DOCSLIB.ORG

THE EFFECTIVENESS of ORAL SUCROSE in MANAGING INFANTS' PAIN DURING IMMUNIZATION Gad R F1, Abusaad FE2, Dowling DA3, Bassiouny MR4, Abd El Aziz MA5

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
THE EFFECTIVENESS of ORAL SUCROSE in MANAGING INFANTS' PAIN DURING IMMUNIZATION Gad R F1, Abusaad FE2, Dowling DA3, Bassiouny MR4, Abd El Aziz MA5 Mansoura Nursing Journal (MNJ) vol.6. No.1 - 2019 THE EFFECTIVENESS OF ORAL SUCROSE IN MANAGING INFANTS' PAIN DURING IMMUNIZATION Gad R F1, Abusaad FE2, Dowling DA3, Bassiouny MR4, Abd El Aziz MA5. 1Faculty of Nursing, Mansoura University 2Faculty of Nursing, Mansoura University 3Frances Payne Bolton School of Nursing, Case Western Reserve University 4Faculty of Medicine, Mansoura University 5Faculty of Nursing, Mansoura University Email of the corresponding author: [email protected] Abstract Treating pain during vaccination should be a part of pediatric primary health care around the world, as untreated pain in children has short and long-term consequences. Few studies of pharmacologic and non-pharmacologic methods of pain relief during immunization have been conducted in low-and-middle-income countries. Finding a cheap and effective pain intervention would improve primary health care. The current study aimed to evaluate the effectiveness of oral sucrose as a method of pain management during immunization among infants through six months of age. A randomized controlled experimental design was used. The study sample included 80 infants distributed into sucrose and control groups. Data were collected in an Egyptian primary health center. Outcome measures, including pain, as measured by the FLACC pain scale, crying time, and heart rate, were measured at three time points (before, during, and after injection). There were statistically significant differences during and after immunization (p<.001) reflecting lower: scores of pain, crying duration, and rising in heart rate for the sucrose group compared to the control group. The study supports the effectiveness of oral sucrose in managing infants' immunization pain and recommends for providing clinical setting with safe resources and education for proper administration of oral sucrose in pain management. Keywords: Immunization, Oral sucrose, pain management 1. Background and Significance Immunization is considered an complication is fear of injections for essential component of primary health care infants and their parents which leads to as a preventive health measure that occurs non or incomplete –adherence to frequently in childhood. Immunization immunization schedules. Negative produces immune-resistance to infectious experiences with injections lead to the diseases and it saves up to 3 million development of needle fears in some children each year (1). Intramuscular children. These consequences are injection is the commonly route used sometimes neglected or inappropriately during immunization. According to the treated in the infant population (5). Egyptian obligatory immunization To ensure infant safety and schedule, most of injections are given prevent long-lasting consequences related during the first 6 months of life (2). to immunization procedures, methods to Research evidence indicates that manage infants’ pain should be provided. Immunization is one of the most painful Interventions for pediatric procedure- procedures in infancy (3,4). This causes related pain in primary care include distress for the infants, parents, and pharmacological and non-pharmacological providers. The most important methods. Concerning pharmacological Gad R F et., al. methods, analgesia is not routinely used infants' pain during Immunization. The for infants under 6 months of age during study addressed the hypothesis of "Oral painful procedures such as immunization, sucrose will decrease the infants' painful heel lance , and venipuncture (6). experience during immunization". Although topical anesthetic [EMLA] such 2. Methods as lidocaine and prilocaine have been 2.1Study design and setting proved to be effective in decreasing A randomized controlled experimental vaccination needle-related pain in various study was conducted in Child Primary studies, it has to be applied for 20 to 60 Health Care Center (Reayt Tefl Awal), minutes before painful procedure located in Mansoura city, Dakahlia according to which commercial Governate, Egypt. preparation is being used. This pre- 2.2Sampling application time is not always available The study population included infants especially in a busy clinical area like aged two, four