The creation of optimal conditions and the organization of special care are determined by the unstable functioning and, to a certain extent, the immaturity of all systems of the child's body, especially in the first years of his life.

The most sensitive to adverse effects are the skin. The anatomical features of the skin of young children are characterized by the presence of a thin and sensitive stratum corneum of the epidermis, represented by two or three rows of weakly interconnected constantly sloughing epithelial cells. The basement membrane is very loose and delicate, which determines the weak connection between the epidermis and the dermis. The skin has a well-developed capillary network. Sweat glands, already formed by the time of birth, do not function enough during the first 3-4 months and have underdeveloped excretory ducts closed by epithelial cells. Further maturation of the structures of the sweat glands, the autonomic nervous system and the thermoregulatory center of the central nervous system ensure the improvement of sweating.

The functions of the skin differ in great originality. The protective function of the skin from adverse external influences is significantly reduced. The skin is easily vulnerable due to the weak development of the epidermis and the low activity of local immunity. A thin stratum corneum and a well-developed vascular system cause an increased resorption function of the skin. The risk of generalization of infection in children of the first years of life is much greater than at an older age. The thermoregulatory function of the skin is unstable: heat transfer dominates over heat production, the sweat glands do not function enough. This makes it difficult to maintain a constant body temperature and leads to the need to create an optimal temperature regime for the child. The respiratory function of the skin is expressed many times stronger than in adults. The peculiar structure of the vessels provides easy diffusion of gases through the vascular wall. The skin contains a large number of extrareceptors. Excessive skin irritation with poor care adversely affects the health of the child.

The basis of care is cleanliness. This applies to the room in which the child is located, the items of care for him and the personal hygiene of the caregiver. It is necessary to carry out daily wet cleaning, air the room several times a day. The air temperature in the room is maintained at 20-22 ° C, humidity - 40-60%; the child does not tolerate dry air, as this increases the loss of water and overheating occurs more easily.

The child should be in his own bed, the side walls of which freely let air through.

A hard mattress is placed in the crib, which is covered with a sheet, under the head - a diaper folded several times.

Child's clothes. It is preferable to use natural, well-washable materials (cotton fabrics, knitwear, wool). Clothing should protect the child from heat loss, but at the same time not cause overheating and not restrict movement. A full-term newborn is swaddled with his hands for the first two or three days, and then his hands are left free. Tight swaddling is not used: the child must move freely. At night after bathing, it is better to swaddle with hands, put on a cap or scarf on your head. At the 3-4th week of life, and sometimes even earlier, the child is put on sliders or overalls.

Morning toilet. The child on the changing table is unfolded and undressed completely, the skin is carefully examined, especially the folds. Face and hands are washed with boiled water. The eyes are washed with sterile cotton wool soaked in boiled water from the outer corner of the eye to the inner; a separate swab is used for each eye. It is necessary to ensure that water does not get from one eye to the other, therefore, washing the left eye, turn the child to the left and vice versa. If signs of conjunctivitis appear, treatment should be started as soon as possible. The oral cavity is not processed, since the mucous membrane is dry and easily injured. However, it must be checked daily. The appearance of white plaques on the oral mucosa (thrush) requires certain measures. The auricles and external auditory canals are cleaned with a dry cotton flagellum only within sight. The toilet of the nose is made with a cotton flagellum dipped in oil or a special stick with cotton wool wound around it, which is inserted into the nasal passages with gentle helical movements. Skin folds behind the ears, on the neck, in the armpits, in the elbows, inguinal, popliteal areas are treated with a cotton swab dipped in oil. The treatment of the genitals of girls is carried out with a cotton swab moistened with oil, or with special sanitary napkins in the direction from front to back. In boys, it is necessary to open the head of the penis as far as possible and treat it with oil.

In a newborn child, during the first 2 weeks of life, the physiological process of healing of the umbilical wound occurs. It must be treated once a day with a 3% solution of hydrogen peroxide, then with a 1% alcohol solution of brilliant green.

Skin care includes removing waste products (urine and feces), cleansing the skin with gentle cleansers, and protecting the skin from irritating factors. Children's hygiene products are designed taking into account the characteristics of the skin (pH-balanced, hypoallergenic). They are divided into cleansing (shampoos, bath foams, soaps, lotions), protecting (oils, powders), nourishing (creams).

Delicate and sensitive baby skin requires gentle but thorough cleansing. For this, gentle detergents are used. Baby skin has a lower irritability threshold than adult skin, so cleansers should not be used in large quantities. Soaps can irritate the skin due to alkaline components, and synthetic detergents (bath foams, shampoos) due to their degreasing effect. Skin irritation can be caused not only by the composition of the detergent and its high concentration, but also by the duration and frequency of bathing, as well as the temperature of the water, the type of towels and sponges used.

Bathing. After separation of the umbilical cord, with an uncomplicated course of the process of epithelization of the umbilical wound, the newborn should be bathed daily. The duration of the hygienic bath is 5 minutes, the water temperature is + 36.5 ... + 37.0 ° С. Until the umbilical wound heals, a solution of potassium permanganate is added to the water to a slightly pink color (the crystals are first dissolved in a separate container). For bathing, you can use unboiled tap water, both hot and cold. Bathe the child with the use of detergents should be no more than 2-3 times a week. At the end of bathing, the child is doused with water, the temperature of which is 1-2 degrees lower than the temperature of the water in the bath. It is necessary to wash the child regularly, after a bowel movement - it is necessary. The skin is dried (but not wiped!) with a towel or diaper made of soft cotton fabric with blotting movements. After 6 months, you can bathe a child every other day (in the hot season - every day at any age), at a water temperature of + 36 ° C, the duration of bathing is up to 10 minutes.

Protection of the skin from the action of irritating factors is carried out by powdering or lubricating with cream, oil. Moderate powdering of the skin of the child protects it from chafing with a diaper or clothes. The powder is first applied to the hands, then to the skin of the child for its more even distribution, without lumps. Sometimes children do not tolerate the rubbing of emollients (creams, oils) into the skin, as this can cause sweat retention and maceration. Excessive use of oils hinders the respiratory function of the skin. Cosmetic skin care products should be selected individually for each child. The main selection criterion is their good tolerability.

A diaper is an essential item for caring for a young child. A healthy newborn urinates 20-25 times a day, he has 5-6 stools. The following types of diapers are used: reusable cotton diapers (gauze or fabric); disposable, the inner cellulose layer of which contains a gel-forming material with increased moisture absorption capacity. Modern disposable diapers quickly absorb urine, securely hold it in the inner layer, while the baby's skin remains dry. Disposable diapers reliably prevent soiling of children's clothes, are comfortable for the child, practical and easy to use.

In recent years, disposable diapers have undergone further improvement: diapers are produced with reusable fasteners, with an improved inner layer (the new additional layer absorbs moisture faster and in greater quantities), the so-called "breathable" diapers, the outer layer of which contains microscopic pores that can pass air to skin and providing the exit of water vapor from the diaper to the outside.

There are several sizes of diapers, the relative guideline in their selection is the body weight of the child. It is recommended to change a disposable diaper before feeding, after each bowel movement with a mandatory toilet (washing up), before going to bed at night and after waking up, before going for a walk. There is no scientific evidence to suggest that disposable diapers may adversely affect the development of boys' genitals. When using disposable diapers, the skin temperature under them rises by no more than 0.5-1.0 ° C, which does not create conditions for a persistent greenhouse effect. Spermatogenesis in boys begins no earlier than 7-8 years, and, therefore, in young children there can be no question of any process of its suppression.

Pediatricians and physiologists consider the age of 12-18 months to be the optimal period for the development of a child's toilet skills. In some children, readiness for learning may form later - at 2-2.5 years. By this time, the child should be able to walk, bend down and pick up small objects from the floor, understand well the speech of an adult addressed to him, speak separate words himself, try to explain to his parents what he wants.

A child's readiness to learn can be determined by the presence of one or more signs: the child remains dry for at least 2 hours and wakes up dry after a nap, adheres to a regular "schedule" of bowel movements, words, gestures, facial expressions, behavior makes it clear that it is time to urinate or bowel movements, is able to follow simple verbal instructions from parents, is uncomfortable with soiled diapers and expresses a desire to change them.

Subsequently, child care and upbringing are inextricably linked. It is necessary from an early age to pay the attention of the child to his appearance, to accustom him to cleanliness and order. During feeding, toileting, putting to bed, you should gently treat the child, showing goodwill and calmness. Caring for him should be accompanied by an affectionate conversation that evokes positive emotions and distracts from unpleasant sensations.

Common diseases of the skin and mucous membranes include omphalitis, vesiculopustulosis, prickly heat, conjunctivitis, candidal stomatitis, diaper dermatitis.

Omphalitis - inflammation of the umbilical region. With catarrhal omphalitis, serous discharge from the umbilical wound, slight hyperemia and infiltration of the umbilical ring are noted. Bloody crusts form, serous-purulent discharge accumulates under them in a small amount. The epithelialization of the umbilical wound is delayed. The child's condition is not disturbed.

With the progression of the inflammatory process, a purulent discharge from the umbilical wound appears, swelling and hyperemia of the umbilical ring, infiltration of subcutaneous fatty tissue around the navel. The umbilical vessels become thickened, well palpable. The umbilical region swells somewhat, the skin around the navel is hyperemic, the vessels of the anterior abdominal wall are dilated. The general condition of the child is disturbed: lethargy, regurgitation appears, body weight decreases, body temperature rises, signs of an inflammatory reaction from the peripheral blood are noted.

In the presence of discharge from the umbilical wound and prolonged detachment of the umbilical cord residue, mushroom-shaped granulations (fungus of the navel) appear at the bottom of the umbilical wound.

Treatment consists in daily treatment of the umbilical wound with a 3% hydrogen peroxide solution, then with 70% ethyl alcohol, 1-2% brilliant green alcohol solution or 3-4% potassium permanganate solution. Zinc hyaluronate (curiosin) has a good effect. With the fungus of the navel, a solution of silver nitrate is used. In case of violation of the general condition and the threat of generalization of the infectious process, antibiotics are prescribed.

Vesiculopustulosis - inflammation in the mouth of the sweat glands. On the skin of the buttocks, thighs, head, in natural folds, small superficially located bubbles appear, filled at first with transparent, then cloudy contents. After 2-3 days, the bubbles burst, small erosions are found, covered with dry crusts, after falling off of which there are no scars and pigmentation.

Hygienic baths are carried out with disinfectants (a solution of potassium permanganate until the water acquires a slightly pink color, decoctions of celandine, chamomile). Abscesses are preliminarily removed with a sterile material moistened with 70% alcohol. Twice a day, the elements are treated with a 1-2% alcohol solution of brilliant green or mupirocin (Bactroban).

Prickly heat - skin lesions associated with hyperfunction of the sweat glands, due to overheating or insufficient skin care. It is clinically manifested by an abundance of small red nodules and spots on the neck, in the lower abdomen, in the upper part of the chest, in the natural folds of the skin. The general condition of the child is not disturbed.

Hygienic baths are recommended with the addition of a solution of potassium permanganate until the water acquires a slightly pink color; thorough drying of the skin with blotting movements; dusting with indifferent powders ("children's", talc with zinc).

Conjunctivitis may be catarrhal and purulent. The disease proceeds mainly as a local process; infection usually occurs when the fetus passes through the birth canal. The disease is characterized by pronounced edema and hyperemia of the eyelids, there may be purulent discharge. With abundant purulent discharge and a long course of the process, the etiology of the disease should be clarified based on the results of microscopic and bacteriological studies.

Assign eye washing with a weak solution of potassium permanganate 6-10 times a day, followed by instillation of a 20% solution of sodium sulfacyl or a solution of a targeted antibiotic (if the pathogen is specified).

Candidal stomatitis (thrush) is characterized by the appearance of a slightly raised white coating on the oral mucosa. When plaque is removed, a hyperemic, slightly bleeding surface is found. Pathogen - candida albicans. The disease, as a rule, occurs with defects in care.

Treatment involves the treatment of the oral cavity with a 2-4% solution of sodium bicarbonate, aqueous solutions of aniline dyes (brilliant green, methylene blue, gentian violet), oral administration of fluconazole (Diflucan).

Diaper dermatitis - a recurring pathological condition of the child's skin, provoked by the influence of physical, chemical, enzymatic and microbial factors when using diapers or diapers.

The disease begins with the appearance of moderate redness, mild rash and peeling of the skin in the genital area, buttocks, lower abdomen and lower back. In the future, if the action of irritating factors is not eliminated, papules, pustules appear on the skin, small infiltrates may form in the skin folds; infection occurs candida albicans and bacteria. With a prolonged course of the disease, confluent infiltrates, weeping, deep erosion are formed.

