A mother comes in with 9-month-old girl NRS 434

Re: Topic 1 DQ 2
Developmental markers for a 9-month-old female infantThe 9-month-old infant displays the 25^th percentile for both her height and head circumference, whereas her weight is in the 5^th percentile per the CDC growth chart. This shows that the infant is underweight. For further assessment of the patient’s healthy growth, the nurse will focus on both physical and mental developmental markers. Physical developmental markers include the ability to imitate words, butt scooching, crawling in the ground, waving, standing up unassisted, and rolling from back to the front among others (Rattana-Umpa, Tanwatthanakul, & Santiboon, 2021). Mental developmental markers include showing curiosity, remembering where specific items in the house are, playing, seeing colors, and expressing separation anxiety among others. Additionally, a 9-month-old is expected to display normal cognitive development assessed by characters such as the infant’s ability to play hide and seek and put things in the mouth among others (Rosas-Blum et al., 2018). The nurse will also need to assess the infant’s dental health and the impact of teething.

EBP Recommendations

The recommendations for the mother are based on the outcomes of the developmental assessment. The 9-month-old female infant is underweight, which narrows down the recommendations to proper feeding and nutrition. For instance, I would advise the mother to give the child solid foods first before breastfeeding to promote the number of calories and nutrition required for normal body weight. I will also advise the mother to adopt the most appropriate breastfeeding technic, to keep the child comfortable hence promoting good health (Agarwal et al., 2020). Such strategies are supported by EBP as displayed by the Intervention Nurses Starting Infants Growing on Healthy Trajectories (INSIGHT) and the WHO Guiding principles on complementary feeding of the breastfed child.

References

Agarwal, P. K., Xie, H., Rema, A. S. S., Rajadurai, V. S., Lim, S. B., Meaney, M., & Daniel, L. M. (2020). Evaluation of the Ages and Stages Questionnaire (ASQ 3) as a developmental screener at 9, 18, and 24 months. Early Human Development, 147, 105081. https://doi.org/10.1016/j.earlhumdev.2020.105081

Rattana-Umpa, N., Tanwatthanakul, J., & Santiboon, T. T. (2021). Associated indicator factors among inappropriate malfunctions’ development for the 9-month-old-baby. J Adv Pediatr Child Health. 2021; 4: 075-083. DOI: 10.29328/journal.japch.1001038

Rosas-Blum, E. D., Granados, H. M., Mills, B. W., & Leiner, M. (2018). Comics as a medium for parent health education: improving understanding of normal 9-month-old developmental milestones. Frontiers in pediatrics, 6, 203. DOI: 10.29328/journal.japch.1001038

A mother comes in with 9-month-old girl NRS 434

Re: Topic 1 DQ 2: A mother comes in with 9-month-old girl NRS 434
No child develops the same or at the same rate. You as the nurse should take the time to assess the infant as well as the family’s SDOH to identify risk factors that could potentially hinder the growth and development of ainfant/child. For an infant at the age of 9 months the developmental markers the nurse should assess for can vary. Regarding fine motor skills according to Green (2018), the child should be able to feed herself finger foods. If the infant is unable to complete this task the mother needs to assist with eating and continue to encourage the infant to advance and develop in order to meet their nutritional needs. Other tasks involve the infant being able to grasp items and transfer them from one hand to the other (Brusie, 2019). In addition, the infant should be able to crawl and sit up without support, pull self to a standing position using supportive objects, and start making step movements (Green, 2018). Regarding language development an infant 6-9 months should be babbling, blowing bubbles, and laughing (Green, 2018). During this age period the infant may be afraid of strangers and this can cause a lot of emotions for the infant. Cognitively they are learning to think, and problem solve on their own. They enjoy exercising these new skills by playing peek-a-boo, putting things in their mouth, and looking for things you hide (CDC, 2020). In terms of language and communication, the infant understands “No!” at this point and cancopy sounds and gestures of others (CDC, 2020). Regarding the infant’s physical measurements, the nurse should consider the environmental hazards the infant and mother is exposed to and the SDOH for the family.Recommendations to mothers of infants can vary according to each unique situation and list of needs. Incorporating games into your infant’s daily routine can encourage physical and cognitive growth according to Brusie (2019). It’s important to educate the mother on the expected growth for a child this age. For example, since birth the child should have grown 10 inches in length, display 0.25-0.5 inches of head growth per month, and should be getting close to tripling their birth weight by the age of 9 months (Brusie, 2019). Furthermore, the nurse should most importantly be educating the mother on the nutritional needs of an infant in this age category, especially in this scenario since the child is in the lower percentile of growth in each category. According to Brusie(2019) your baby needs 750-900 calories per day, of which half of those should come from breast milk (approx. 24 ounces). As stated by Brusie (2019) a child at 9 months of age often becomes distracted while breastfeeding and without proper intervention can cause inadequate feeding thus reducing daily intake which leads to low body weight and development. Some tips listed would be to nurse in a cool dim area, use a cover to prevent distractions, and gently tell your baby “No!” if they try to look around while being breastfed as they now know the meaning of “No” at this age (Brusie, 2019).ReferencesBrusie, C. (2019). VerywellFamily: Your 9-month-old Baby’s Development. Retrieved 4/29/20 from https://www.verywellfamily.com/your-9-month-old-baby-development-and-milestones-4172786