or six months who were vaccination clinics (7). Other attending the immunization clinic to pharmacological methods like vapocoolant undergo routine immunizations. Healthy sprays and ethyl chloride which not only breastfed infants who came to the clinic provide immediate onset of action and with their mothers are included in the approximately 20 seconds of dermal and sample. Infant exclusion criteria included epidermal anesthetic duration but also infant unable to tolerate oral fluids, or had produce unpleasant anxious cold sensation received paracetamol in the day prior to particularly in children who perceive it as immunization. The sample size was a painful sensation (8). Delayed onset of determined by using a power = .80 and a action, cost, and inconvenience of medium effect size (.5). The total sample Pharmacological methods have resulted in size was 80 infants, 40 infants in each outweighing of non-pharmacological ones group of the two (sucrose & control) regarding acute pain management (9). groups. Non-pharmacological methods 2.3Instruments have been shown to be effective, costless, Two instruments were used in this study. and convenient in reducing procedure- The first is the Demographic related pain. Administration of sweet- Characteristics instrument, which was tasting solutions, mainly sucrose, has developed for the purposes of the study. It been found to have a pain relieving includes the infant’s name, ID number, effect in both term and pre-term gender, age, weight, pre-injection state, newborns(10). Releasing an endogenous time since last feeding, and randomized opioid activated by the sweet taste is the group (A, B, or C). It was developed by mechanism in which oral sucrose reduces the researcher and revised by pediatric pain, (11). There are a large number of nursing experts. studies and evidence demonstrating The FLACC scale was used to measure analgesic effects of sweet solution in pain before, during, and after the neonatal population but, studies with older immunization injection. The FLACC infants especially those who live in Middle scale, developed by (13), measures pain Eastern countries are lacking (12). based on observations in five categories: Examining the use of non- facial expression, position of legs, activity, pharmacological methods for reducing cry, and consolability, scored 0-2 for each. immunization pain is necessary. The aim Total scores range from zero to ten; 0-4 of this study is to evaluate the indicates mild pain, 5-6 indicates moderate effectiveness of oral sucrose in managing 152 THE EFFECTIVENESS OF ORAL SUCROSE IN MANAGING etc… pain, while 7-10 indicates severe pain. crying time in response to injection up to 2 Interrater reliability is high 0.94 (14). minutes then she assessed the FLACC pain Additionally, crying time and heart rate score. changes were measured as indirect After injection, the researcher reassessed measures of pain. The infant’s crying the FLACC pain score while the second duration in response to the needle- related RA counted the infant's heart rate for one procedure was measured in seconds using full minute. the android application stopwatch (G Stop) The timing of the interventions before offered in Google play store (15). Crying injection was based on the determination was measured up to 2 minutes after of a systematic review (16) that found that injection. to be effective sweet solutions used for Procedure. infants beyond the neonatal period needed After the approval of the Research Ethics to be given not more than one minute Committee of Faculty of Nursing, before the painful procedure for Mansoura University, the official sustainability of the analgesic effect. After permission for conducting the study was finishing the study session, the RA gave obtained from Agency of Egyptian the infant the oral polio vaccine to Ministry of Health and health complete the infant’s required administration office in Dakahlia vaccinations. Governate. The research team consisted of 3. Data collection the researcher and three research assistants Data collection was carried out weekly (RA) who were associate degree nurses over 7 weeks in the spring season of 2015. working in the study setting. The number of participants ranged from The first RA determined if the mother met 15-20 every day. Each infant spent 4 to 6 the inclusion criteria and obtained a minutes in the vaccination room. written consent. 