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OCN LEVEL 4 POSTNATAL MATERNITY NURSE CARE AWARD

Introduction

Sudden Infant Death Syndrome is the sudden and unexplained death of an infant or a child. In recent times, a lot of cases related to sudden infant death have been found. This made the issue quite serious. There are a few preventive methods that can be used to tackle this issue. This includes back to sleep, breastfeeding, sleeping in the same room as the parents, etc. In this report, we will talk about the such issue along with the importance of a good night’s sleep for the baby and the parents. There are various sleeping theories that are being adopted by parents that can help them and their child to sleep better which would be mentioned in the research. Some of the diseases that a child any suffer will also be mentioned to get a better overview. Along with this breastfeeding and its importance and the proper position and attachment when it comes to breastfeeding will be discussed in the article.

Back to Sleep

Protective measure

The back to sleep is said to be a very effective method when it comes to preventing the risk of Sudden Infant Death Syndrome. In this method, the infant is made to sleep on his or her back. In this method, the child is made to sleep on the back for around one year of age. In this method, the baby is made to sleep to sleep on his back rather than on his stomach or any other body part (LaPorta and PGY, 2016). If the baby rolls on in his sleep from his back then it is alright, but for this measure to be effective the main focus is to make the baby sleep on his back.

Why this reduces the risk of SIDS

This is because as compared to all the other positions sleeping on the back provides solid support to the child. It is found that this measure has reduced the death percentage of the child to a huge level making it very effective in its existence. The Back to sleep measure is said to reduce the risk of cot death which is very common in the first year of child’s life. As they are more likely to choke on their stomach as compared to the back, this method reduces the risk of Sudden Infant Death Syndrome making it very much in use in the current scenario.

Breastfeed

Protective measure

Breastfeeding is also a very crucial way through which one can prevent Sudden Infant Death Syndrome. It is even said that breastfeeding can reduce the risk of the disease by about fifty percent. There are various types of research that state the same. The nutrients in the milk of the mother are such are helpful in the control and reduction of the disease to a such a great extent. It is therefore suggested to breastfeed the child until at least six months after birth to make them strong enough to fight the symptoms.

Why this reduces the risk of SIDS

The substance present in the mother’s milk helps the infant to fight against various diseases which in other cases may lead to the death of the child. Infants who are not breastfed are more likely to die from this as they do not get the proper nutrition. Also, the mother’s milk keeps the child more active which helps them fight the disease in a better way (Thompson.et.al.2017). It is also easier to digest as compared to artificial milk or other products. Many reports suggest that breastfeeding is very effective for the better sleep of the child which is another reason this measure can reduce the risk of Sudden Infant Death Syndrome.

No smoking

Protective measure

Smoking at any time near a baby can be very dangerous. The risk with SIDS is all the more. This is because infants who are exposed to the smoking of any kind are more likely to suffer from SIDS. Smoking during the time and after the pregnancy hurts the health of the child. This is because it affects their breathing and lungs and makes them more prone to death. Making the child sleep with someone who is a smoker may lead to cot death which is very usual in such a scenario.

Why this reduces the risk of SIDS

The reason no smoking is such a preventive measure is that the smoke from the cigarette can choke the child which may lead to their death. The smoke from substances contains harmful things which make it difficult for the child to breathe resulting in their death (Task Force on Sudden Infant Death Syndrome, 2016). Not smoking and allowing others to smoke in areas near the child helps them breathe in the fresh open air which can be effective in the prevention of this disease.

In the same room as parents for the first six months

Protective measure

Making an infant sleep in the same room as his parents in the first six months of his birth is an effective way to prevent SIDS. It is said that sharing the same room as the parents reduces the risk of disease to around 50%. It should be made sure that the child should be slept in the same room but not in the same bed as it may lead to suffocation or any other problem in the first six months of their birth. It is also said that sleeping knowing that the parents nearby allows one child to feel safe in their sleep leading to better sleep for them.

Why this reduces the risk of SIDS

The reason this helps in reduction of the SIDS is because parents can keep a check on the baby during their sleep both during the day and night time. Any unusual movement or event can be easily monitored helping in the prevention of an issue. A child can suffer from many problems while they are in their sleep (Bokor. et.al.2017). Sleeping with parents nearby helps to keep everything in check. They can detect if there is some unusual breathing or any such other pattern in the child in their sleep which is difficult to measure if the child is sleeping in some other room that is away from the parents.