For treatment, it is necessary to use hygroscopic disposable diapers, their frequent change is shown (including at night). Special diaper creams are applied to the affected areas of the skin, drapolen cream, desitin ointments, bepanten are used. With candidiasis, a cream or powder with antifungal drugs (miconazole, clotrimazole, ketoconazole) is applied to the affected skin. If the child's condition is complicated by itching, antihistamines are indicated. In severe diaper dermatitis or its combination with allergic dermatitis, topical glucocorticosteroids (advantan, elocom) are applied topically.

Literature

1. Zanko N.I. Efficiency of new technologies for skin care in young children: Ph.D. dis. ... cand. honey. Sciences, M., 2000.
2. Shabalov N. P. Neonatology. M., 2006. T. 1. S. 593-607.
3. Darmstadt G. L., Dinulos J. G. Neonatal skin care// Pediatr Clin North Am. 2000; 47(4): 757-782.
4. Madison K. C. Barrier function of the skin: ‘la raison d’etre’ of the epidermis// J Invest Dermatol. 2003; 121:231-241.
5. Odio M., Friedlander S. F., Railan D. et al. Diaper dermatitis and advances in diaper technology// Curr Opin Pediatr. 2000; 12(4): 342-346.

N. A. Belousova, Candidate of Medical Sciences
E. G. Belousova
MMA them. I. M. Sechenov, Moscow

Nursing in pediatrics is the area of ​​work of nurses who care for newborns, children and adolescents. The nurse plans and implements the care plan together with the attending physician.

We will tell you what are the features of the nursing process in pediatrics, what skills and abilities a nurse should develop in herself.

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The main thing in the article

Nurse in pediatrics: specifics of work

Nursing in pediatrics is one of the important areas of the nursing process. High-quality care for children and adolescents can be provided by nurses who have undergone special training and have the necessary knowledge.

Nurses who specialize in this area are also called child care nurses.

Working with the children's population has a certain specificity. First of all, in this case, the nurse does not work with patients one-on-one - the child's parents and other relatives interfere in her work, which makes the work of a specialist difficult.

✔ How to conduct health education in children's medical organizations, we will tell in the System Chief Nurse

Stages of nursing

The nursing care process can be divided into 5 main steps:

1. Nursing examination of the patient.
2. Statement of the patient's problems.
3. Drawing up a plan for nursing manipulations.
4. Implementation of the plan.
5. Evaluation of the results of the work carried out.

For the pediatrics section, nursing is built according to the same plan. Let us consider in more detail the content of the work of a nurse with a patient on each of them.

Examination of the child

Nursing in pediatrics is based not only on identifying the problems of the patient, the nurse must also identify the current knowledge of his legal representatives about the needs of the child.

Often nursing examination of children faces certain difficulties:

• due to age characteristics, young children cannot reliably explain and understand their complaints;
• in relation to a small child, it is difficult for a nurse to establish the degree of pain and its localization;
• in pediatrics, you can find a big difference between the state of the child and his well-being. For example, a child may be active and carefree even with a significant change in body temperature.

Implementation of the plan

If in the early stages the nurse correctly assesses the situation and follows the decision-making model, then the stage of implementing the care plan will not be difficult for her.

However, if nursing in pediatrics is not sufficiently studied by a specialist, she may face a lack of knowledge on some issues.

1. What action is required from the patient. For example, gargle, take medication, and stay in bed.
2. Selecting the type of behavior for a particular installation. It is necessary to discuss the features of therapeutic nutrition with the patient and his family, separately from other issues.
3. Monitoring the patient and assessing his emotional state. Many children may be afraid of people in white coats, or, for example, as the patient recovers, he more carefully performs the actions prescribed by the doctor.
4. Discuss in detail with the child's representatives the criteria for recovery. For example, if a therapeutic diet is recommended to a patient, then it is necessary to explain to them what consequences can follow if the diet is violated.
5. Discuss with parents short-term and long-term plans to improve the health of the child.
6. Setting realistic goals. For example, with some diseases, a complete recovery of the patient is impossible.

CHAPTER 9 PECULIARITIES OF CARE FOR NEWBORN AND INFANT CHILDREN

CHAPTER 9 PECULIARITIES OF CARE FOR NEWBORN AND INFANT CHILDREN

The past decade has seen significant changes in early childhood care practices. Primitive cotton wool and gauze have been replaced by modern items of children's hygiene, convenient disposable tampons, electronic scales, children's ear thermometers, "smart" toys, children's toothbrushes with a limiter, bottles with a heating indicator, nipples with an anti-vacuum effect, nasal aspirators, children's tweezers - nippers (scissors), various sponges, washcloth mittens, baby creams, oils, lotions, gels, diapers, etc. However, the fundamental principle of child care has remained the same - the observance of the daily routine, which is especially needed by sick children. The so-called free mode, when the child sleeps, stays awake and feeds depending on his desire (the method is common in our country thanks to the books of the American pediatrician B. Spock) is unacceptable in a hospital. For children of the first year of life, the main elements of the daily routine should be fixed: the time of wakefulness, sleep, the frequency and time of feeding a sick child (Fig. 14).

In newborns and infants, all pathological processes in the body proceed extremely rapidly. Therefore, it is important to timely note any changes in the patient's condition, accurately record them and notify the doctor in time to take urgent measures. The role of a nurse in nursing a sick infant cannot be overestimated.

The basis of care is the observance of the strictest cleanliness, and for a newborn child - sterility (asepsis). Infant care is carried out by paramedical personnel with the mandatory supervision and participation of a neonatologist (the first weeks of life) or a pediatrician. Persons with infectious diseases and purulent processes, malaise or elevated body temperature are not allowed to work with children. Nursing ward health workers are not allowed

Rice. 14.The main elements of the day regimen of an infant

wear woolen clothes, jewelry, rings, use perfumes, bright cosmetics, etc.

The medical staff of the department where infants are located should wear disposable or white, carefully ironed gowns (when leaving the department they are replaced by others), hats, in the absence of a forced ventilation mode, disposable or four-layer marked gauze masks and replaceable shoes. Strict observance of personal hygiene is obligatory.

Upon admission to the children's ward of a newborn, the doctor or nurse checks the passport data of the “bracelet” (a “bracelet” is tied on the child’s hand in the maternity unit, which indicates the mother’s last name, first name and patronymic, body weight, gender, date and hour of birth) and “ medallion” (the same records on the medallion worn over the blanket) with records in the history of its development. In addition, the time of admission of the patient is noted.

For newborns and children of the first days of life with jaundice, it is fundamentally important to control the level of bilirubin in the blood, a significant increase in which requires serious measures, in particular, the organization of a replacement blood transfusion. Bilirubin in the blood is usually determined by the traditional biochemical method. Currently, "Bilitest" is also used, which allows, with the help of photometry, with one touch to the skin, to obtain operational information about the level of hyperbilirubinemia (an increase in the level of bilirubin in the blood).

Skin and mucous membrane care. The goal of care is healthy skin. The integrity of the protective layer of the skin of a newborn is promoted by absolute cleanliness, the exclusion of contact with potent substances, a decrease in the degree of moisture and friction of the skin on diapers and other external surfaces. Any items for newborn care, underwear - everything should be disposable. The equipment of the children's ward or room includes only the necessary care items and furniture. The air temperature should reach 22-23°C, the rooms must be constantly ventilated or air-conditioned. The air is disinfected with UV rays. After the end of the adaptation period, the air temperature in the nursery is maintained within the range of 19-22 °C.

A newborn child, as well as a baby in the future, needs to observe the most important rules of hygiene: washing, bathing, caring for the navel, etc. When swaddling, the baby's skin is carefully examined each time. Care should not cause him discomfort.

Morning and evening toilet the newborn consists in washing the face with warm boiled water, washing the eyes with a sterile cotton swab moistened with boiled water. Each eye is washed with a separate swab in the direction from the outer corner to the bridge of the nose, then dried with clean napkins. During the day, the eyes are washed as needed.

The nasal passages of the child have to be cleaned quite often. To do this, use cotton flagella made from sterile cotton wool. The flagellum is lubricated with sterile vaseline or vegetable oil and gently advanced into the depth of the nasal passages by 1.0-1.5 cm with rotational movements; the right and left nasal passages are cleaned with separate flagella. This manipulation should not be carried out for too long.

The toilet of the external auditory canals is carried out as necessary, they are wiped with dry cotton flagella.

The oral cavity of healthy children is not wiped, as the mucous membranes are easily injured.

With a swab moistened with vegetable oil, the folds are treated, removing excess cheese-like lubricant. To prevent diaper rash, the skin of the buttocks, axillary areas, and the folds of the thighs are lubricated with 5% tannin ointment.

The nails of a newborn baby and an infant should be trimmed. It is more convenient to use scissors with rounded branches or nail clippers.

At the end of the neonatal period (3-4 weeks), the child is washed in the morning and in the evening, and also as needed. The face, neck, auricles (but not the ear canal), the child's hands are washed with warm boiled water or wiped with cotton wool soaked in water, then wiped dry. At the age of 1-2 months, this procedure is carried out at least twice a day. From 4-5 months, you can wash your child with tap water at room temperature.

After urination and defecation, the child is washed away, following certain rules. Girls are washed from front to back to avoid contamination and infection of the urinary tract. Washing is carried out with a hand, on which a stream of warm water (37-38 ° C) is directed. In case of severe pollution, neutral soap is used (“Baby”, “Tick-tock”, etc.).

It is unacceptable to wash children with stagnant water, for example in a basin.

After washing, the child is placed on the changing table and the skin is blotted with a clean diaper. Then the skin folds are smeared with a sterile cotton swab moistened with sterile vegetable (sunflower, peach) or vaseline oil. For pros

diaper rash lactation, skin folds are lubricated with sterile vegetable oil or baby creams (cosmetic oils such as Alice, Baby Johnson-and-Johnson, Desitin, Drapolen ointments, etc.) in a certain sequence: behind the ears, neck crease, axillary, elbow, wrist, popliteal, ankle and inguinal regions. The method of applying the oil or cream is called "maternal hand dosing": the mother (nurse) first rubs the oil or cream into her palms, and then applies the remainder to the baby's skin.

Treatment of the umbilical wound carried out once a day. Recently, it is recommended to refrain from the use of dyes, so as not to miss the redness and other signs of inflammation of the umbilical wound. Usually they use 70% ethyl alcohol, alcoholic tincture of rosemary, etc. After the umbilical cord falls off (4-5 days), the umbilical wound is washed with 3% hydrogen peroxide solution, then 70% ethyl alcohol and cauterized with 5% potassium permanganate solution or lapis pencil.

Bathing. Wash newborns with baby soap under warm (temperature 36.5-37 ° C) running water, wipe the skin dry with a diaper with light blotting movements.

The first hygienic bath is usually carried out for a newborn after the umbilical cord falls off and the umbilical wound epithelializes (7-10 days of life), although there are no contraindications to taking a bath from 2-4 days of life. During the first 6 months, the child is bathed daily, in the second half of the year - every other day. For bathing, you need a bath (enamelled), baby soap, a soft sponge, a water thermometer, a jug for rinsing the baby with warm water, a diaper, a sheet.

The bath is pre-washed with hot water with soap and a brush, then treated with a 0.5% solution of chloramine (if bathing is carried out in a children's institution) and rinsed with hot water.

For children of the first half of the year, the temperature of the water in the bath should be 36.5-37 ° C, for children of the second half of the year - 36-36.5 ° C. The duration of the bath in the first year of life should be no more than 5-10 minutes. With one hand, gently support the head and back of the child, with the other they lather the neck, torso and buttocks; especially carefully washed folds in the neck, in the elbow, inguinal areas, behind the ears, under the knees, between the buttocks (Fig. 15, a). At the final stage of bathing, the child is taken out of the bath, turned back up and poured with clean water.

(Fig. 15, b). The child is quickly wrapped in a diaper and dried with blotting movements, after which, having treated the skin folds with sterile vaseline oil, they are dressed and laid in a crib.

Rice. 15.Bathing an infant:

a - bathing position; b - dousing after bathing

Bathing soap is used no more than 2 times a week, it is better to use Johnson's baby or Baby shampoo foam from the top to the heels. In some children, daily bathing, especially in hard water, can cause skin irritation. Under these conditions, it is recommended bath with the addition of starch: 100-150 g of starch is diluted with warm water and the resulting suspension is poured into the bath.

Children of the first half of the year are bathed in the prone position, the second half of the year - sitting.

