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Infant Assessment and Development © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC CHAPTER NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION 14 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Infant Assessment and Development © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION newborn’s abilities and behaviors are linked closely to Peristalsis Sudden infant death A breastfeeding. Therefore, an understanding of newborn Placid baby syndrome (SIDS) reexes and characteristics is important when assessing Projectile vomiting Sudden unexplained infant breastfeeding. The lactation consultant can identify and help © Jones & Bartlett Learning, LLC © JonesProne & Bartlett Learning, LLCdeath (SUID) parents learn to watch and interpret their babies’ behaviors. In NOT FOR particular,SALE OR babies DISTRIBUTION signal to their mothers through hunger cues.NOT FORPyloric SALE stenosis OR DISTRIBUTIONSupine Patterns of behavior, growth, sleeping, crying, and digestion Rapid eye movement Swaddling vary from one baby to another. Certain infant conditions may (REM) rush require a change in your approach to assisting a mother. A Reexes Turgor complete medical history and assessment of the mother and Rooting Uvula infant will help you identify© Jones situations & that Bartlett may affect Learning, lactation. LLCSling © JonesVentral & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTIONSpitting up NOTVoiding FOR SALE OR DISTRIBUTION Sucking Yeast infection Key Terms Acrocyanosis© Jones & Bartlett Learning,Fontanel LLC © Jones & Bartlett Learning, LLC AlveolarNOT ridge FOR SALE OR FoodDISTRIBUTION sensitivity NOT FOR SALE OR DISTRIBUTION Approach behaviors Frenulum Assessment of the Newborn Asymmetry Frenum A newborn’s rst assessment will be documented by Average baby Gastroesophageal reux means of an Apgar score, which ranges from 0 to 10 (see Avoidance behaviors (GER) Table 14-1). e Apgar score is performed at 1 minute © Jones &Bauer’s Bartlett response Learning, LLCGastroesophageal reux © Jonesof life & andBartlett again at Learning, 5 and 10 minutes. LLC e score rates ve NOT FOR BifurcatedSALE OR or bidDISTRIBUTIONdisease (GERD) NOT FORcomponents: SALE heartOR DISTRIBUTIONrate, respiratory eort, muscle tone, Bovine IgG Grooming reex irritability, and color, each of which is given a score Buccal pads Hirschsprung’s disease of 0, 1, or 2. e score oers a quick status of the newborn Candidiasis Hunger cues and the response to resuscitation if needed (American Caput succedaneum Hydration Academy of Pediatrics [AAP], 2008). Scores are inu- Cephalhematoma © JonesHypertonic & Bartlett Learning, LLCenced by drugs, trauma, congenital© Jones anomalies, & Bartlett infections, Learning, LLC Clavicle NOT FORHypotonic SALE OR DISTRIBUTIONhypoxia, hypovolemia, andNOT prematurity. FOR SALEIf you work OR with DISTRIBUTION Cle lip Infant acne newborns in a hospital, Apgar scores are an intrinsic Cle palate Intravenous part of the baby’s information. If you work with the baby Colic Lactase aer hospital discharge, be aware that Apgar scores have Constipation Lactase deciency (lactase less relevance. However, low 5-minute scores, with other Cosleeping© Jones & Bartlett Learning,non-persistence) LLC markers, ©may Jones identify & infantsBartlett at riskLearning, of developing LLC sei- Cow’sNOT milk FOR allergy SALE OR LactoseDISTRIBUTION overload zures. It alsoNOT gives FOR you SALEa snapshot OR of DISTRIBUTIONa baby who may have Dancer hand position Leukocytes had a challenging transition at birth with ensuing feeding Diaper rash Macular diculties. Diarrhea Molding Generally, your initial contact with a breastfeeding Down syndrome New Ballard Scale (NBS) mother would include an assessment of her baby. is © Jones &Erythema Bartlett toxicum Learning, LLCPalate © Jonesguideline & Bartlett applies Learning,especially when LLC there is concern about NOT FOR FlexionSALE OR DISTRIBUTIONPeriosteum NOT FORpoor weightSALE gain, OR foodDISTRIBUTION intolerance, irritability, lethargy, 293 © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 9781284078954_CH14_293_230.indd 293 18/06/15 6:35 pm 294 CHAPTER 14 Infant Assessment and Development © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FORTABLE SALE 14-1 OR Apgar DISTRIBUTION Score NOTHypotonia FOR SALE OR DISTRIBUTION Five factors are used to evaluate the baby’s condition, and A hypotonic infant has very low body tone and tends to each factor is scored on a scale of 0 to 2, with 2 being the “droop” over the examiner’s hand. e extremities are best score. in extension, and there is minimal resistance to passive 1. Activity and muscle tone © Jones & Bartlett Learning, LLCmovement. e baby appears ©oppy, Jones