2.a The reasons for implementing a good sleeping routine with a newborn for both the parent and baby

Establishing a good sleeping routine is very important both for the infant and the parents. Implementing a routine is very necessary as it creates a balance both for the parents and the newborn. Proper sleep will be very effective as it helps in the proper flow of blood to all body parts. Along with that, it helps the body to unwind allowing one to relax from the day-to-day chaos. Though, it is advised to start a routine after three to four months after the birth of the child as they are likely to sleep a lot in the initial days. Implementing a routine is beneficial for the child because:

  • It helps in the growth of the child- It is found that establishing a good routine for the child helps in their growth process. Proper sleep helps a child to develop and reduces their chances to become fat.
  • Keeps them in a happy mood- Children with improper sleep tend to become crankier and unhappy which is not good for both the child and the parents (Adams.et.al.2015). A proper sleep routine makes the child joyful keeping everyone happy around them.
  • Learning- Proper sleep gives the child’s brain the rest that it needs which makes them refreshed to learn new things and grasp them at a faster rate as compared to them not sleeping properly.

Benefits for the parents:

  • More sleep- Setting a routine with the child allows a parent to get some free time in hand. This time can be used by them to catch up on their sleep or do some other pending activity making it a perfect gateway for some quality time.
  • Fewer chances of depression- Lack of sleep in parents, especially mothers can lead to serious diseases, one among them being postnatal depression. Less sleep makes a mother crankier and may lead to depression. The routine also helps in establishing a strong bond between the child and the parents.

2.b Supporting a parent to implement this routine

There are various ways through which one can help a parent to implement this sleeping routine in their life. This is important to set everything in order. This can be done by:

  • Setting a routine- Establishing a routine of doing everything at the same time every day can be a great start to it. This will make the child’s body adapt to the same action every time helping them follow the routine.
  • Not overexerting oneself or the child- Doing too much at one time can be very tiring for the child as well for the parent making them break the routine or not follow it. Allowing the child to sleep early or for too long can disrupt the routine. A set pattern should be followed as much as possible helping a parent to implement this routine.
  • Trying different activities- Using activities such as a warm bath before bed, singing lullabies to the child, and creating a calm and soothing environment before sleep can be very helpful for the parent to establish such a routine (Gelfer and Tatum, 2014). If the child is not falling asleep then switching off the light or T.V. or reading something to them can be effective. Following it for some time can help a parent fall into a pattern that can be followed anytime the child suffers from any sleeping issue.

3. Babies are born with all the neurons they need

A Baby’s brain is said to start developing long before they come into the world. It starts developing in the third week after its conception which gives one immense time to develop until the time the child is born. It is said that a baby is born with around 100 billion neurons. These are the total number of neurons a human needs in their whole life. When a child is born, his brain consists of neurons and synapses. Both of them are very essential for the human brain to function. The count of synapses per neuron is 2500 when a child is born, but as time progresses, it turns into 15000 per neuron allowing one’s capacity to increase.

These neurons are very important in sending and receiving messages. As a child understands many things while still in the womb of his mother, it is all because of these neurons. These start to develop with time which is around seven to eight weeks after the conception of a child (Alm.et.al.2016). It is with the help of these neurons that a child develops his first movement allowing him to grow in the process. This also helps the brain to function and understand various aspects which help to track the growth and development of the child even before it is born.

3.b The process of synapse formation, and the correct conditions required, i.e. in the absence of the stress hormone cortisol

A child’s brain consists of neurons and synapses which are essential for its growth. Though at the time of birth of a child they are less in number that change as and when they grow. All the changes happen until three years of human age. This is the reason the number of synapses created during this time is way more than at any other time of human life. The existence of so many synapses makes humans more prone or likely to react to the external environment. This allows them to learn and grasp things at a faster pace which tends to get slower in the later stage of their life.

The lack of stress hormones in the child’s brain makes them convenient for the human brain to adapt to things easily helping it to grow optimally. This helps the brain to grow in the best environment which helps in regulating the stress hormone cortisol (Wennergren, 2016). Lack of the stress hormone is very necessary as it can hurt the growth of the brain and may affect its development altogether.