Sometimes, after frequent washing with soap, the hair becomes dry. In such cases, after bathing, they are lubricated with boiled vegetable oil or a mixture consisting of 1/3 castor oil and 2/3 vaseline (or boiled sunflower) oil. After treatment, the hair is wiped with a dry cotton swab.

Cosmetic care products for newborns. Children's cosmetics are a special type of cosmetic products designed for daily care and full protection of the sensitive skin of a child. Cosmetic lines of Mir Detstva, Svoboda, Nevskaya Kosmetika, Ural Gems (Drakosha and Little Fairy series), Infarma, Johnson's baby, Avent a, "Huggies", "Bubchen", "Ducray" (A-Derma), "Noelken GmbH" (Babyline), "Qiicco", etc. contain

all the necessary products for baby care: moisturizing, protective creams, toilet soap, shampoo, bathing foams, lotions, creams, powders, etc. Like many other products, children's cosmetics contain extracts of medicinal plants: chamomile, string, celandine, calendula, yarrow and wheat germ. These extracts are well tolerated and gentle on baby's skin.

It is usually recommended to use products of the same cosmetic line, as they complement and enhance each other's action. Domestic children's cosmetics are not inferior to imported ones. In the manufacture of most of them, the basic dermatological requirements are observed: neutral pH, the absence of preservatives, the predominance of mineral components over organic ones (in oils), high-quality animal fats, herbal extracts are used, the “no tears” formula is used in shampoos, exclusive medicinal products are included in diaper rash creams. components - panthenol or zinc.

Swaddling rules and clothes for children of the first year of life. For the first 2-3 weeks, it is better to swaddle a full-term newborn with hands, and subsequently, at the appropriate air temperature in the ward, hands are placed over the blanket. Given that tight swaddling hinders movement, the newborn is dressed in special clothes: first they put on two long-sleeved vests (one light, the second flannel), then wrap them in a diaper. In this form, the child is placed in a cotton envelope. Usually a soft flannel blanket is placed in the envelope, and if necessary, a second flannel blanket is placed on top of the envelope.

Swaddling is carried out before each feeding, and children with diaper rash or skin diseases - more often. The swaddling process is schematically as follows: you need to bend the top edge of the diaper and lay the baby down; the top edge of the diaper should coincide with the line of the shoulder; the baby's arms are fixed along the body; the right edge of the diaper is wrapped around the baby and fixed; wrap the baby with the left side of the diaper. The lower end of the diaper is straightened, folded and fixed. To keep the hands free, the diaper is lowered in such a way that the upper edge of the diaper reaches the armpits (Fig. 16).

The diaper is placed on the perineum, after which the child is wrapped in a thin diaper. If necessary, enclose polyethylene

Rice. 16.Stages of swaddling a baby. Explanation in the text

a new diaper (oilcloth) measuring 30x30 cm (upper edge - at the level of the waist, lower - to the level of the knees). Then the child is wrapped in a warm diaper, if necessary, covered with a blanket on top.

The changing table and oilcloth mattress after swaddling each child are thoroughly wiped with a 0.5-1% solution of chloramine. On the changing table, children are swaddled without purulent manifestations; if it is necessary to isolate the child, all manipulations (including swaddling) are carried out in bed.

Under the condition of daily washing and boiling of linen, a certain set of linen is provided for children in the first months of life (Table 11).

Table 11Set of linen for children of the first months of life

A thin vest is wrapped around the back, and a warm one is wrapped around the child's chest. The sleeves of a warm vest are longer than the arms, they should not be sewn up. The bottom edge of the vest should cover the navel.

From 1-2 months of age, during the daytime “wakefulness”, diapers are replaced with sliders or “body”, from 2-3 months of age they begin to use diapers (usually on walks), which are changed every 3 hours, and at 3-4 months, when profuse salivation begins, a breastplate is put on over the vest.

Caps, a scarf or a hat made of cotton are put on the head only after a bath and during a walk.

At 9-10 months, the vests are replaced with a shirt, and the sliders are replaced with tights (in winter with socks or booties). On fig. 17 shows the main clothes of children of the first year of life.

Diapers. In the modern system of care for children in the first year of life, disposable diapers confidently occupy a dominant place, displacing reusable diapers. Disposable diapers are another system of baby care that frees up time for parents to take care of the baby, providing real "dry" nights, the possibility of long walks, and quiet visits to medical institutions.

The main "goal" of using disposable diapers is to ensure that the child's skin is dry and minimally traumatized. This is achieved by selecting a diaper in size, its correct

Rice. 17.The main clothes of children of the first year of life

use, timely change and appropriate skin care under the diaper.

The disposable diaper works according to the following principle: the liquid passes through the cover layer and is absorbed by the absorbent material. In this case, the liquid turns into a gel, which allows it to be retained inside the diaper, leaving the surface dry. At present, there are no longer polyethylene diapers with replaceable absorbent inserts that retain moisture and create the effect of a “compress”.

When choosing a diaper, be sure to ask your parents what brand of diapers they use. However, diapers from well-known manufacturers do not differ much in terms of basic characteristics. So, a high-end diaper (for example, HUGGIES Super-Flex breathable diapers, etc.) usually consists of 6 main elements:

1. The inner layer, which is adjacent to the baby's skin, must be soft, so as not to cause irritation by rubbing against the skin, it is good to pass liquid.

2. The conductive and distributing layer quickly absorbs moisture and promotes its even distribution throughout the diaper so that it does not accumulate in one place.

3. The absorbent layer absorbs moisture from the conductive layer and keeps it inside by turning the liquid into a gel. The amount of absorbent material (absorbent) is not infinite, and at some point the diaper "overflows", which can be understood by its appearance or feel. This is the main signal that the diaper needs to be changed. If it is not changed, then it functions like an impenetrable cloth diaper and acts as a compress with a local increase in temperature and a greenhouse effect.

4.Internal barriers block fluid from flowing out from the side of the diaper, around the legs. The quality of the internal barriers is an important consideration when fitting a diaper to an infant, as the ratio of fit and elasticity varies from diaper to diaper. This determines a number of negative phenomena: the flow of moisture during the movements of the child, pinching or loose coverage of the hips, etc.

5. Outer covering of the diaper. It should not let liquid through, but it should be porous (breathable). Breathability is ensured by a porous fabric that passes air to the baby's skin, which creates an additional effect of evaporation and increased dryness.

6. Mechanical fasteners. They can be disposable or reusable. Reusable and elastic fasteners are more convenient, as they allow you to repeatedly refasten the same diaper if necessary. For example, in order to make sure that the child is dry and not dirty.

When using disposable diapers, it is preferable not to lubricate the skin with anything, but only dry the buttocks. In necessary cases, special creams, light lotions or milk for diapers are used, with application dosed through the hands of the person caring for them, powders, but not talc or flour. Fatty oils are also undesirable.

If irritation or diaper rash occurs, it is necessary to do air baths as often as possible, and after applying therapeutic ointments or creams, wait at least 5-10 minutes for their maximum absorption, remove the remnants with a damp cloth, and only then put on a disposable diaper.

It is necessary to change the diaper when it is full and always after a stool - this is the most important factor in the prevention of lower urinary tract infections in children, vulvitis in girls and balanitis in boys.

Feeding children in the first year of life. There are three types of feeding: natural (breastfeeding), mixed and artificial.

natural (breast) breastfeeding is called breastfeeding. Women's milk is unique and the only balanced food product for a newborn baby. No milk formula, even close in composition to human milk, can replace it. It is the duty and obligation of any medical worker, whether a doctor or a nurse, to constantly emphasize the benefits of human milk, to make every effort to ensure that every mother breastfeeds her child for as long as possible.

Mother's milk contains proteins, fats, carbohydrates, macro- and microelements in optimal ratios. With the first drops of milk (in the first 5-7 days after the birth of a child - this is colostrum), the newborn receives a complex of specific and non-specific protective components. So, in particular, immunoglobulins (Ig) of classes A, M, G provide the transfer of passive immunity factors from the mother to the child. The level of these immunoglobulins is especially high in colostrum.

That is why the early attachment of the child to the mother's breast (some authors currently recommend

breathing in the delivery room) improves the mother's lactation and provides the transfer to the newborn from a few (5-8) to tens (20-30) g of an immunologically complete protein. For example, IgA in colostrum contains from 2 to 19 g/l, IgG - from 0.2 to 3.5 g/l, IgM - from 0.5 to 1.5 g/l. In mature milk, the level of immunoglobulins decreases, averaging 1 g / l, which nevertheless provides natural protection against various pathogenic microorganisms.

Great importance is attached to the early attachment of the child to the breast - in this case, the intestinal microflora is better and faster formed in the newborn. By itself, feeding leads to the development of the so-called dynamic food stereotype, which ensures the interaction of the child's body with the external environment. It is important that natural feeding allows the newborn to better endure the conditions inherent in this period of life. They are called transitional or borderline - this is a transient loss of the initial body weight, hyperthermia, etc.

From the moment of the first attachment of the child to the mother's breast, a special relationship is gradually established between them, in essence, the process of raising a newborn begins.

When breastfeeding a child, certain rules are observed:

1. Before feeding, the mother should gently wash her breasts with boiled water with clean washed hands.

2. Express a few drops of milk with which bacteria are removed from the terminal sections of the excretory glandular ducts.

3. Take a comfortable position for feeding: sitting, placing the left foot on the bench if feeding from the left breast, and the right foot from the right breast (Fig. 18).

4. It is necessary that when sucking, the child captures with his mouth not only the nipple, but also the areola. The child's nose must be free to breathe properly. If nasal breathing is difficult, then before feeding, the nasal passages are cleaned with a cotton flagellum moistened with vaseline oil, or with an electric suction.

5. The duration of feeding should not exceed 20 minutes. During this time, the child should not be allowed to fall asleep.

6. If after feeding the mother has milk left, then its remains are expressed into a sterile dish (in a bottle with a funnel or a glass). The most effective way is to suck milk with a vacuum apparatus. In its absence, a rubber pad is used, a breast pump with a rubber canister. Breast pumps must be sterilized before feeding (Fig. 19).

Rice. 18.Breastfeeding in the position: a - sitting; b - lying down

Rice. 19.Breast pump options

In the absence of a breast pump, milk is expressed by hand. Beforehand, the mother washes her hands with soap and dries them dry. Then he puts his thumb and forefinger on the outer border of the areola, strongly and rhythmically squeezes his fingers. The nipple should not be touched.

7. In order to prevent the formation of cracks and maceration of the nipples, after feeding, the breast must be washed with warm water and dried with a clean, thin linen diaper.

When breastfeeding, the child himself regulates the amount of food he needs. However, in order to know the exact amount of milk he received, it is necessary to systematically carry out the so-called control feeding. For this, the baby is swaddled as usual before feeding, then weighed (in diapers), fed, re-weighed in the same clothes without changing diapers. By the difference in mass, the amount of sucked milk is judged. Control feeding is mandatory in case of insufficient weight gain of the child and in case of illness.

If the child sucked out an insufficient amount of milk, and also if he is sick or the mother is ill, then he is fed or supplemented with expressed human milk. Store expressed milk in the refrigerator at a temperature not exceeding 4 ° C. Within 3-6 hours after pumping and in case of proper storage, it can be used after heating to a temperature of 36-37 ° C. When stored for 6-12 hours, milk can only be used after pasteurization, and after 24 hours of storage it must be sterilized. To do this, put a bottle of milk in a saucepan, pour warm water slightly above the level of milk in the bottle. Further, during pasteurization, water is heated to a temperature of 65-75 ° C and a bottle of milk is kept in it for 30 minutes, during sterilization, the water is brought to a boil and boiled for 3-5 minutes.

Bottles of expressed milk are stored at the nursing station in the refrigerator along with milk mixtures. Each bottle should have a label that says what it contains (breast milk, kefir, etc.), the date of preparation, and on the bottle with expressed milk - the hour of pumping and the name of the mother.

Unreasonable introduction of partial bottle feeding (other food and drink) should be prohibited, as this may adversely affect breastfeeding. In addition, breastfeeding mothers should be aware that it is very difficult to return to breastfeeding.

With a lack of breast milk, an additional feeding system is used. The baby will suckle at the breast while receiving bottled food through special capillaries. At the same time, the physiological and psycho-emotional components of breastfeeding are preserved and milk production is stimulated.

When a mother has temporary difficulties with breastfeeding or breastfeeding, it is recommended to use a soft spoon (SoftCup). The graduated spoon is convenient for feeding due to the continuous dosed supply of food. A graduated spoon can be used to feed a child immediately after feeding, in the pre- and postoperative period in children with pathology of the maxillofacial apparatus.

mixed is called feeding, in which the child, along with breast milk, additionally receives artificial milk mixtures.

artificial is called feeding a child in the first year of life with artificial milk mixtures.