sluggish, & Bartlett and accid Learning, LLC 2. Pulse (heart rate) (see Figure 14-1). A hypotonic baby may have diculty 3. Grimace response (medicallyNOT known FOR as SALE “reex irritability”)OR DISTRIBUTIONstaying latched to the breast becauseNOT FORof a weak SALE suck. ORHe or DISTRIBUTION 4. Appearance (skin coloration) she may nd it dicult to maintain intraoral negative pres- 5. Respiration (breathing rate and effort) sure, even on the examiner’s nger. e infant frequently nurses with the shoulders elevated to just beneath the ears © Jones & Bartlett Learning, LLC in an eort ©to Jonessupport the& Bartlettneck and chin.Learning, In the ventral LLC position, the hypotonic baby lays over the examiner’s hand NOT FOR SALE OR DISTRIBUTION with the headNOT hanging FOR down, SALE unable OR to bringDISTRIBUTION it up. or sucking diculties. To perform the assessment, the Hypotonia is a marker for certain syndromes and neu- baby should be completely undressed and lying on a at rologic disorders. In fact, ineective sucking and hypo- rm surface. Evaluate the infant’s posture, skin, head, tonia are oen symptoms of an underlying problem, not oral structure, clavicle, reexes, color, elimination, and © Jones & Bartlett Learning, LLC © Jonesthe problem & Bartlett itself. ItLearning, may be associated LLC with prematu- hunger cues. Be alert for any areas on the baby’s body that rity, Down syndrome, autism spectrum disorder (ASD), NOT FORcause SALE pain orOR discomfort. DISTRIBUTION NOTPrader-Willi FOR SALE phenotype OR DISTRIBUTION of fragile X syndrome, or botu- If you are unfamiliar with assessing newborns, you will lism infection. nd the New Ballard Scale (NBS) helpful in assessing the normal newborn (see Table 14-2). is gestational assess- Hypertonia ment tool evaluates the tone of the infant’s total body, wrist, biceps muscle, knee© Jonesjoint, shoulder & Bartlett girdle, andLearning, pel- ALLC hypertonic infant has very rigid© Jones body tone. & With Bartlett hyperto Learning,- LLC vic girdle. “Girdle” refersNOT to the FOR bones SALE that encircleOR DISTRIBUTION the nia, the baby is oen in hyperextension,NOT FOR arching SALE away OR from DISTRIBUTION shoulder and pelvis. A detailed description and free online the breast and the mother (see Figure 14-2). e mother illustration of the scale are available at www.ballardscore. may report that her baby is dicult to comfort, pulls away com. Chapter 24 covers preterm infants, and Chapter 26 from contact, and does not snuggle into her chest or neck. discusses a variety of infant medical conditions. Instead, her baby leans back and away from her. © Jones & Bartlett Learning, LLC Many hypertonic© Jones babies & Bartlett cannot tolerate Learning, anyone LLC han- dling them and prefer to interact from a safe distance. PostureNOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION ey are oen very alert and squirmy, and they will hold Babies favor the fetal position, and healthy, full-term their heads erect from a prone (face-down) position or newborns generally hold their arms and legs in moderate on the shoulder. When held in the ventral position, a exion. eir sts are closed and usually held near their hypertonic baby will be virtually straight, liing both the © Jonesface. & Bartlett When awake, Learning, the infant LLC resists having the extremi- © Joneshead and & Bartlettbuttocks and Learning, maintaining LLC them on a horizontal NOT FORties SALE extended OR and DISTRIBUTION may cry at attempts to do so. As babies NOTplane. FOR Hypertonia SALE OR is associatedDISTRIBUTION with neurologic damage mature, they remain in the fetal position less oen and or disorders, respiratory syncytial virus (RSV) infec- will spend more time comfortably in semi-extension. tion, and prenatal drug exposure (including cocaine and Observing the baby’s body tone will give you clues about methamphetamine). potential problems. When held in the ventral (abdom- inal) position, normal ©infants Jones lie &on Bartlett their abdomen, Learning, SkinLLC © Jones & Bartlett Learning, LLC draped over the examiner’sNOT hand, FOR and SALE alternate OR between DISTRIBUTION NOT FOR SALE OR DISTRIBUTION trying to bring their head up and putting it down again. A healthy newborn’s skin is warm and dry, with a pink or At extreme positions, a baby’s body tone may be too loose ruddy appearance. e ruddiness is a result of increased (hypotonic) or too rigid (hypertonic). concentration of red blood cells in the blood vessels, Babies whose mothers have taken antidepressants in the coupled with minimal subcutaneous fat deposits. Small selective© Jonesserotonin & reuptake Bartlett inhibitor Learning, (SSRI) LLC class may moles and birthmarks© Jones are & notBartlett uncommon.
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