4. Statistical analysis Eighty cards marked A or B were arranged Data were analyzed with SPSS version 21. in a small box; where the first RA nurse Discrete data were described using number asked the eligible infant’s mother to and percent. Association between choose a card from the cards box that categorical variables was tested using Chi- indicated the assigned group: sucrose square test. Data of the study were meeting (Group A) or control group (Group B). In the criteria of parametric data using the vaccination room, the second RA Shapiro-Wilk Test of Normality. assisted the mothers to be seated in a chair Continuous variables were presented as and in holding the baby in a right-sided, mean ± SD (standard deviation) and cradled position then she counted the compared with Student t test. All statistical infant's heart rate for one full minute. After tests were done at fixed values the researcher assessed the FLACC pain significance
Load more

Recommended publications
  • The Crying Baby: Differential Diagnosis and Management Plan
    ACTA SCIENTIFIC PAEDIATRICS Volume 2 Issue 7 July 2019 Review Article The Crying Baby: Differential Diagnosis and Management Plan Gihad I Alsaeed1*, Ibrahim G Alsaeed2 and Mohamed G Alsaeed3 1Department of Pediatrics, Al-Takhassusi Hospital, Saudi Arabia 2Intern Medical Student, Faculty of Medicine, Milan University, Italy 3Intern Medical Student, Faculty of Medicine, Pavia University, Italy *Corresponding Author: Gihad I Alsaeed, Department of Pediatrics, Al-Takhassusi Hospital, Saudi Arabia. Received: May 20, 2019; Published: June 17, 2019 DOI: 10.31080/ASPE.2019.02.0093 Abstract Crying baby is one of the most common causes of Emergency Room visits during infancy and is associated with adverse outcomes organic causes that could be serious or life threatening if not diagnosed early. The aim of this article is to illustrate the organic and for some mothers and babies. 20% of parents report problems with their Infant crying in the first 3 months. 5% of crying babies have non-organic causes of crying baby and to outline a professional approach and management plan. Keywords: Crying Baby; Infantile Colic; Formula Intolerance; Cow'S Milk Allergy; Breast Feeding Problems; Organic Causes; Crying Medication Introduction peaks at 6 weeks of age. Abnormal crying, by contrast, may occur at any time, with no response to parental soothing, and could be as- infancy; an explosion of feelings that might be disclosed or deliv- sociated with painful characters, pallor, cyanosed or mottled skin, Crying is the first communication skill to be developed in early ered in the form of the systemic activity of crying. Crying could be tearing, sweating, vomiting, or abnormal movements.
    [Show full text]
  • The Crying Baby: What Approach? Pamela S
    The crying baby: what approach? Pamela S. Douglasa and Peter S. Hillb aDiscipline of General Practice, University of Purpose of review Queensland and bSchool of Population Health, University of Queensland, Herston, Queensland, Cry-fuss problems are among the most common clinical presentations in the first few Australia months of life and are associated with adverse outcomes for some mothers and babies. Correspondence to Pamela S. Douglas, MBBS, Cry-fuss behaviour emerges out of a complex interplay of cultural, psychosocial, FRACGP, General Practitioner, Adjunct Senior environmental and biologic factors, with organic disturbance implicated in only 5% of Lecturer, Discipline of General Practice, University of Queensland, Royal Women’s and Children’s Hospital, cases. A simplistic approach can have unintended consequences. This article reviews Herston 4027, QLD, Australia recent evidence in order to update clinical management. Tel: +61 432982831; e-mail: [email protected] Recent findings New research is considered in the domains of organic disturbance, feed management, Current Opinion in Pediatrics 2011, 23:523–529 maternal health, sleep management, and sensorimotor integration. This transdisciplinary approach takes into account the variable neurodevelopmental needs of healthy infants, the effects of feeding management on the highly plastic neonatal brain, and the bi-directional brain–gut–enteric microbiota axis. An individually tailored, mother- centred and family-centred approach is recommended. Summary The family of the crying baby requires early intervention to assess for and manage potentially treatable problems. Cross-disciplinary collaboration is often necessary if outcomes are to be optimized. Keywords breast-feeding, colic, infant, infant crying, infant feeding, sleep Curr Opin Pediatr 23:523–529 ß 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 1040-8703 and child abuse [10,11].