For hygienically impeccable feeding of infants, special utensils are used: bottles made of the purest and most heat-resistant glass, nipples made of rubber and silicone, and quick sterilizers for them (Fig. 20).

Feeding a baby with a milk mixture with mixed and artificial feeding is mainly carried out through a nipple from a bottle. Use graduated bottles with a capacity of 200-250 ml (division - 10 ml). A nipple with a hole is put on the bottle. A hole in the nipple is pierced with a needle calcined over a flame. The hole in the nipple should be small so that when the bottle is turned upside down, the milk flows out in drops, and not in a stream. Mixture or milk should be given to the child heated to a temperature of 37-40 ° C. To do this, before feeding, the bottle is placed in a water bath for 5-7 minutes. The water bath (pan) must be labeled “For heating milk”. Each time it is necessary to check whether the mixture has warmed up enough, whether it is too hot.

When feeding children with adapted (close in composition to mother's milk) milk mixtures such as "Detolact", "Baby", "Bona", the sequence of preparatory operations is somewhat different. Boiled water is poured into a sterilized bottle, dry milk mixture is added with a measuring spoon. Then the bottle is shaken and a clean nipple is put on it. After feeding, the bottle is washed with soda using a ruff.

Rice. 20.Baby bottles, nipples, pacifiers, thermoses and bottle sterilizers, bottle cleaning brushes

When feeding, the bottle must be held so that its neck is filled with milk all the time, otherwise the baby will swallow air, which often leads to regurgitation and vomiting (Fig. 21).

The child is held in the arms in the same position as when breastfeeding, or in the position on the side with a small pillow placed under the head. During feeding, you can not move away from the baby, you need to support the bottle, monitor how the baby sucks. You can't feed a sleeping baby. After feeding, you need to carefully

Rice. 21.Correct (a) and incorrect (b) position of the bottle during artificial feeding

but dry the skin around the baby's mouth, gently lift it and move it to a vertical position to remove the air swallowed during feeding.

When feeding a baby, every “little thing” matters. For children prone to hiccups and flatulence, it is better to use the so-called exclusive anti-hiccup nipples, such as Antisinghiozzo Kikko, which have discharge channels-grooves for free access of air inside the bottle during feeding. This compensates for the volume of milk sucked by the baby. The process of gas formation decreases, and thereby the possibility of developing intestinal colic in a newborn and infant. A choice of special slits in the nipple for any type of food is provided, so that it is possible to offer the child the right option at the right time (Fig. 22).

Rice. 22.Nipple hole options for different types of artificial feeding

Rice. 23.Feeding "in the hem"

the posture prevents dysmotility of the gastrointestinal tract, excludes the possibility of curvature of the spine in a child, in addition, it is convenient for a nursing mother.

For better assimilation of food, it is necessary to observe the established feeding hours. If the general condition is not disturbed and the appetite is preserved, then the diet of patients can be the same as healthy children of the same age (children under 2 months are fed 6-7 times, up to 5 months - 6 times, from 5 months to 1-1, 5 years - 5 times). In a serious condition of the child, poor appetite, they are fed more often (after 2-3 hours) and in portions of a smaller volume.

Sick children are sometimes very difficult to feed, not only because they have a poor appetite, but also because of the habits acquired at home. Great patience is required, since even a short-term refusal to eat weak and malnourished children can adversely affect the course of the disease. In hospitals, all mixtures for children of the first year of life are received in the catering unit. Dry mixes in the buffet are turned into ready-to-eat immediately before feeding the baby. The type of mixture, its volume and frequency of feeding for each child is determined by the doctor.

The younger the child, the more he needs the most adapted mixtures. The mixtures recommended for feeding children during the first six months of life include Nutrilak 0-6 (Nutritek, Russia), Nutrilon-1 (Nutricia, Holland), Semper Bebi-1 (Semper, Sweden). ), Pre-Hipp and HiPP-1 (KhiPP, Austria), Humana-1 (Humana, Germany), Enfamil-1 (Mead Johnson, USA), NAS-1 "("Nestte", Switzerland), "Gallia-1" ("Danone", France), "Frisolak-1" ("Friesland Nutrition", Holland), etc.

“Following” mixtures recommended for feeding children in the second half of life: Nutrilak 6-12 (Nutritek, Russia), Nutrilon 2 (Nutricia, Holland), Semper Bebi-2 (Semper, Sweden), HiPP-2 (KhiPP, Austria), Humana-2, Humana Folgemilch-2 (Humana, Germany), Enfamil-2 (Mead Johnson, USA), NAN-2 (Nestte, Switzerland), Gallia-2 (Danone, France), Frisolak-2 (Friesland Nutrition, Holland), etc.

For children of the first year of life, in addition to sweet adapted mixtures, adapted sour-milk mixtures have been created: liquid sour-milk mixture "Agusha-1" (Russia) for children aged 2-4 weeks of life to 5-6 months; "Baby" (Russia); "NAN fermented milk" ("Nestb", Switzerland) with bifidobacteria, "Gallia lactofidus" and "Lactofidus" ("Danon", France). Partially adapted acidic

There are also children's therapeutic mixtures that are prescribed for newborns with low birth weight ("Alprem", "Humana-0"), with lactose intolerance (A1-110, "NutriSoya"), with polyvalent allergy to cow's milk proteins, soy , severe diarrhea ("Alfare", "Prosobi", "Portagen", "SimilakIzomil").

With artificial feeding, the volume of sucked milk mixture is determined according to the graduated scale of the bottle. The amount of sucked milk from the mother's breast or formula from the bottle is noted after each feeding in the individual nursing sheet filled out for each infant.

Already in the first year of life, starting from the 4-5th month, the child is gradually accustomed to new types of food (complementary foods). When introducing complementary foods, certain rules must be observed. Complementary foods are given before breastfeeding or mixtures, and from a spoon. Complementary foods include cereals, vegetable purees, meat hashes (minced meat, meatballs), yolk, broth, cottage cheese, etc. Since the child begins to sit from 6 months, he should be fed at a special table or by sitting on the lap of an adult. When feeding a baby, an oilcloth apron or just a diaper is tied to the chest.

The timing of the introduction of complementary foods into the diet of breastfed children is regulated by the Institute of Nutrition

RAMS (Table 12).

Table 12The timing of the introduction of complementary foods with natural feeding

research institutes for children

In the first year of life, especially in infant wards, sterile utensils should be used for feeding.

Feeding premature babies - extremely difficult and responsible task. Premature babies who do not have a swallowing reflex or stop breathing during feeding are fed through a tube (Fig. 24). Feeding with a disposable tube is carried out when it is inserted into the baby's stomach for only one feeding, and permanently if the tube is left in the stomach for 2-3 days. A permanent probe, unlike a disposable one, is smaller in diameter, so it can be inserted through the nasal passages, although the introduction of a probe through the mouth is considered more physiological, since external respiration is not disturbed.

Sterilization rules for teats and bottles. Dirty nipples are thoroughly washed first with running water, and then with warm water and soda (0.5 teaspoon of baking soda per glass of water), while they are turned inside out. Then the nipples are boiled for 10-15 minutes. Teats are sterilized once a day, usually at night. Conducted by her ward nurse. Clean rubber nipples are kept dry in a closed (glass or enamel) container labeled "Clean nipples". Clean nipples are removed with sterile tweezers, and then put on the bottle with cleanly washed hands. Used nipples are collected in dishes labeled "Dirty nipples".

Bottles are sterilized in the pantry. First, the bottles are degreased in hot water with mustard (50 g of dry mustard per 10 liters of water), then washed with a ruff, washed with running water

Rice. 24.Feeding a premature baby through a tube

outside and inside (use a device in the form of fountains for rinsing bottles) and rinse. Clean bottles are placed neck down in metal nets, and when the remaining water drains, the bottles in the nets are placed in a dry-heat cabinet for 50-60 minutes (temperature in the cabinet is 120-150 ° C).

Bottles can be sterilized by boiling. To do this, they are placed in a special dish (tank, pan), poured with warm water and boiled for 10 minutes.

Store sterile bottles with necks closed with sterile cotton-gauze swabs in separate cabinets.

Stool observation and registration. In newborns, the original feces (meconium), which is a thick, viscous mass of dark color, departs by the end of the first day of life. On the 2-3rd day, the so-called transitional stool appears, which has a mushy texture, darkish color, and then a normal yellow stool with a sour smell is established. The frequency of stool in newborns is 2-6 times a day, by the year - 2-4 times a day.

The nature and frequency of stools depend on the type of feeding. When breastfeeding, the stool is 3-4 times a day, yellow, mushy, with a sour smell. With artificial scar-

stools are observed less frequently in chilning - 1-2 times a day, more dense, shaped, light green, sometimes grayish-clay, reminiscent of putty in consistency, with a pungent odor.

Loose stools can be with digestive disorders; the color of the feces changes, pathological impurities appear in the form of mucus, greenery, blood, etc.

The nurse should be able to determine the nature of the stool, since its appearance can reveal the initial signs of the disease. Pathological changes in the stool should be reported to the doctor and the stool should be shown. In the nursing list, it is necessary to note how many times there was a chair, and its character is a special symbol: mushy (normal); liquefied; with an admixture of mucus; with an admixture of greenery; blood in the stool; decorated chair.

Prevention of skeletal deformities. Skeletal deformities occur if the child lies in a crib in one position for a long time, with tight swaddling, with a soft bed, high pillow, with an incorrect position of the child in his arms.

In order to prevent deformations of the skeleton, a thick mattress stuffed with cotton wool or horse hair is placed on the crib. For children in the first months of life, it is better to put a pillow under the mattress: this prevents excessive bending of the head, and also prevents regurgitation.

The child in the crib must be laid in different positions, periodically picked up.

When swaddling, it is necessary to ensure that diapers and undershirts freely fit the chest. Tight swaddling and tightening of the chest can lead to deformation of the latter and respiratory failure.

Given the weakness of the musculoskeletal apparatus, children under 5 months of age should not be placed. If the child is picked up, then the buttocks should be supported with the forearm of the left hand, and the head and back should be supported with the other hand.

Transportation of infants. Transportation of infants does not present serious difficulties. Children are usually carried on their hands (Fig. 25, a). It is necessary to use the most physiological and comfortable position. Such a position can be created by using only one hand to carry the child, and leaving the other hand free to perform various manipulations (Fig. 25, b, c).

Rice. 25.Ways to carry an infant. Explanation in the text

Rules for using the couveuse. For nursing weakened newborns, premature babies and children with low body weight, incubators are used. Kuvez is a special medical incubator that maintains a constant temperature, humidity and the required concentration of oxygen in the air. Special devices make it possible to organize the necessary care for the child, to carry out various manipulations up to weighing, without removing the child from the incubator (Fig. 26). The upper part of the incubator is transparent, made of organic glass or plastic, which allows you to monitor the condition and behavior of the child. A thermometer and a hygrometer are fixed on the front wall of the hood, according to the readings of which one can judge the temperature and humidity of the air inside the cavern.

The incubator must be well ventilated and disinfected before use. According to the operating instructions, it is recommended to disinfect the incubator with formalin. To do this, put a piece of cotton wool moistened with a 40% formalin solution under the hood and turn on the flask for 6-8 hours, after which the cotton wool is removed and the incubator is left on with the hood closed for another 5-6 hours. In addition, the inner walls of the hood, a bed for the child and the lining mattress are thoroughly wiped with a 0.5% solution of chloramine.

The incubator is turned on in the following sequence: first, the water evaporation system is filled with water, then it is connected to the mains, then the required microclimate is selected by smooth rotation of the temperature and humidity controller.

Rice. 26.Closed couveuse

The child in the jug is naked. A constant temperature of 34-37 °C and relative air humidity of 85-95% are maintained. Oxygen mixed with atmospheric air is supplied to the flask, and the oxygen concentration does not exceed 30%. A special alarm system notifies with a sound signal about violation of parameters.

The duration of stay in the incubator is determined by the general condition of the child. If the newborn is in it for more than 3-4 days, then the microbial contamination increases significantly. According to existing rules, in this case, the child should be transferred to another incubator, washed and ventilated.

Nursing premature babies in an incubator for 3-4 weeks greatly increases the effectiveness of therapeutic measures and nursing, reduces the risk of various complications.