3.c Approaches such as ‘Crying it Out’ hurting a child

Crying it out is an approach where one tends to let the child cry and fall into sleep or get calm down. Though a lot of relatives and family members may suggest it, science has a different take on it. It is said that this method if used on a frequent basis, can have a harmful effect on the child. This is because:

  • More stress on the child- The regular use of this approach can have neurological stress in the child. The stress that the child suffers on a regular basis is way too high for them to handle which can hurt their health. It creates cerebral pressure on the mind of the child which is not a good sign.
  • A crankier unhappy child- Allowing a child to cry out on themselves without any support or condolence from their parents can make them crankier and unhappy children. This can even have a long-term effect on their mind taking a tool on their emotional well-being (Dufer and Godfrey, 2017). Also, a lack of emotional support may make a child feel inferior or depressed which is not a good way to start a life.

Along with these, the crying it out approach may hurt the immune and the heart of a child. Thus, one can say that it is bad for both the emotional and physical well-being of any child and should be avoided whenever possible.

4. Common sleep theories

There are different sleep theories such as:

  • Babies should be seen and not heard strategies
  • Prescriptive, routine-based strategies
  • Routine and different temperaments of babies
  • Baby-centered strategies
  • Attachment-focused strategies

A comparison of these theories will help us to decide which one is most suitable for the infant. The Ferber and Weissbluth theory suggests to babies should be seen and not heard when it comes to sleeping. Though, a lot of experts do not agree with this method. This is because they believe that a sound of a child reveals a lot about him that may not be visible to the naked eye. Another sleep theory is that of Gina which is based on prescriptive routine-based strategies. It states that a set routine can be very helpful for both the child and the parents (Centor, 2016). This is a great thing as the set routine makes it very easy to handle the baby and helps them fall to sleep at night which is the biggest issue with a newborn. Though, a lot of experts contradict it as they feel that it tends to confuse the parents and child which may not be so good for them.

Another theory in this line is that of Tracy Hogg who is based on the different temperaments of the babies. It is based on the mindset that the sleeping habit of a child varies on the mood they are in. Some babies sleep without any break while others take a lot of time and break in between to get their routine sleep. It all depends on the nature of the babies as some are more active than others while some are more persistent when it comes to their sleep. Therefore when need to set the sleeping habit that is in sync with their child. The theory suggested by Elizabeth Pantley is based on the no-cry sleep solution. It is one of the most suggested sleeping theories. It states that parents should not let their children cry themselves to sleep. This can have an adverse impact on their physical and mental well-being (Woolridge, 2017). Either the parents can choose their own time and let the child cry or pay them the proper care and attention and nurture them to the proper sleep. It is a highly recommended theory as many parents and experts can vouch for the same.

The theory suggested by Dr. Sears is based on the concept of attachment-focused strategies. It says that attention plays a crucial role when it comes to the sleep-related aspects of their children. It is because attachment is very important in how one responds to a child helping them in their sleeping habit. This is backed by a lot of researchers who believe in the same theory (Schafer and Genna, 2015). All these theories in some other ways affect the sleep aspect of the child.

Q.1 The difference between colic and reflux

Q.1 a Define colic, physiological reflux, and gastro-esophageal reflux disease

Colic is a disease majorly suffered by babies which is caused due to the wind which gets obstructed in the intestine part. Babies also suffered from colic which involves excessive crying on their part. It lasts until six months of age of a child. This is not so serious but if the crying continues for a long period for a major number of days then one must consult an expert. Though there is no big medical help or medicine available for the cure of the same. Gastro-oesophageal reflux is an episode when the acid flows back into the esophagus of the baby. This burns the boundaries of the esophagus. This is very common in infants and is likely to stop by the age of one or so (Fewtrell. et.al.2016). This is not such a huge problem. In most cases, this reflux is physiological. But there are times when this may be pathological which may affect the health of the baby.

Q.1 b the symptoms associated with colic, physiological reflux, and gastro-oesophageal reflux disease

The symptoms associated with these diseases vary. Of colic includes

  • the excessive crying of the child (more than three hours in a day)
  • clenched hands and flushed face
  • Drawing the knees to the stomach and crying a lot during late afternoon and evening.

The symptoms associated with gastro-oesophageal reflux include:

  • Acid reflux
  • Heartburn
  • Discomfort in the abdominal and chest area
  • Trouble swallowing anything
  • The problem is weight gain and sleeping
  • Vomiting
  • Frequent cough and wheezing

Symptoms of physiological reflux are:

  • Arching of the back especially at times of feeding
  • A lot of crying
  • Vomiting
  • Regurgitation
  • Refusing to eat and regular discomfort.