    [Show full text]
  • Etiology of Excessive Crying in Infants Aged Between 1 Month to 12Months in Peripheral Institute of Himachal Pradesh, India
    www.ijcrt.org © 2020 IJCRT | Volume 8, Issue 6 June 2020 | ISSN: 2320-2882 ETIOLOGY OF EXCESSIVE CRYING IN INFANTS AGED BETWEEN 1 MONTH TO 12MONTHS IN PERIPHERAL INSTITUTE OF HIMACHAL PRADESH, INDIA 1Subhash chander, 2Avishek dhiman 1Dr Subhash Chander, MD Pediatrician, Civil hospital, Jwalamukhi, Kangra Himachal Pradesh 2Dr Avishek Dhiman MS ENT, Civil hospital, Jwalamukhi, Kangra Himachal Pradesh Abstract Inconsolable crying conveys the evidence about an infant’s state as well as mental health which, when carefully seen can provide diagnostic information for parents and clinicians. When crying is inconsolable and imprudent, it can stress parents, disrupt parenting and in rare cases, make infant at risk for abuse. Around 25% of all infants cry excessively during their first months of life. This phenomenon has been termed “infant colic.” In most cases, clinicians are unable to determine the cause of the colic. In this study we are finding causes for the excessive cry in infants aged between1month to 12 months. The causes for the excessive crying like infantile colic, nasal blockade, diaper rash, hunger, acute otitis media, and post vaccination febrile illness, cow milk protein allergy, flatulence, fever, sepsis, and meningitis, foreign body in eye, hair tourniquet syndrome and excessive maternal concern were studied. Key words: excessive cry, infantile colic, acute otitis media Introduction Inconsolable infant behaviour and colic are usually used to express a range of behaviours in infants aged up to 1 year that include prolonged episodes of crying, difficulties with sleeping and also feeding1. Studies suggest that it is 20% prevalent and incidence rate is equal between both genders2-3.
    [Show full text]
  • Clinical an Urgent Care Approach to Excessively Crying Infants
    Clinical An Urgent Care Approach to Excessively Crying Infants Urgent message: Infants who cry excessively pose a challenge to physi- cians and parents. A systematic approach to the history and physical exam can guide the diagnostic approaches to determine if a benign—or serious— condition is responsible. TONI CLARE HOGENCAMP, MD rying is a primitive form of communication that infants Crely on to communicate their distress. Because infants cannot verbalize their discomfort, they must rely on their cry to communicate with caregivers. Estimates indicate that infants cry a total of 1 to 2 hours per day. Newborns cry the least, but crying steadily increases during the first few weeks to a peak of approx- imately 3 hours per day at about 6 to 8 weeks of life, after which it declines. It is often the excessive crying, when the total hours are consolidated or when the infant is inconsolable, that is the most stressful for parents.1 Parents may complain of excessive crying or excessive fussiness and may describe their infant as “colicky” or irritable. Most parents seek care when they are con- cerned that there is a serious medical problem respon- sible for the crying, whereas others seek care when they have become exhausted. The list of potential etiologies for excessive crying can © Corbis.com be exhaustive, but studies suggest that from 5% to 60% of infants evaluated in an emergency department (ED) from benign colic to serious conditions, such as menin- for excessive crying have a serious medical condition.2-3 gitis, congenital heart disease (CHD), and abusive head A more recent, prospective study of 254 infants present- trauma.
    [Show full text]
  • Approach to Infantile Colic in Primary Care
    Singapore Med J 2019; 60(1): 12-16 Practice Integration & Lifelong Learning https://doi.org/10.11622/smedj.2019004 CMEARTICLE Approach to infantile colic in primary care Teck Meng Lawrence Lam1, MBBS, Poh Chong Chan2, MMed, MRCPCH, Lay Hoon Goh1, MMed, FCFP Ms Sally Tan, a first-time mother, took her two-month-old baby boy Ayden to see you, their family doctor. Ayden had been crying incessantly for the past two weeks and Sally was at her wits’ end. She said that Ayden usually cried for 3–4 hours in the evenings, causing a lot of frustration for Sally and her husband, as they were unable to find the reason for his crying and could not console Ayden. Sally was keen to try oral simethicone because she had read online that it was effective. WHAT IS INFANTILE COLIC? caregivers. Often, the diagnosis of colic can be provided to the Colic or excessive crying is a common benign, self-limiting family once other possible causes are excluded. The features of condition that can occur in 40% of infants.(1,2) Although it is one of paroxysms, qualitative differences in crying and hypertonia can the most distressing problems of infancy,(2-4) it has no clear cause, be used to distinguish colic from normal crying. no gold standard remedy or preventative action.(5,6) It is common for infants to cry more during the first three months of life, with a Paroxysms mean duration of crying of two hours per day.(2) When the baby Episodes usually happen in the evening hours and are unrelated is aged 10–12 weeks, the mean duration of crying decreases to the baby’s prior activity.