Rice. 27.Rehabilitation bed for newborns with neurological pathology

Rehabilitation bed for newborns and infants. For premature newborns and infants with neurological pathology, special bath beds (of the Saturn-90 type) are used, which provide comfort for a sick child by creating the effect of buoyancy and simulating conditions close to intrauterine. The lowest possible contact pressure on the child's body prevents microcirculatory and trophic disorders. The device is a stainless steel bath with a porous bottom filled with glass microballoons. Under the bathtub on the frame there is a supercharger, a unit for stabilizing the temperature of the forced air, a control and automatic control system. The filter sheet separates the body of a child floating in a "dry liquid" from glass microballoons (Fig. 27).

CONTROL QUESTIONS

1.Who are not allowed to care for infants?

2. What is the care of the skin and mucous membranes in a newborn and infant?

3.How is a hygienic bath performed?

4. What is included in the set of clothes for children in the first months of life and the second half of the year?

5. Name the rules for breastfeeding a child.

General childcare: Zaprudnov A.M., Grigoriev K.I. allowance. - 4th ed., revised. and additional - M. 2009. - 416 p. : ill.

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Introduction

1.3 Newborn baby's primary toilet

1.4 Organization of the first feeding of a newborn baby

1.5 Anthropometry of a newborn baby

1.6 Documentation. The history of the development of the newborn

2.1 Immunoprophylaxis of the newborn

2.2 Assessment of the condition of the newborn baby

2.3 Physiological conditions of the newborn baby

2.5 Screening testing

Chapter 3

Conclusion

Bibliography

Introduction

Neonatology is a section of pediatrics that studies the physiological characteristics and diseases of children in the first month of life. The development of neonatological care at the present stage is characterized by the creation of highly specialized services for the family, pregnant women, newborns, infants and young children, united in perinatal centers. The stages of medical care for newborn children are provided by the work of obstetric and pediatric services.

The staff of the obstetric (and sometimes gynecological) departments is responsible for the life of both the mother and the child. In obstetrics and gynecology departments, a nurse should be ready to provide emergency obstetric and gynecological care to women, and in some cases to newborns, before the arrival of a doctor. She also has to work in the department of pathology of pregnant women, and sometimes in the maternity unit, replacing the midwife.

The staff of obstetric and gynecological departments must be well versed in the methods of psychological therapy, since on the eve of childbirth it is necessary to inspire a woman with self-confidence; it is necessary to take into account the psychological status of patients in order to avoid premature termination of pregnancy, eclampsia, exacerbation of extragenital pathology (hypertension, heart failure).

Medical care for newborns begins to be provided from the maternity unit. Examination of a newborn in the delivery room is an important, so-called primary filter, on the basis of which most serious abnormalities are detected, indications for appropriate therapy are given in urgent cases, and the nature of further assistance is determined if the child is transferred to the appropriate department. It should be taken into account that we provide medical care to children not only in the delivery room, but also in the obstetric hospital. From how the sanitary and hygienic rules, obstetric benefits in childbirth, the primary toilet of the newborn, daily care for the baby will be observed, his health in the future will depend. Therefore, professional medical care for a newborn in an obstetric hospital is very important.

The purpose of this course work is to study the activities of medical staff in the neonatal period and determine the importance of compliance with all the rules and regulations for caring for a newborn child for his health in the future.

Tasks - to expand and consolidate knowledge on the organization of medical care for newborns, on compliance with the sanitary and epidemic regime in an obstetric hospital, to analyze theoretical sources on the research problem, to develop a memo on nursing care for newborn children.

Chapter 1

1.1 Characteristics of the neonatal period

The neonatal period (neonatal) is divided into early and late neonatal periods. It starts with the birth of the child and lasts 4 weeks.

Early neonatal period - from the moment of birth to the 7th day of life.

The main adaptation of the body to life in new conditions occurs. The speed of adaptive processes in the body during this period is the highest and never happens again in life. The respiratory system begins to function, the circulatory system is rebuilt, digestion is turned on.

All organs and systems are in a state of unstable balance, so the child needs especially careful care.

During this period, the child may have developmental defects, hemolytic disease, respiratory distress syndrome, and other pathologies. In addition to pathology, the newborn manifests various physiological states that reflect the processes of adaptation. These include: physiological catarrh of the skin, physiological jaundice, sexual crisis. Due to the predominance of inhibitory processes in the central nervous system, the newborn sleeps almost continuously. By the end of this period, all body systems come to a fairly stable balance, gas exchange is established at the level of an adult, weight gain begins. By the end of the first week of life, close contact between the newborn and the mother is established, especially if the child is breastfed. Most of this period the child is in the hospital.

Late neonatal period - from the 8th day to the 28th day of life. Characterized by further adaptation to the environment. At this time, the umbilical wound completely heals, body weight and body length increase intensively, analyzers develop, conditioned reflexes and coordination of movements begin to form.

The gestational age or true age of the newborn is considered to be gestational weeks from the first day of the last menstrual period. Depending on the period of gestation, newborns are divided into:

term (38-42 weeks)

premature (less than 38 weeks)

postmature (more than 42 weeks).

Prematurity signs:

intrauterine development cycle 38-42 weeks;

body weight not less than 2500 g;

body length not less than 45 cm;

have all the signs of maturity: it maintains a constant body temperature, has pronounced swallowing and sucking reflexes, a stable and correct rhythm of breathing and heartbeat, and actively responds to external stimuli.

1.2 Activities with the baby in the delivery room

The first task after removal of the baby and its separation from the mother is to avoid unnecessary heat transfer, especially in children with low body weight and in newborns who need special assistance, such as resuscitation, prolonged examination, etc. The newborn should be placed under the source of radiant heat and his skin should be carefully dried with prepared heated diapers.

In accordance with the generally accepted scheme, suction of the oral cavity, pharynx and nasal passages should be carried out simultaneously. This traditional technique acts as a powerful reflex stimulus, usually eliciting a first breath of the quench type, and its use is therefore justified.

The presence and quality of this reflex response is also a sign that serves to calculate points in assessing vital functions. The absence of this reaction indicates the possibility of inhibition of the respiratory centers. The role of suction in clearing the airways should not be overestimated, since the amount of suctioned contents is usually small and not essential for respiratory function.

For reasons of principle, the suction time should not be too long, since prolonged irritation of the upper respiratory tract can reflexively cause bradycardia or apnea. 1 minute after the complete extraction of the fetus, the doctor conducts a scoring of the basic vital functions of the newborn according to the Apgar scale.

1.3 Newborn's primary toilet

The primary toilet of a newborn is one of the first procedures that is performed by medical staff immediately after the birth of a child.

The first procedure is the suction of the contents of the oral cavity and nasopharynx. It is performed as soon as the baby's head appears in the birth canal, to prevent aspiration of amniotic fluid. Suction of the contents is carried out using a sterile rubber bulb or suction.

The next procedure is the ligation of the umbilical cord and its processing. This element of newborn care consists of two stages. Immediately after the birth of the baby, two sterile Kocher clamps are applied to the umbilical cord during the first ten to fifteen seconds. The distance between them is 2 cm. The first clamp is applied 10 cm from the umbilical ring. The umbilical cord between the clamps is treated with 5% alcohol solution of iodine or 96% ethyl alcohol and crossed with sterile scissors. The final ligation of the umbilical cord is carried out mainly to avoid secondary bleeding from the vessels of the umbilical cord.

It must be aseptic, since the drying residue and the demarcation zone are the main site of infection, which can go deep into the vessels and cause umbilical sepsis. From a mechanical and hygienic point of view, compression with a clamp is optimal for closing the umbilical cord.

Currently produced clips, as a rule, are made of plastic, have a small sharp corrugation, due to which they remain elastic when bent and cannot slip off the rest of the umbilical cord.

The advantage of this clamp is a stable elastic pressure, which ensures the stability of the compression of the residue during its mummification. Closing the remainder with a sterile band, which also leaks secretions and creates breeding ground for microorganisms, is less advantageous.

Disinfection with a Polybaktrin nebulizer (polymyxin, bacitracin, neomycin) also gives good results, which, however, is associated with a risk of sensitization. The treated cord residue is left open or a light air bandage is applied to it. After 2 days and later, the mummified part of the stump is cut off with a knife at the border of healthy tissue. Then the child is wrapped in a sterile warm diaper and placed on a changing table, which should be heated from above by a radiant heat source. This avoids cooling the baby and also reduces heat loss from the evaporating amniotic fluid. After that, the processing of the umbilical cord residue is continued, that is, they proceed to the second stage. The umbilical cord is treated with a cloth soaked in an alcohol solution, and then with a dry sterile gauze cloth. Further, at a distance of 0.2-0.3 cm from the umbilical ring, a special Rogovin staple is applied to the umbilical cord. At a distance of 1.5 cm from the staple, the umbilical cord is cut. The intersection site is treated with a 5% solution of potassium permanganate, and a sterile gauze bandage is applied by Chistyakova.

The next step in the primary toilet of a newborn is the treatment of the skin of the child. With a sterile gauze napkin, previously moistened with sterile vaseline or vegetable oil, excess primordial grease and mucus are removed.

A lot of important when carrying out the primary toilet of a newborn is the prevention of gonoblenorrhea. it is carried out with a 20% solution of sodium sulfate (albucid) immediately after birth, in the first minutes of life. One drop of the solution is instilled under the conjunctiva of the lower eyelids. Repeat after 2 hours. You can also use 1% tetracycline eye ointment for this. For girls, 1-2 drops of a 1-2% solution of silver nitrate are instilled once into the genital slit. Prevention of gonorrheal eye infection (credeization) is mandatory in the Russian Federation. According to Crede's original proposal, which has existed for almost 100 years, the main preventive method remains the instillation of a 1% solution of Argentum nitricum or Argentum aceticum into the conjunctival sac. The effect is very reliable, but its disadvantage is that the solution sometimes has a chemically irritating effect and, at an occasional high concentration, is toxic to the eyes.

The solution should be stored in a tightly closed dark glass bottle and changed to freshly prepared every week. Less irritating is the instillation of a solution of Ophthalmo-Septonex, but the effect of this drug on gonococci is controversial.

Prevention should be carried out very carefully so that the disinfectant solution penetrates the entire conjunctival sac. Experience shows that this condition is not always met. The determination of body weight and length ends the primary care of the newborn in the delivery room. Establishing linear parameters (head-heel length, head and chest circumference) immediately after birth is not very reliable, because the head can be deformed by a birth tumor and compression in the birth canal, the lower limbs are in a tonic flexion position.

If it is required to obtain accurate data, for example, for the purpose of research and statistics, then it is better to repeat the measurement of linear parameters after the disappearance of postpartum changes, that is, after 3-4 days.

Bathing a newborn in the delivery room, which was customary in the past, is no longer performed. The skin of the child is only gently rubbed with a soft diaper to eliminate grease and blood, or original feces. In newborns requiring special care, mainly respiration, primary treatment is carried out only after the condition is normalized; some procedures are carried out only when the child is already in the appropriate department.

1.4 Organization of the first feeding

If the baby was born full-term and the mother gave birth normally, the first application to the mother's breast is recommended immediately after birth. It is important to establish a feeding schedule for the child even in the neonatal unit. Subsequent feedings are carried out after 3-3 * / 2 hours. In most maternity hospitals, 7-fold feeding of newborns is accepted. Before feeding, the nurse carefully examines the newborns, changes diapers if necessary, then the children are transported on special gurneys or carried in their arms to the mother's wards. Before feeding, the mother washes her hands thoroughly, with a cotton swab gently rinses the nipple with a solution of furacilin (1: 5000) or a 0.5% solution of ammonia. With her hand, the mother expresses a few drops of milk to remove accidental contamination of the excretory ducts of the mammary glands. It is necessary to ensure that the child, when sucking, takes into his mouth not only the nipple, but also the areola. In the first 2 - 3 days, the mother feeds the child lying down. The child is applied to only one breast. On the 3rd - 4th day, the mother begins to feed the baby while sitting. Breastfeeding lasts 20-30 minutes. With the establishment of lactation, the child remains at the mother's breast for 15-20 minutes, during which time he sucks out all the necessary amount of milk. At the end of feeding, the breasts are washed with boiled water and dried with gauze or cotton.

In the first days after birth, the child sucks from the mother's breast from 5 to 30 - 35 ml of milk, that is, an average of about 150 - 200 ml per day. From the 3-4th day, the amount of milk received by the child increases, reaching 450-500 ml per day by the 8-9th day. The amount of milk a baby needs during the first days of life can be calculated using the formula:

where n is the day of the child's life, 7 is the number of feedings.

The pediatrician and nurse carefully monitor the condition of the newborn, the movement of the curve of his body mass. If it is necessary to determine whether the mother's lactation is sufficient, the child is weighed before and after feeding. The difference in body weight indicates the amount of sucked milk. A more complete picture of the state of lactation can be obtained after 2-3 control weighings during the day. One of the main conditions for full lactation of a nursing mother is the regular attachment of the baby to the breast and the observance of the time and duration of feedings.