Q.1 a. correct positioning and attachment at the breast

Breastfeeding is a very important aspect of the growth and development of a child. It is through this that the child receives all the essential nutrients that help in the proper growth of his mind and body. A correct position and attachment at the breasts are very important both for the mother and the child. This is because it helps in the release of two essential substances known as prolactin and oxytocin which are vital for the baby (Kent. et.al.2015). The correct positioning and attachment are supremely critical as it helps in preventing sore nipples and engorgement which are common issues in mother who are not able to breastfeed properly.

The main focus should breastfeed the baby and not nipple feeding as this will be of no use to anyone. So the main attention is to fetch the breast to the mouth of the baby so that his lower lip and tongue latch on to the breast and nipple. Correct positioning is pivotal else it will cause discomfort to the child and they may not attach to the breast for a longer period and may cause bleeding and pain to the mother.

Q.1 b Steps to achieve good positioning and attachment and justify why this practice is important

S. No. Positioning and attachment method Ways to ensure this method is correct
1 Adopt a comfortable position. Make sure that the baby’s body is in a straight line with that of his head. The breast should be faced with the shoulder of the baby. Using pillows and cushions can be helpful. Keeping a normal hold on the baby that is not too tight or too loose.
2 The nose of the baby should be opposite to that of the nipple. The neck is supported while the hands are free to move. The neck should be tilted back so that it becomes easy to bring the mouth of the baby close to the nipple. Proper support is provided by bringing the baby’s body and mouth close to the nipple (Rosen-Carole. et.al.2017). The baby should be held very carefully with gentle care.
3 The nipples can be brushed on the lips of the baby for breastfeeding. If the baby does not open the mouth than repeat the process while taking the nipple away once in a while. The nipple is within easy reach to the baby. It should be such that he can extend his neck and open his mouth in order to reach out to it. The baby should be comfortable with the nipple so that he can latch on it without much effort.
4 As soon as the baby opens its mouth wide enough, bring it closer to the breast. This should be done in such a way that the chin of the baby comes in contact with the breast first. The top lip of the baby should be at as much distance as possible from the mouth or lip of the baby (McGann.et.al.2018). This is done so that the lower lip of the baby along with the tongue is first in contact. The comfort of both the mother and the child should be taken into consideration.

Q.1 Factor that develop and maintain good milk supply and ways in which supply can be increased

A good and proper supply of milk is very important both for the mother and the child. There are various factors that can develop and maintain a good milk supply. These are:

  • Complete milk drainage- A great way that can help in increase in the supply of milk and maintain it in healthy quantity is possible if there is full drainage of the milk from the breast. The milk that remains in the breast may lead to less production of prolactin which is not good for the baby and the mother (Sung and St James-Roberts, 2016). With full drainage of the milk, the prolactin will get attach to the membrane which is very good for the production and supply of milk.
  • Effective feeding- Proper nursing of the baby is also a great way to maintain a good milk supply. This can be done by frequently nursing and avoiding the use of any pacifier or bottle in the process.
  • Continuous contact with the skin: Continuous contact with the body and skin leads to more and more production of milk in the breast. This is the reason breastfeeding is promoted so much as this will lead to more supply which is beneficial for the baby.
  • Other factors include unrestricted feeding, good positioning and attachment, etc.

Q.2 Practices that may decrease milk production

There are various practices that may lead to less milk production in the breast. Efforts should be made to avoid these practices as much as possible. These practices include:

  • Infrequent feeding- Irregular and infrequent feeding is highly responsible in this case. This is because once the placenta is removed from the mother’s body after birth, milk production increases tremendously. Less usage of milk may clot it in the breast. Also, the body is made such that as much milk is removed and replaced by the same amount of good milk (Anderson, 2017). Thus to increase the supply of milk, more and milk needs to get used by the baby.
  • Not allowing the baby to finish the breast one at a time- It is very necessary that there is a rotation regarding the breast that feeds the milk to the child. But it should be seen that only when the milk of one breast is emptied that the other breasts are offered to the child (Ward and Balfour, 2016). This is important as the break in the between may disrupt the child, and they may not want to get fed anymore.
  • Other reasons include poor positioning while breastfeeding, unscheduled feeding or sleepy babies and ineffective feeding, etc.