    [Show full text]
  • The Health of Your Child
    Anglais THE HEALTH OF YOUR CHILD Recommendations for parents English-French Vocabulary Hello Bonjour My child’s name is Mon enfant s’appelle My child is …. Months old Mon enfant a …. mois My child is …. Years old Mon enfant a …. ans I am pregnant Je suis enceinte My child is sick Mon enfant est malade My child has fever Mon enfant a de la fièvre My child has a cough Mon enfant tousse My child is having problems breathing Mon enfant a de la peine à respirer My child has been sick Mon enfant a vomi My child has diarrhoea Mon enfant a des diarrhées My child has a sore tummy Mon enfant a mal au ventre My child experiences a burning sensation Mon enfant a des brûlures when urinating en faisant pipi My child has fainted Mon enfant a fait un malaise My child has skin problems Mon enfant a un problème de peau My child has been injured Mon enfant s’est blessé My child is constipated Mon enfant est constipé My child is crying Mon enfant pleure My child does not eat/drink anymore Mon enfant ne mange plus/ne boit plus My child is hungry/thirsty Mon enfant a faim/soif My child is bleeding Mon enfant saigne My child has a runny nose Mon enfant a le nez qui coule My child fell Mon enfant est tombé My child is allergic to… Mon enfant est allergique à… I need help J’ai besoin d’aide I need to go to Accident and Emergency Je dois aller aux urgences I need to see a doctor/dentist Je dois voir un médecin/dentiste Where is the hospital? Où se trouve l’hôpital? It is an emergency! C’est une urgence! Medicine Médicaments Thermometer Thermomètre Band-aid Pansement Table of contents The body ..................................................................................................
    [Show full text]
  • Brief Interventions: the Crying Infant Bi-Ped Project
    BRIEF INTERVENTIONS: THE CRYING INFANT BI-PED PROJECT (BRIEF INTERVENTIONS: PEDIATRICS) Emotional Health Committee Maryland Chapter American Academy of Pediatrics Barbara Howard M.D. and Ken Tellerman M.D. (This article is an updated version of Dr Howard’s article that originally appeared in Pediatric News 2009 http://www.pediatricnews.com/columnists/behavioral-consult.html) All babies cry, but some babies cry a lot. Some infants will have real pathology such as GERD, food allergies, volvulus, a hair tourniquet or an injury. However, the vast majority of high crying infants are not ill but are instead suffering from overstimulation or a normal but immature digestive system. Keep in mind that although your level of concern may be low, parental anxiety may be extremely high particularly in the case of new parents. In what has been referred to as the “fourth trimester”, babies and mothers are making significant adjustments during the first few months of life and the inability of a parent to comfort their infant can be emotionally devastating. An extremely fussy baby for which there is no quick fix is also a challenging problem for the pediatric practitioner. What’s more is that the stakes couldn’t be higher because a third of child abuse occurs in the first 6 months of life. Why on earth would parents vigorously shake or physically injure a defenseless newborn? Because the parents are physically exhausted and the baby won’t stop crying despite traditional interventions: breastfeeding or bottle feeding, a new diaper, rocking and cradling. Pediatric practitioners may grasp for a solution that is quick to implement, advising a switch of formulas or worse, suggesting a breastfeeding mother switch to formula.