After 10 days of life, the child should receive per day the amount of milk equal to 1/5 of his body weight.

There are three types of feeding of children of the 1st year of life: breastfeeding (natural), mixed (supplementary feeding) and artificial.

Natural feeding is feeding when the child during the first 5 months. life receives only mother's milk, and after 5 months. up to 1 year along with breast milk receives complementary foods.

Mother's milk is the best food for a child of the 1st year of life, it has a number of advantages. Breast milk contains all the nutritional ingredients necessary for a child and, moreover, in such quantities and ratios that most fully satisfy all the needs of an intensively growing child's body during this period. Proteins, fats and carbohydrates in breast milk are in such a combination (1:3:6) that creates optimal conditions for their digestion and absorption.

Mixed feeding is a type of feeding when, due to certain circumstances, in the first half of the year, along with mother's milk, supplementary feeding is given in the form of milk formulas, and the mixtures should be more than "/5 of the child's daily diet. The most common indication for transferring a child to mixed feeding on the part of the mother is a developing (gradually or quickly) hypogalactia - an insufficient amount of breast milk.

Artificial feeding is a type of feeding when a child does not receive mother's milk in the first half of the year or its amount is less than 1/5 of the total food. The grounds for transferring a child to artificial feeding is a serious illness of the mother or the complete absence of milk from her. This type of feeding of children of the 1st year of life is rarely used. With the current level of knowledge, properly carried out artificial feeding, as a rule, gives a good effect.

1.5 Anthropometry of the newborn

After the primary toilet, an obligatory element of newborn care is the anthropometry of the child. Anthropometry includes: determining the mass and length of the body, measuring the circumference of the head and chest. At the end of anthropometry, gauze ties with oilcloth bracelets are put on the child's wrist. They indicate: the name of the mother, the date and time of birth, the sex of the child, weight and length.

The child remains in the delivery room for 2 hours under the supervision of an obstetrician-gynecologist or pediatrician, then is transferred to the ward (department) for newborns. Before being transferred to the neonatal unit, the doctor re-examines the child, checks the condition of the umbilical wound. If there is bleeding, the umbilical cord must be re-tied.

When a newborn is admitted to the children's ward, a doctor or a nurse checks the passport data of the bracelet and medallion with the records in the history of its development and marks the time of admission of the child in it.

1.6 Documentation. The history of the development of the newborn

1. When registering the history of the development of a newborn, the number of the history of the development of the child must necessarily correspond to the number of the mother's birth history.

2. In the relevant columns of the history of the development of the child, information on:

diseases of the mother during pregnancy by trimesters and the course of labor, the duration of the I and II stages of labor separately, the duration of the anhydrous period, the nature of the amniotic fluid, the drug therapy of the mother during childbirth, information on steroid prophylaxis and antibiotic therapy with the name of the drug deserves special attention , dates of appointment and cancellation, route of administration, duration of the course and a single dose of the drug. A separate emphasis is placed on information from a tuberculosis dispensary about the epidemiological situation on this issue in a woman.

3. In case of operative delivery, the indications for it, the nature of anesthesia and surgical intervention are indicated.

4. The neonatologist in the appropriate columns on the 2nd page of the history of the development of the newborn gives a detailed assessment of the child's condition according to the Apgar scale at the end of 1 minute and after 5 minutes, as well as in accordance with the Methodological recommendations of the Ministry of Health and Social Development of Russia N 15-4 / 10 / 2-3204 of 21.04 .2010 "Primary and resuscitation care for newborns" after 10 minutes, if the Apgar score did not reach 7 points after 5 minutes after birth.

5. All newborns in the delivery room must complete the insert-card of primary and resuscitation care for the newborn in the delivery room, provided for in Appendix N5 of the Methodological Recommendations of the Ministry of Health and Social Development of Russia N15-4 ​​/ 10 / 2-3204 of 04/21/2010. "Primary and resuscitation care for newborns".

It is possible to use an augmented version of the insert card, on the back of which columns are added for a brief description of the examination of the child in the delivery room immediately after birth (Appendix 21).

6. In the history of the development of the newborn, the indicators of the weight and height of the child, the circumference of the head and chest are given, the method of processing the umbilical cord is indicated. A special note is made on the prevention of gonoblenorrhea.

7. In case of premature birth, in case of excess of the body weight of the child at birth and an increase in the average values ​​for the specified gestational age, the neonatologist, together with the obstetrician-gynecologist, draws up an act (the version of the act is presented in Appendix 22).

8. In the presence of blood type O (I) and / or a negative Rh factor in the mother, as well as in the presence of a Rh conflict, a mark is made on taking blood from the umbilical cord for group and Rh affiliation, bilirubin.

9. In the history of the development of the newborn, the temperature of the child's body is monitored during the entire period of his stay in the delivery room, and the method of keeping warm (the kangaroo method or skin-to-skin contact) is also indicated. The results are recorded in the temperature control card of the child in the delivery room (Appendix 6).

10. 2 hours after birth, the neonatologist makes a record in the history of the development of the newborn about the condition of the child (when he is transferred to the department for newborns) in the section “Initial examination of the newborn” with the obligatory indication of the date and exact time (hours and minutes) of the examination. If necessary, due to the severity of the condition or other objective reasons, the recording of the initial examination of the newborn can be performed earlier than 2 hours after birth with the obligatory indication of the date and exact time (hours and minutes) of the examination.

11. When a newborn develops a clinic of respiratory failure in the first minutes and hours after birth, the neonatologist assesses the state of the respiratory function of the newborn at the time of transfer using the Silverman scale (the form is presented in Appendix 23).

12. According to the order of the Ministry of Health of the Russian Federation N 921n dated November 15, 2012 “On approval of the Procedure for the provision of medical care in the neonatology profile, during the first day of life in the physiological department, the child is examined by a pediatric nurse every 3-

3.5 hours to assess the condition of the newborn and, if necessary, provide him with emergency medical care with the obligatory entry of the results of the examination into the medical documentation (version of the examination card in Appendix 6.

13. According to the order of the Ministry of Health of the Russian Federation N 921n dated November 15, 2012 “On approval of the Procedure for the provision of medical care in the neonatology profile”, a neonatologist examines a newborn daily, and if the child’s condition worsens with such a frequency as determined by medical indications, but at least once at three o'clock. The results of the examination are recorded in the history of the development of the newborn, indicating the date and time of the examination.

14. Daily records of the neonatologist (see above, paragraph 1, section 2, paragraph 2.8). Daily appointments in the history of the development of the newborn are taken out by the attending neonatologist in the fields on the right in compliance with the necessary requirements (see above, paragraph 2, section 2, paragraph 2.20).

15. In order to maintain the necessary continuity in the supervision of a newborn between the maternity hospital and the children's clinic, the neonatologist of the maternity hospital must note in the discharge epicrisis:

Basic information about the mother: the state of her health, the features of the course of pregnancy and childbirth, the surgical interventions that took place,

Assessment of the newborn on the Apgar scale, activities carried out in the delivery room (if the child needed them),

Features of the course of the early neonatal period: the time of falling off of the umbilical cord and the condition of the umbilical wound, body weight and condition at the time of birth and at discharge, the date of vaccination and the series of vaccine against hepatitis B and BCG-M (if not done, the rationale for its withdrawal), data on the neonatal screening and audio screening, data from laboratory and other examinations,

In case of incompatibility of the blood of the mother and the newborn according to the Rh affiliation or according to the ABO system, the Rh affiliation, the blood group of the mother and the child and the blood parameters in dynamics are noted in the exchange card,

In case of hypogalactia in the mother, this is indicated in the exchange card, recommendations are given for solving this problem,

In cases of asphyxia, birth trauma, illness of the child, the exchange card indicates not only the diagnosis, examination data of the child and the treatment performed, but also recommendations for the further management of the child, feeding, and therapeutic measures.

16. Along with the discharge summary issued to the mother in her hands, the head nurse of the neonatal department clarifies the mother’s home address and informs the children’s polyclinic at the child’s place of residence (except for non-residents) on the day of the child’s discharge by phone, basic information about the discharged child - for a faster the first patronage at home - and notes in the journal of the department (ward) for newborns and at the end of the history of the development of the newborn, the date of discharge and the name of the clinic employee who received the telephone message.

Instructions for filling out the insert-card of primary and resuscitation care for a newborn in the delivery room

1. An insert-card of primary and resuscitation care for a newborn in the delivery room (Appendix N 5 of Methodological recommendations No. 15-4 / 10 / 2-3204 of April 21, 2010 “Primary and resuscitation care for newborn children”) is filled out for each newborn in all medical - preventive institutions in which obstetric care is provided, by a doctor (neonatologist, pediatrician, obstetrician-gynecologist, anesthesiologist-resuscitator) or, in the absence of a doctor, by a midwife after completing a set of primary resuscitation measures. It is an insert sheet to the form 097 / y "History of the development of the newborn."

2. Insert-card of primary and resuscitation care for a newborn in the delivery room contains information:

On the nature of the amniotic waters;

On the state of the newborn according to the signs of live birth (independent breathing, heartbeat, pulsation of the umbilical cord, voluntary movements of the muscles), as well as the color of the skin, in dynamics;

On ongoing primary and resuscitation activities;

On the outcome of primary and resuscitation care.

Chapter 2

2.1 Immunoprophylaxis

In the maternity hospital, a newborn baby is given two vaccinations. On the first day of life, a hepatitis B vaccine is administered. Then, over the next 3-7 days, a tuberculosis vaccine is given - BCG or BCG-M.

Primary vaccination is carried out for healthy full-term newborns in the first four days of life and premature ones after reaching a body weight of 1.5 kilograms. Newborns are allowed to be vaccinated after being examined by a pediatrician, with an admission to vaccination in the history of the newborn.

Vaccinations for newborns are carried out in a vaccination room equipped with a refrigerator, a thermal container, disposable tuberculin syringes, grafting material, and anti-shock therapy drugs. Vaccination of newborns is carried out by a nurse of the vaccination room, who has access to vaccinations, on the basis of a medical prescription, in the presence of the mother of the child. The received vaccination, data on the vaccine (manufacturer, series, dose, expiration date, date of vaccination) are recorded in the history of the newborn and the exchange card, which, after the child is discharged from the maternity hospital, is transferred to a medical institution at the place of residence.

During the mother's stay in the maternity hospital, she is taught the timing of further vaccinations that the child will receive after being discharged from the maternity hospital and is given a Vaccination Passport with the vaccinations received in the maternity hospital.

The BCG vaccine is administered strictly intradermally at the border of the upper and middle third of the outer surface of the left shoulder in a volume of 0.05 ml for children under one year old and in a volume of 0.1 ml for children older than one year old, vaccinated with vaccines from foreign countries. The Russian vaccine is administered in a volume of 0.1 ml, regardless of age.

To obtain a vaccination dose equal to a volume of 0.05 ml, 1.0 ml of a standard solvent is added to a vial (ampoule) of a 20-dose packaging; 2.0 ml of a solvent is required to dilute a 40-dose vaccine. The diluted vaccine should give a uniform suspension within one minute.

Due to the high sensitivity of the BCG vaccine to daylight and sunlight, it should be stored in a dark place using a black paper cylinder.

BCG vaccine can only be used within six hours of reconstitution, so the time and date the vaccine was opened is stamped on the label. Unused vaccine is destroyed by boiling for 30 minutes or by immersion in a 5% chlorine disinfectant solution for two hours or by burning in an oven.

Before using the vaccine, it is necessary to carefully study the instructions attached to it, check the labeling and integrity of the ampoule (vial), the compliance of the drug with the attached instructions.

In the fight against viral hepatitis B, the main role is assigned to active specific immunization - vaccination against hepatitis B, which in Russia is included in the National Immunization Calendar and is enshrined in law. There are several vaccination schemes against this virus, consisting of the introduction of 3 or 4 doses of vaccination (according to such schemes, they are also vaccinated in our country).

Traditional option:

Under normal conditions, the vaccination course consists of 3 vaccinations (according to the 0-1-6 scheme):

The 1st vaccination (the first dose of the vaccine) is administered on the so-called day 0 (the first 12 hours of life).

The 2nd vaccination (the second dose of the vaccine) is administered 1 month after the first.

The 3rd vaccination (the third dose of the vaccine) is given 6 months after the first vaccination (that is, when the baby is six months old).