Centers for Disease Control and Prevention (CDC). (2019). Important Milestones: Your Baby By Nine Months. Retrieved 4/29/20 from https://www.cdc.gov/ncbddd/actearly/milestones/milestones-9mo.html

Green, S. Z. (2018). Health assessment: Foundations for effective practice. Chapter 1: Health assessment of the infant. Retrieved from https://lc.gcumedia.com/nrs434vn/health-assessment-foundations-for-effective-practice/v1.1/#/chapter/1

Topic 1 DQ 2: A mother comes in with 9-month-old girl NRS 434

The first year of life is a time of important growth and development that will have an impact on the rest of the baby’s health and well-being. The nursing assessment of the infant is important to screen for any delays that will require special interventions. When the nurse finds the infant is delayed in areas such as physical growth, developmental milestones, or psychosocial development, the nurse will have a better picture of other possible health concerns and will be able to promote health in order to prevent further delays that could have a life long impact.

At 9months of age, the infant should be developing fine motor skills as well as gross motor skills. Some fine motor skills that the nurse should see in the 9 month old would be banging objects on the table, moving objects from one hand to the other, feeding themselves finger foods and show signs of advancing onto behaviors like poking objects with one finger, drinking from a cup with help, pinching objects with the thumb and forefinger to pick them up, or taking objects out of a container. Some gross motor skills to look for are sitting up on their own, crawling, the ability to get into a standing position and standing with support and making stepping movements. At 9 months old the infant could be advancing onto more challenging actions such as getting into a sitting positions without help, standing alone, walking along furniture, possibly taking steps alone and have developed the concept of object permanence. (Green, para 8.) These are general guidelines and it is important to remember that not every infant will reach each of these markers in the same time frame. The infant at 9 months of age should be laughing, babbling, and blowing bubbles to imitating sounds, recognizing the word no, clapping, or pointing in order to develop language as well as exploring the car givers face and display attachment to the caregiver.

According to the website bump.com, the average 9-month-old female infant should weigh 18.1lbs and be 27.6 inches long. The infant in this situation weighs a bit under at 14.9lbs and 26.9 inches long, so according to these standards she is not quite up to the growth development standards. Some developmental delays the I would assess for are if the infant does not put weight on her legs when standing, doesn’t sit when assisted, doesn’t make babbling sounds like “mama” or “dada”, doesn’t respond to her name, and doesn’t pass objects from hand to hand. When it comes to the infants lower than expect size, I would ask the caregiver about the diet of the infant and determine if there are issues with breast feeding, or what kind of education the care giver needs. I would educate the caregiver to make sure that the infant is receiving nutrition every two to three hours, essentially three meals and two snacks. Adding foods to the diet of breast milk or formula is important during this time. By adding foods at one or two tablespoons at a time to see if the infant shows signs of still being hungry. I would stress the importance of balance with adding solid foods to the liquid diet. I would encourage this care giver to add more liquid nutrition as well as solid foods to the child diet.

Green, S. (2018) Chapter 1 in Health Assessment: Foundations for Effective Practice.URL:https://www.gcumedia.com/digital-resources/grand-canyon-university/2018/health-assessment_foundations-for-effective-practice_1e.php

Important Milestones: Your Baby By Nine Months. (2019, December 9). Retrieved from https://www.cdc.gov/ncbddd/actearly/milestones/milestones-9mo.html

The Bump. (2017, June 19). 9 Month Old Baby – Baby Month by Month. Retrieved from https://www.thebump.com/baby-month-by-month/9-month-old-baby

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A mother comes in with 9-month-old girl NRS 434