    [Show full text]
  • Understanding and Responding to Unsettled Infant Behaviour
    Understanding and responding to unsettled infant behaviour A discussion paper for the Australian Research Alliance for Children and Youth Prepared by Jane Fisher, Heather Rowe, Harriet Hiscock, Brigid Jordan, Jordana Bayer, Anne Colahan and Vivienne Amery Understanding and responding to unsettled infant behaviour: A discussion paper for the Australian Research Alliance for Children and Youth Prepared by: Jane Fisher i,ii, Heather Rowe i, Harriet Hiscock iii, Brigid Jordan iv, Jordana Bayer iii, Anne Colahan v, Vivienne Amery vi i. Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria 3168 ii. Masada Private Hospital Mother-Baby Unit iii. Centre for Community Child Health Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute, Parkville, Victoria 3052 iv. Social Work Department & Infant Mental Health Group, Royal Children’s Hospital Melbourne, Murdoch Children’s Research Institute, Parkville, Victoria 3052 v. Maternal & Child Health Service, Victorian Department of Education and Early Childhood Development, Melbourne, Victoria 3000 vi. Tweddle Child and Family Health Service, Footscray Victoria 3011 About ARACY ARACY is a national non-profit organisation working to improve the wellbeing of children and young people by advancing collaboration and evidence-based action for all Australia’s children and young people. Despite Australia being a wealthy, developed country, crucial aspects of the health and wellbeing of our young people have been declining. ARACY was formed to progress evidence-based action to prevent the major problems affecting children and young people. ARACY tackles these complex issues through building collaborations with researchers, policy makers and practitioners from a broad range of disciplines.
    [Show full text]
  • Caring for Babies with Prenatal Substance Exposure
    CARING FOR BABIES WITH PRENATAL SUBSTANCE EXPOSURE Ministry of Children and Family Development Vancouver Coastal Region In partnership with Acknowledgements ACKNOWLEDGEMENTS 2nd Edition updated December 2003, Ministry of Children and Family Development (MCFD), British Columbia Radhika Bhagat, MN, RN, & Pam Munro, MSN, RN Review and Contributions: • Child Development Centre, Prince George: Linda Martindale, Physiotherapist, Carol Oosthizen, Speech & Language Pathologist • Foster Parents: Colleen Anderson, Lorraine Jamieson, Laura Lang, • Forest Cottage Coaching: Tanya Helton-Roberts, www.ForestCottageCoaching.com • Infant Development Program: Bonnie Barnes, IDP Consultant, Vancouver; Dana Brynelson, Provincial Advisor, Annie Wolverton, Regional Advisor, Lower Mainland. • Ministry for Children and Family Development, /Vancouver Coastal Region: Sandi Karmel, Resources Social Worker, Lyna Kiviste, Resources Supervisor • Sunny Hill Health Centre for Children: Janice Duivestein, Lois Woo, & Nicole Raftis, Occupational Therapists; Janet Schlenker, Clinical Paediatric Dietitian • Vancouver Coastal Health Authority: Leslie Cochrane & Laraine Michalson, Community Health Nurses, Sheway Program; Corinne Eisler, Anne Swann, Nutritionists; Sue Wastie, Speech & Language Pathologist; Tana Wyman, Dental Program Coordinator • University of BC: Paul Thiessen, M.C.,F.R.C.P,(C), Clinical Professor, Pediatrics Pictures: Lenora Marcellus, MSN, RN, Mitch Stringer, & MCFD Illustrations: Infant Development Program & Doug Quiring The 1st Edition of this guidebook
    [Show full text]
  • INFANT CRYING Theoretical and Research Perspectives \0 Sarai,} Z
    INFANT CRYING Theoretical and Research Perspectives \0 sARAi,} z. WtLlv YsU llwAvs. I '-', II c. CI.. r-"'-- fa r- '1 <:J lJ o.l\lJ~: ~\~L~o~'\\ ~ crL1tf\j . 6 ~ Written by 8-year-old Alyssa to her S-year-old sister, Sarah INFANT CRYING Theoretical and Research Perspectives Edited by Barry M. Lester and C. F. Zachariah Boukydis The Children 's Hospital and Harvard Medical School Boston, Massachusetts PLENUM PRESS • NEW YORK AND LONDON Library of Congress Cataloging in Publication Data Main entry under title: Infant crying. Includes bibliographies and index. 1. Crying. 2. Infant psychology . 3. Crying-Research. 4. Interpersonal communica­ tion in children. I. Lester, Barry M. II. Boukydis, C. F. Zachariah. [DNLM: 1. Com­ munication-in infancy & childhood . 2. Crying-in infancy & childhood . 3. Language Development. WS 105.5.E5 143] BFnO.C78154 1985 155.4'22 84·26414 ISBN-13: 978-1-4612-9455-9 e-ISBN-13: 978-1-4613-2381-5 DOl: 10.1007/978-1-4613-2381-5 © 1985 Plenum Press, New York Softcover reprint of the hardcover 1st edition 1985 A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise , without written permission from the Publisher To our fathers, Norman C. Lester and A. Charles Boukydis, and to John Lind, one of the fathers of cry research. Contributors MARTIN BAX, Community Paediatric Research Unit, St.