Conclusion

SIDS is a very serious issue across the globe. This is the reason even the UN has considered ways to prevent it. Providing the right and full knowledge to the parents can be effective in preventing this disease. This along with proper sleep can be beneficial for the mental and physical well-being of the child and the parents. Breastfeeding plays a vital role in preventing SIDS and helping in the growth and development of the child. Proper positioning and attachment need to be included to achieve the best results. This along with the correct and proper way to sleep and the use of various sleeping theories can be effective as this will help the parent and child to grow and relax in the best way possible.

References

Adams, S.M., Ward, C.E. and Garcia, K.L., 2015. Sudden infant death syndrome. American family physician91(11).

Alm, B., Wennergren, G., Möllborg, P. and Lagercrantz, H., 2016. Breastfeeding and dummy use has a protective effect on sudden infant death syndrome. Acta Paediatrica105(1), pp.31-38.

Anderson, J.C., 2017. Infant reflux-not is as simple as we might think. Breastfeeding Review25(2), p.25.

Bokor, J., Danics, K., Bencze, E., Keller, E. and Szollosi, Z., 2017. A single-centre review of suspected sudden infant death cases. Medicine, Science and the Law57(2), pp.84-90.

Centor, F.H., 2016. SIDS Prevention Through a Back to Sleep Campaign. Journal of Obstetric, Gynecologic & Neonatal Nursing45(3), p.S29.

Dufer, H. and Godfrey, K., 2017. Integration of safe sleep and sudden infant death syndrome (SIDS) education among parents of preterm infants in the Neonatal Intensive Care Unit (NICU). Journal of Neonatal Nursing23(2), pp.103-108.

Fewtrell, M.S., Kennedy, K., Ahluwalia, J.S., Nicholl, R., Lucas, A. and Burton, P., 2016. Predictors of expressed breast milk volume in mothers expressing milk for their preterm infant. Archives of Disease in Childhood-Fetal and Neonatal Edition, pp.fetalneonatal-2015.

Gelfer, P. and Tatum, M., 2014. Sudden infant death syndrome. Journal of Pediatric Health Care28(5), pp.470-474

Kent, J.C., Hepworth, A.R., Langton, D.B. and Hartmann, P.E., 2015. Impact of measuring milk production by test weighing on breastfeeding confidence in mothers of term infants. Breastfeeding Medicine10(6), pp.318-325.

LaPorta, M.D. and PGY, J., 2016. SIDS Prevention.

McGann, J., Manohar, J., Hiscock, H., O’Connor, D., Hodgson, J., Ball, F. and Sung, V., 2018. Caring for crying babies: A mixed‐methods study to understand factors influencing nurses’ and doctors’ management of infant colic. Journal of paediatrics and child health.

Rosen-Carole, C.B., Auinger, P., Howard, C.R., Brownell, E.A. and Lanphear, B.P., 2017. Low-Level Prenatal Toxin Exposures and Breastfeeding Duration: A Prospective Cohort Study. Maternal and child health journal21(12), pp.2245-2255.

Schafer, R. and Genna, C.W., 2015. Physiologic breastfeeding: a contemporary approach to breastfeeding initiation. Journal of Midwifery & Women’s health60(5), pp.546-553.

Sung, V. and St James-Roberts, I., 2016. Infant Colic 34. Pediatric Neurogastroenterology: Gastrointestinal Motility and Functional Disorders in Children, p.369.

Task Force on Sudden Infant Death Syndrome, 2016. SIDS and other sleep-related infant deaths: Updated 2016 recommendations for a safe infant sleeping environment. Pediatrics, p.e20162938.

Thompson, J.M., Tanabe, K., Moon, R.Y., Mitchell, E.A., McGarvey, C., Tappin, D., Blair, P.S. and Hauck, F.R., 2017. Duration of breastfeeding and risk of SIDS: an individual participant data meta-analysis. Paediatrics140(5), p.e20171324.

Ward, T.C.S. and Balfour, G.M., 2016. Infant safe sleep interventions, 1990–2015: A review. Journal of community health41(1), pp.180-196.

Wennergren, G., 2016. Why it is important to present all the available facts about bed sharing and breastfeeding. Acta Paediatrica105(1), pp.22-22.

Woolridge, M., 2017. Baby controlled breastfeeding: Biocultural implications. Breastfeeding: Biocultural perspectives.

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