NOC Child Development Infant

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INTERVENTIONS

Assess behavioral states of the infant including: periods of quiet and active sleep, habituation, orientation, and self-consoling ability.

Introduce one caregiving intervention at a time, observing responses; allow for "time out" if infant displays stress signals, such as finger splaying, grimacing, tongue extension, worried alertness, spitting up, back arching, gaze aversion, yawning, hiccuping, color changes, or changes in cardiac or respiratory functioning.

Cluster caregiving, while not overstimulating infant; continuously monitor infant for signs of stress during caregiving, providing rest periods as needed.

Remain at bedside after procedures/ caregiving to assess infant's

RATIONALES

Assessment provides information about the infant's unique abilities to cope with environmental stimulation. Allows planning of individualized supportive care.

Prevents overstimulation and further maladaptation to the environment.

Promotes longer periods of alert and/ or deep sleep which will enhance the body's own natural defenses; providing rest periods will allow infant to recover prior to initiation of additional caregiving; prevents sudden disruptions in sleep; promotes stability and adaptive behaviors.

Prevents or minimizes maladaptive responses which often occurs up to response; if maladaptive responses occur, use "time-out" to allow infant to adapt.

Alter physical environment by decreasing light and sound. physiological functioning.

Facilitate handling by providing containment: holding infant's arms and legs in a flexed position, close to their midline using the caregiver's hands and/or positioning aids such as rolled blankets; premature or ill infants should be positioned prone or side-lying, maintaining soft flexion.

Place the infant in a flexed position with hands to midline, or swaddled with hands free; providing pacifier and/or fingers to suck on; providing objects to encourage hand grasping such as blankets, tubing, and fingers during caregiving.

Provide a primary care team to work collaboratively with the parents in developing an individualized plan of care reviewed daily and discussed at intervals with the parents.

Provide individualized feeding support determined by the infant's own needs and strengths; feeding focus should be positive and pleasurable, with attention to infant's cues or signals.

Provide optimal level of family support through utilization of family centered caregiving principles: enhanced parental involvement in all aspects of caregiving and decision-making; promote family comfort with homelike environment.

Assist parents in learning their infant's signals or cues and interpreting them appropriately.

Instruct and encourage parents in caregiving activities throughout the NICU stay, at a level parents are comfortable with (specify).

Teach and assist parents in promoting infant adaptive behaviors through use of containment, swaddling, promotion and maintenance of flexion, non-

20 minutes after caregiving is completed.

Prevents or decreases maladaptive behaviors; both light and sound levels in the NICU have been implicated in interfering with sleep and stable

Promotes flexion and stabilizes infant's motor and physiologic systems.

Promotes self-consoling/soothing behaviors which facilitate organization and adaptive behaviors.

Promotes element of trust for both the infant and family, improving parent-infant relationships; allows caregivers to identify infant's behavioral cues.

Promotes positive feeding experiences, that facilitate weight gain and feeding competency.

Promotes feelings of belonging and control which enhances parent-infant relationship.

Promotes positive parenting role and minimizes infant's maladaptive behaviors, promoting improved long-term growth and development.

Promotes improved parental confidence, enhances parenting skills, and improves parent-infant relationship/interactions.

Promotes positive adaptive behaviors in the infant and increases parental participation and feelings of control.

nutritive sucking, and finger grasping.

Encourage parents to personalize infant bed space by bringing in clothes, blankets to be used over isolettes/ cribs, and pictures from home.

Teach and encourage parental participation in Kangaroo care or skin-to-skin holding when infant is medically stable; this method is accomplished by placing infant on parent's chest under their clothing.

Support parents in making the difficult transition from hospital to home; allow ample time for teaching and communication of needs and feelings; validate feelings of anxiety as normal; give brief and accurate information, with time for clarification and provide supplemental written materials; allow parents permission to be in control of decisions and maintain structure in their own lives; discuss feelings of anger and guilt openly; adapt teaching and communication techniques to different family styles, customs, and cultures.

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