    [Show full text]
  • Resource Manual Section F. Other Nutritional Concerns
    Feeding Healthy Term Infants Resource Manual Section F. Other Nutritional Concerns F.1 Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) Overview Gastroesophageal reflux (GER) occurs when gastric contents pass into the esophagus with or without regurgitation (“spitting up”).1 It is due to temporary relaxation of the lower esophageal sphincter or inadequate adaptation of the sphincter tone to changes in abdominal pressure.2 GER is a normal physiologic process that can occur several times a day in healthy infants.1 Regurgitation occurs daily in approximately 50% of healthy term infants 0-3 months of age, 67% of infants 4 months of age and only 5% of infants by 10-12 months of age.2 Most infants who regurgitate have no symptoms or complications and do not require treatment.1 GER is relatively common in healthy infants and generally resolves between 6-12 months.3 Gastroesophageal reflux disease (GERD) occurs when gastric reflux leads to symptoms or complications.1 Investigation of GERD is necessary when there is recurrent vomiting with poor weight gain, excessive crying or irritability, disturbed sleep, feeding problems or respiratory problems.2 Recommendations a) Most infants with uncomplicated GER can be managed conservatively with parental education and reassurance regarding its natural course. b) In otherwise healthy appearing infants with effortless regurgitation, a history and physical exam may be sufficient to diagnose uncomplicated GER. It is recommended that health care providers obtain a thorough feeding history, observe feeding behaviour and obtain measures of infant growth to assist in diagnosing and monitoring the severity of GER. c) Breastfeeding should not be discontinued due to regurgitation.
    [Show full text]
  • Community Paediatric Review Vol 15 No 3
    Fluid Intake in Infants and Young Children Problems with too many sweet drinks Illness/Fever When children are unwell they may not feel like drinking Sweet drinks such as cordial, soft drink, sports drinks and Why water is important children are consuming spring or rain water, a fluoride or eating despite an increased need for fluids. This is an supplement may be necessary but this should be fruit juices are not necessary for children and excess Water has many important roles in the body. It helps appropriate time to offer flavoured beverages such as discussed with the child’s dentist. consumption can contribute to common nutritional c p r Community Pædiatric Review transport nutrients, maintains blood volume, regulates watered down juice or flat and diluted soft drink to problems. A NATIONAL PUBLICATION FOR COMMUNITY CHILD HEALTH NURSES AND OTHER PROFESSIONALS body temperature and removes waste products. Milk or milk products are essential for ensuring young encourage fluid intake and provide some energy children (over 12 months) have an adequate intake of key • Toddler Diarrhoea (kilojoules). Infants and young children: Juices and soft drinks are especially concentrated and nutrients such as calcium and zinc. However, too much Gastroenteritis/Diarrhoea some children may find it difficult to digest such large www.rch.org.au/ccch Sleep and Settling Development in Infants • Have a higher metabolic rate which increases heat milk may contribute to nutrient deficiencies as the child Maintaining hydration is critical in children with loads of sucrose or fructose. Managing toddler production, waste products and fluid requirements. will easily fill up on milk at the detriment of other foods.
    [Show full text]