To create full-fledged immunity, you should adhere to the recommended timing of the introduction of the vaccine. Then effective immunity against hepatitis B is formed in at least 95% of those vaccinated. However, in some cases (illness of a child, change of residence, lack of a vaccine), the vaccination schedule is violated. It must be remembered that the interval between the first and second doses of the vaccine should not exceed 2-3 months, and the introduction of the third vaccination should not be later than 12-18 months from the start of vaccination.

Hepatitis B vaccines are generally well tolerated. Side effects (redness, induration and soreness at the injection site, feeling unwell and a slight increase in body temperature up to 37.5 degrees C) are rare, short-term, usually mild and, as a rule, do not require medical attention. Very rarely, severe allergic reactions may appear: anaphylactic shock or urticaria.

2.2 Newborn assessment

Assessment of the child's condition is carried out at the first and fifth minutes of life. The result is written as a fraction, for example - 8/9. The Apgar scale is an assessment of the state of health of the newborn, and no predictions about the future condition of the child can be made from it. At the time of the study, the results are evaluated as follows:

7-10 points - deviations in the state of health were not revealed;

5-6 points - small deviations;

3-4 points - serious deviations from the normal state;

0-2 points - a condition that threatens the life of the newborn.

If possible (this depends mainly on the condition of the woman in labor), the obstetrician-gynecologist conducts a cursory examination of the newborn, paying attention to his vital functions and the presence of serious malformations or birth trauma.

To assess the physical development of newborns, statistical indicators of the main parameters are used depending on gestational age or percentile evaluation tables. The parameters of the physical development of the newborn, located in the interval M ± 2 s (s - standard deviation) or P10 - P90 are normal physical indicators for a given gestational age. The parameters of the physical development of newborns depend on the parameter and age of his parents, nutritional habits, living conditions and the serial number of pregnancy in a woman. The characteristic of the proportionality of the physique and nutrition of newborns is important.

A full-term newborn is a child born at a gestational age of 37-42 weeks. In a full-term newborn, due to the prevailing development of the brain, the head makes up 1/4 of the body. Of particular importance is the determination of head circumference at birth (and in dynamics) of body weight, as well as its shape. The variants of the normal form include the following: dolichocephalic - elongated in the anterior-posterior direction, brachiocephalic - in the transverse direction, and the tower skull. The bones of the skull are malleable, they can overlap each other along the sagittal and coronal sutures. Features are reflected in the maturity table.

A premature newborn is a baby born before 37 weeks of gestation. Live births at 22 to 28 weeks gestation and surviving the first 168 hours of life. Normal developmental parameters in terms of 28-37 weeks include children with a body weight of 1000.0 to 2500.0 g, a length of 38-47 cm, a head circumference of 26-34 cm and a chest of 24-33 cm. According to statistics from different countries, premature from 6 to 13% of children are born. Body weight cannot be the main criterion for prematurity. There is the concept of "low birth weight" or "low weight" - these are children weighing less than 2500.0 g at birth who were born at term.

Postterm newborns include children born after 294 days or 42 weeks of gestation. The frequency of birth of such children is from 8 to 12%. In children, clinical signs of trophic disorders are observed: a decrease in skin turgor, thinning of the subcutaneous fat layer, desquamation, dryness and peeling of the skin, lack of lubrication, dense skull bones, often with closed sutures.

When comparing gestational age and indicators of physical development, the following groups are distinguished:

newborns with a large body weight, which is higher than the average for a given period by 2s or 90 percentiles or more;

with normal physical development for a given gestational age;

with low body weight in relation to gestational age or intrauterine growth retardation.

The following types of IUGR are encountered: immaturity or "small for date", dysplastic or asymmetric and late type or intrauterine malnutrition. Combinations of different types of IUGR may occur in the same child. The pathogenesis of developmental and growth retardation in the fetus is diverse. When only body weight lags behind the gestational age of the fetus, adverse factors, as a rule, interact in the last trimester of pregnancy. With a lag in body weight and length from gestational age, unfavorable conditions for the existence of the fetus are observed at the end of the first and beginning of the second trimester of pregnancy. Violation of body proportion, often combined with dysbriogenetic stigmas and malformations, is referred to as a dysplastic type and is observed in children with chromosomal and genomic disorders, as well as in intrauterine, generalized infections. Various types of IUGR occur in full-term, premature, and post-term newborns.

The maturity of the newborn is determined by a combination of clinical, functional and biochemical parameters. In each age period, starting from the zygote, the adaptation features of the fetus, newborn and infant correspond to its calendar age in conjunction with the environment that surrounds it and interacts with it. The state of the central nervous system is an informative characteristic of maturity. When examining a child, posture, position, spontaneous facial motor skills, emotional reactions, congenital unconditioned reflexes, and sucking activity are assessed. According to clinical signs, the maturity of the newborn is determined using evaluation tables by the sum of the scores of each sign.

2.3 Physiological conditions of the newborn

In some newborns, transient states specific to this age are observed, depending on changes in the conditions of the external and internal environment that occur after birth.

These conditions, being physiological, are observed only in newborns and never recur in the future. However, these conditions border on pathology and, under unfavorable conditions, can turn into painful processes.

The most common are the following physiological conditions.

The skin of a newborn is covered with a cheese-like lubricant - ver-nix caseosa. This lubricant consists of almost pure fat, glycogen, extractives, carbonic and phosphate salts, as well as cholesterol, odorous and volatile acids. Its color under normal conditions is grayish-white. If it has a yellow, yellow-green or dirty gray color, then this indicates intrauterine pathological processes (hypoxia, hemolytic processes, etc.). As a rule, the cheese-like lubricant is not removed in the first 2 days, as it protects the body from cooling and the skin from damage, contains vitamin A, and has useful biological properties. And only in places of accumulation (inguinal, axillary folds) the lubricant undergoes rapid decomposition, so here the excess must be carefully removed with sterile gauze dipped in sterile vegetable oil.

In a full-term baby, yellowish-white dots are often noted on the tip and wings of the nose, slightly rising above the skin. Their origin is explained by excessive secretion of the sebaceous glands, especially in the last months of fetal development. By the end of the 1st week or the 2nd week, they disappear when the epidermis changes and the ducts open.

Neonatal erythema, or physiological skin catarrh, develops as a result of skin irritation to which it is exposed to new environmental conditions, while the skin becomes brightly hyperemic, sometimes with a slight bluish tint. Hyperemia is observed from several hours to 2-3 days, then small, rarely large peeling appears, especially pronounced on the palms and feet. With abundant peeling, the skin is lubricated with sterile oil (castor, sunflower, olive, fish oil). In the absence of erythema in a newborn in the first hours and days of life, it is necessary to find out the reason for this: it is absent in pulmonary atelectasis, intrauterine toxemia, due to various pathological conditions of the mother during pregnancy, intracranial hemorrhages.

Physiological jaundice usually appears on the 2-3rd day after birth and is observed in 60-70% of newborns. The general condition of the children is good. In this case, a more or less pronounced icteric staining of the skin, mucous membranes of the oral cavity and somewhat less sclera appear. Due to the strong redness of the skin in the first days, jaundice may not be noticeable at first, but it is easily detected if you press a finger on any area of ​​the skin. Stools of normal color, urine does not contain bile pigments. From the side of the internal organs, no deviations from the norm are observed. Children are actively suckling.

The appearance of jaundice is due to the emerging imbalance between the enzymatic capacity of the liver (glucoronyl transferase deficiency) and the increased breakdown of red blood cells (the number of which is increased during fetal development). The immature enzymatic system of the liver is not able to process and release a large amount of bilirubin.

Physiological jaundice lasts for several days, and its intensity gradually decreases, and by the 7-10th day, rarely by the 12th, it disappears. Much less often, jaundice lasts 2-3 weeks. A protracted course of jaundice is often observed in children born prematurely or in severe asphyxia, who were injured during childbirth.

The prognosis for physiological jaundice is favorable. Treatment is not required. With severe jaundice, children are given a 5–10% glucose solution, an isotonic sodium chloride solution–50–100 ml / day with 100–200 mg of ascorbic acid. With jaundice that appears very early, a rapid increase in the color of the skin and a long course, it is necessary to doubt its physiological nature, thinking first of all about the hemolytic disease of the newborn, and show the child to the doctor.

Physiological mastitis - swelling of the mammary glands is observed in some newborns, regardless of gender. It is due to the transition of estrogenic hormones from mother to fetus in the prenatal period. Swelling of the mammary glands is usually bilateral, appears in the first 3-4 days after birth, reaches its maximum value by the 8-10th day. Sometimes the swelling is insignificant, and in some cases it can be as large as a plum or more. The swollen glands are mobile, the skin over them is almost always of normal color. A liquid that resembles colostrum may come out of the nipple. As the body releases from maternal hormones, the swelling of the glands also disappears. Any pressure is strictly prohibited because of the danger of injury, infection and suppuration of the glands. Physiological mastitis does not require treatment.

Catarrhal vulvovaginitis occurs in some newborn girls. It occurs under the influence of follicular hormones of the mother. In the first days after birth, the squamous epithelium is secreted along with the glandular tissue of the cervix in the form of a mucous, viscous secretion, sometimes there may be bloody discharge from the genital slit. In addition, there may be swelling of the vulva, pubis and general swelling of the genital organs. The normal phenomena arising under the influence of hormones of mother, the swelling of a scrotum which is observed sometimes at boys belongs. All these phenomena can be observed on the 5-7th day of life and last 1-2 days. This does not require special treatment. Girls should only be washed more often with a warm solution of potassium permanganate (dissolved with boiled water in a ratio of 1:5000-1:8000), squeezing it out of cotton wool.

Physiological weight loss is observed in all newborns and is 3--10% of birth weight. The maximum weight loss is observed by the 3-4th day of life. In most newborns, body weight is restored by the 10th day of life, and in some - even by the end of the 1st week, only in a small group of children the initial body weight is restored only by the 15th day. Overheating, cooling, insufficient air humidity and other factors increase the loss of body weight. The amount of physiological weight loss is also influenced by the course of childbirth, the degree of full-term and maturity, the duration of jaundice, the amount of sucked milk and the resulting fluid. Physiological weight loss in newborns is due to the following circumstances: 1) malnutrition in the early days; 2) the release of water through the skin and lungs; 3) loss of water with urine and feces; 4) discrepancy between the amount of received and released fluid; 5) often regurgitation of amniotic fluid, a slight loss of moisture when the umbilical cord dries out. With a loss of more than 10% of the initial body weight, it is necessary to clarify the reason for this. It must always be remembered that often a large drop in body weight is one of the initial symptoms of a disease. It is possible to prevent a large loss of body weight under the following conditions: proper care, early attachment of children to the breast - no later than 12 hours after birth, the introduction of a sufficient amount of fluid (5-10% relative to the child's body weight).

Uric acid kidney infarction occurs in half of newborns and is manifested in the fact that a large amount of uric acid salts is excreted in the urine. Urine becomes cloudy, more brightly colored, and on the days of the greatest weight loss takes on a brown tint. When standing in the urine, a significant precipitate appears, which dissolves when heated. A large amount of uric acid salts in the urine can be judged by the reddish color of the sediment and by the reddish-brown spots remaining on the diapers. All this is associated with the release of urates as a result of uric acid infarction of the kidneys, which is based on the increased formation of uric acid in the body of a newborn due to increased decay of cellular elements and protein metabolism. With the appointment of a large amount of fluid and with the release of a large amount of urine, the infarction disappears approximately within the first 2 weeks of life. As a rule, it does not leave consequences and does not require treatment.

Physiological conditions also include transitional stools after the release of meconium from the intestine.

Meconium is the original feces, which is formed from the fourth month of intrauterine life. It is a dark olive, viscous, thick, odorless mass, which consists of secretions of the embryonic digestive tract, separated epithelium and swallowed amniotic fluid; the first portions of it do not contain bacteria. By the 4th day of life, meconium is completely removed from the intestine. The transition to normal milk stools in a child does not occur immediately with proper feeding. Often this is preceded by the so-called transitional chair. At the same time, the stools are rich in brownish-greenish mucus, watery, sometimes foamy. Newborns often have accumulation of gases and distention of the intestines, which causes anxiety for the child, the frequency of bowel movements fluctuates sharply, and the type of bowel movements changes. The chair is 2-6 times a day, homogeneous, the color of mashed mustard, mushy consistency.

2.4 Care of the mucous membranes and skin of a newborn baby

After the child enters the neonatal ward, the nurse constantly monitors the nature of his behavior, crying, especially sucking, regurgitation. Particular attention is paid to the care of the skin, mucous membranes, umbilical cord stump.

