
thickness .
 Easily digestible
 Culturally acceptable
 Available: use locally available home - made
foods e.g. yogurt, soft cooked egg, rice, cereals,
mashed potatoes or bananas, mahalabia, belila
with milk fruits, tomato juice, vegetable soup, etc.

How to introduce weaning food:

 Start, by a small amount (1-2
teaspoonful) once daily then increase
gradually.
 The food should be sieved and smooth in
texture to be acceptable Then,
 Gradually increase in texture.
 Do not give 2 new foods together.
 Do not offer new food if he not well.
 Use the spoon and not the bottle.
 It is natural that the infant refuses or spits out the food at
the start. Keep trying every day until the infant takes the
food well.
 By one year, allow the infant to handle the food and feed
himself under supervision.
 The frequency of offering of weaning foods should be
gradually increased .
 Instruct the mother about proper hygienic measures.
 6th months: cereals and legumes, vegetable soup,
egg yolk, yogurt, soft cheese + breast milk.
 7th months: as for 6th months plus small pieces of
minced liver or chicken
 8th months: as for7th months plus minced meat.
 9-12th months: as for previous months with some
increase in quantity.
 2nd year: family food plus one glass of milk when
breast feeding stops.
 1. Contamination: weaning food should be
prepared, stored, and fed in -hygienic way.
 2. Offering non - nutrient food or insufficient
quantities:
 3. Allergy to certain new food may develop e.g
bananas, eggs. and fish.
 Accidental injuries are a leading cause of
hospitalization and death for young children.
 Children are at risk for injury from the moment they
are born.
 Therefore, injury prevention strategies must be
implemented even before newborns come home
from the hospital. As children grow, they become
more mobile. With this mobility comes a greater risk
for injury.
 falls
 Suffocation or Choking
 Poisoning
 Scalds and Burns
 Motor Vehicle Accidents
 Drowning
 Bodily damage
 Never leave infants on a raised surface, such as table.
 Always pull the crib side all the way up when children
are in the crib.
 Don't allow infant to sit on counter tops or play on
balconies unsupervised
 Cover all sharp furniture edges.
 Make sure all play areas are free of falling hazards
such as deep holes, glass or sharp objects.
 Avoid walkers especially near stairs.
 Dress infant in safe shoes and clothing.
 Strap children when using infant seats.
 Restrain children in automobile safety seats.
 Make sure infants are placed in safety seats
facing rearward instead of forward.
 Use required safety harnesses that come with
the child safety seat.
 Make sure the seat belts and/or harnesses used
to secure children into the safety seats are tight
enough and in the correct position.
 Never leave a stroller behind a parked car.
 Do not cover mattresses or pillows with plastic.
 Store all plastic bags, latex balloons and small
sharp object out of reach.
 Use baby powder cautiously.
 Never pin or tie pacifiers to children.
 Don’t feed infant while he is lying.
 Take an infant/child CPR course.
 Free small objects from any area that children’s
reach is.
 Infants should always be supervised in a
bath-tub.
 Keep bathroom door and lid on toilet closed.
 Tub and pails should be emptied completely
after each use.
 Children shouldn't be left unattended in tub
bath.
 Never leave infants unsupervised near water.
 Infants should always be supervised in a
bath-tub.
 Keep bathroom door and lid on toilet closed.
 Tub and pails should be emptied completely
after each use.
 Children shouldn't be left unattended in tub
bath.
 Never leave infants unsupervised near water.
 Infants should always be supervised in a
bath-tub.
 Keep bathroom door and lid on toilet closed.
 Tub and pails should be emptied completely
after each use.
 Children shouldn't be left unattended in tub
bath.
 Never leave infants unsupervised near water.
 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.
Thanks