Every day before morning feeding, a newborn toilet is carried out in a certain sequence: washing, treating the eyes, nose, ears, skin and, last but not least, the perineum. Wash the child with running warm water. In the presence of irritation of the conjunctiva or discharge from the eyes, a solution of furacilin (1: 5000) is used, and each eye is washed with a separate cotton swab from the outer corner of the eye to the inner. The toilet of the nose and auricles is produced with separate sterile wicks moistened with a solution of furacilin or sterile oil (sunflower or vaseline). Do not use sticks, matches or other hard objects for this purpose.

The skin folds (cervical, axillary, popliteal) are lubricated during the first 2 days with a cotton ball soaked in 1% alcohol solution of iodine, and in the following days they are lubricated with sterile vaseline or vegetable oil. The use of powders in a newborn is not recommended, as they can cause skin maceration.

To wash the newborn, the nurse lays him back on his left arm so that the head is at the elbow joint, and the sister's hand holds the newborn's thigh. The area of ​​the buttocks and perineum is washed with warm running water with baby soap in the direction from front to back, dried with a blotting motion with a sterile diaper and lubricated with sterile vaseline oil.

The umbilical cord is cared for in an open way. The stump of the umbilical cord is treated 1-2 times a day with 70% ethyl alcohol, 2% hydrogen peroxide solution. Treatment of the umbilical wound is carried out until it heals (on average from 10 days to 2 weeks). Until the umbilical cord falls off, it is recommended to use only sterile diapers and diapers. At this time, it is undesirable to use diapers of the "diaper" type due to possible reactive changes as a result of the friction of the edge of the diaper on the wound.

Weighing of newborns is carried out daily before the first feeding. The undressed child is placed on a diaper and weighed, then the weight of the diaper is subtracted from the resulting figure and the net body weight of the newborn is obtained.

Swaddling a newborn should be done before each feeding and after each urination to avoid diaper rash. The clothes of the child should be light, comfortable, warm. The first set of underwear for a newborn includes 4 sterile diapers, a vest and a blanket.

A pediatric nurse should be able to properly swaddle a baby. At the same time, it must be remembered that clothing should protect the newborn from large heat loss and at the same time not hamper his movements and not prevent evaporation from the skin.

A full-term newborn is swaddled with handles for the first 2-3 days, and in the following days, at the appropriate air temperature in the ward, the handles are laid out over the blanket.

The generally accepted method of swaddling has the following disadvantages: the physiological posture of the child is forcibly changed, his movements are shy, breathing is difficult, blood circulation is disturbed. With this in mind, special clothes for newborns have been introduced in maternity hospitals. The child is put on two blouses with long sleeves (one light, the second flannel, depending on the time of year). Then it is loosely wrapped in three diapers, leaving the head and arms open, without restricting the legs. In this form, the newborn is placed in a cotton envelope, in which a soft flannel blanket folded 3 times is inserted. If necessary, a second flannelette blanket is placed over the envelope. With this method of swaddling, the movements of the newborn are not limited and, at the same time, heat is better retained under the clothes.

When swaddling, the baby is placed in such a way that the top edge of the diaper reaches the armpits. The diaper is placed on the perineum, after which the child is wrapped in a thin diaper. Enclose a polyethylene diaper (oilcloth) measuring 30x30 cm (upper edge at the level of the waist, lower - to the level of the knees). Then the child is wrapped in a warm diaper. If necessary, the child is covered with a blanket on top. From 1-2 months of age, during the daytime "wakefulness", diapers are replaced with sliders, from 2-3 months of age they begin to use disposable diapers (usually on walks), which are changed every 3 hours, and at 3-4 months. when profuse salivation begins, a breast cap is put on over the vest. A scarf or a cotton cap is put on the head only after a bath and during a walk. At 9-10 months. undershirts are replaced with a shirt, and sliders are replaced with tights (in winter with socks or booties).

Swaddling is done before each feeding, and in children with irritated skin or with diaper rash, more often.

The changing table and the oilcloth mattress on it after swaddling each child are thoroughly wiped with a disinfectant solution. Healthy children are swaddled on the changing table. In the case of isolation of the child, swaddling is done in the crib.

2.5 Screening testing

Newborn screening is an analysis for common hereditary diseases: phenylketonuria, cystic fibrosis, galactosemia, congenital hypothyroidism and adrenogenital syndrome.

Neonatal screening is a government screening program for all newborn babies.

Its goal is to detect certain serious genetic diseases as early as possible.

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Permission to care for infants.

The basis of care is the observance of the strictest cleanliness, and for a newborn child and sterility (asepsis). Care for infants is carried out by paramedical personnel with the obligatory supervision and participation of a doctor. Persons with infectious diseases and purulent processes, malaise or elevated body temperature are not allowed to work with children. Medical workers of the department of infants are not allowed to wear woolen clothes, jewelry, rings, use perfumes, bright cosmetics, etc.

The medical staff of the department where infants are located should wear disposable or white, carefully ironed gowns (when leaving the department they are replaced with others), hats, four-layer marked masks and removable shoes. Strict observance of personal hygiene is obligatory.

Care of the skin and mucous membranes in the newborn and infant. Hygiene.

Daily care of the newborn is carried out by a nurse in the children's ward of the maternity hospital or in the mother-child ward. After discharge from the maternity hospital, care is taken by the mother in a specially designated corner of the children's room, on the changing table, which should be covered with a blanket, oilcloth, and on top with a clean diaper. Good lighting is required, the air temperature is 20–22 ° C.

Washing hands with warm water with a brush and soap for 2 minutes is mandatory before toileting an infant. After laying out the undressed child, on a pre-treated changing table, he is carefully examined, paying special attention to the umbilical wound, as well as to the places most dangerous in relation to the occurrence of diaper rash (behind the ears, neck, axillary, inguinal folds). Eyes washed with boiled water, in the direction from the outer corner to the inner. Separate sterile cotton swabs are used for each eye, first wet, then dry.

In the presence of conjunctivitis, the eyes are treated repeatedly during the day with a solution of furacillin at a dilution of 1:5000 or a solution of KMnO 4 at a dilution of 1:8000 (0.8% solution).

Nasal toilet is carried out in order to remove dry crusts, mucus, milk, which can get there when regurgitation. The nose is cleaned with cotton flagella soaked in sterile vaseline oil, which are inserted into the nasal passage for one to one and a half centimeters with rotational movements. To remove the crusts that form in the baby's nose, first, warm vaseline oil is instilled into each nostril, and after 15 minutes the nose is cleaned with cotton flagella. Cleansing of the nasal passages is carried out alternately, with different flagella. It is strictly forbidden to use matches, sticks and other items with cotton wool wrapped around them for the toilet of the nasal passages. auricles wipe with a well-wrung wet cotton swab dipped in boiled water. Once every two to three weeks, the external auditory canals are cleaned with wet and then dry cotton flagella.

Oral toilet children are carried out only if there are special indications (thrush, aphthous stomatitis).

Thrush (mucosal candidiasis) occurs on the mucous membrane of the oral cavity (cheeks, palate, gums, tongue) in the form of multiple dot raids resembling semolina or curdled milk, located on a hyperemic background. Plaque is easily removed with a gauze swab, exposing a moist, erosive, painful surface, which makes it difficult to move the mouth when sucking and swallowing. For the treatment of thrush, the following solutions are used: 1% solution of gentian violet, 2% soda solution, 20% solution of borax with glycerin, nystatin, irrigation with ascorbic acid. Processing of the affected mucous membranes is carried out 3-4 times a day, before feeding. With a sterile stick with a cotton swab dipped in one of the solutions, with careful rotational movements, without pressure, the elements of the thrush are removed.

The face, neck, hands are washed with boiled water using a cotton ball. The skin of infants is very delicate and thin. It is easily damaged by the slightest impact. Microbes freely penetrate through damaged skin, and the child's body is not yet able to actively counteract them. Therefore, even individual pustules, redness and skin lesions can lead to generalization of the infection in a short time. In this regard, any skin diseases in young children require medical advice. The child's skin is carefully examined and wiped with a sterile cotton swab dipped in sterile vaseline or boiled vegetable oil. You can also use baby cream to wipe the skin. Particular attention is paid to natural folds, which are wiped in the following order: behind the ear, cervical, axillary, elbow, wrist, popliteal, inguinal, buttocks.

diaper rash- limited inflammatory changes in the skin, in areas easily exposed to friction and maceration (natural folds). Diaper rash occurs when there is a violation of the care of a newborn: rare washing, excessive wrapping, trauma to the skin with coarse diapers, etc. Treatment of diaper rash is reduced to the elimination of care defects. The child should be washed after each urination and stool, linen should be changed often, and diapers should be changed at least an hour later. Assign general baths with KMnO 4 (water temperature 36–38 ° C), local air baths for 5–10 minutes. The lesions are powdered with talcum powder with dermatol (3-5%), lubricated with sterile vegetable oil. When prickly heat(small red spots that merge into a general redness) it is recommended to wipe the skin with vodka diluted by half with water. Since prickly heat occurs when overheating, it is necessary to switch to free swaddling. Mandatory daily baths with string or potassium permanganate. Air baths are also useful.

Children are washed with warm running water at a temperature of 36-38 ° C. During washing, the child is held on weight, in the left hand, and washed with the right. In case of severe contamination, washing is carried out with a soapy hand. When washing girls, they are kept face up and must be washed from front to back, this is done in order to prevent infection of the urinary tract with fecal matter. Then, with careful blotting movements, the child is dried. Wash the child at the end of the morning toilet and after each act of defecation. Children with sensitive skin, with a tendency to diaper rash, are recommended to wash after each urination.

Genital toilet in girls, it is carried out in the presence of vaginal discharge. The cotton wool is moistened in a solution of furacillin 1:5000 or KMnO 4 1:8000, and gently wipe the genital gap. The accumulation of smegma between the foreskin and the glans penis in boys should not be removed, as the mucosa can be damaged. With diaper rash and maceration of the penis, local baths with a solution of KMnO 4 1:8000 are shown.

Nails the child is cut with small scissors, at least once a week. Scissors are pre-treated with cologne or alcohol. To make the procedure less unpleasant, it can be likened to a game - to tell something about each finger. On the hands, the nails are cut in an arcuate manner, on the legs - with a straight cut (for the prevention of an ingrown nail). Nails are cut over an unfolded sheet of paper so as not to scatter them; trimmings should not fall into the child's face and onto the bed. Hair cutting is a very unpleasant procedure for children, so it must be done carefully, using a typewriter or sharp scissors, after cutting, you should wash your hair with baby soap or shampoo.

Bathing a child. Daily bathing of the newborn is started 2-3 days after the umbilical cord has fallen off, after the umbilical wound has healed. Bathing is recommended before the penultimate feeding. A hygienic bath is carried out up to 6 months of age daily, in the second half of the year - every other day, from a year to two - twice a week, after two years - once a week. In the first month, it is preferable to use boiled water for a hygienic bath. For children with an unhealed umbilical wound, a solution of potassium permanganate is added to boiled water (the color of the water is light purple). With soap, the child is bathed no more than once or twice a week. More frequent use of soap can cause skin irritation. The duration of the bath for children of the first year is usually 5–7 minutes, the air temperature in the room is 20–22 ° C, the water temperature for children of the first half of the year is 36.5–37.0 ° C, for the rest - 36 ° C.

The baby bath is washed with hot water with soap and a brush (if bathing is carried out in a children's institution, then the bath is additionally treated with a disinfectant solution) and rinsed with hot water. Before bathing, clothes for the child are prepared. It must be folded in the order in which it will be used after the bath. It is recommended to warm up the laundry, for which it can be put on a rubber or electric heating pad. The bath is filled with water, so that the child can be immersed up to the shoulders. One diaper, folded four times, is placed on the bottom of the bath. The child is carefully immersed in the bath, supporting the buttocks with the left hand, the head and back with the right hand (upper left figure), while the child's head is on the bather's forearm, and the back is in the palm of his hand. With the right hand, you can hold the child in another way: with a brush, the bather covers the right shoulder of the child, so that the neck and head of the child rest on his forearm. After that, the left hand is released. The child is washed with the free left hand (upper right and lower left figures), with a special terry or flannel mitten or sponge. The scalp (lower right figure) is washed last, lathered in the direction from the forehead to the back of the head. Do not wash your face with bath water. After bathing, the child is taken out of the bath with his back up, poured with water 1-2 0 C lower than the water in the bath. The bathed child is placed on an unfolded towel or sheet, wiped with blotting movements, while only the part that is wiped remains open, the rest of the body remains closed to prevent cooling.

Clothing for children in the first months of life and the second half of the year.

The clothes of the child should protect him from a large loss of heat, but at the same time not cause overheating and do not restrict movement. In this regard, for infants, underwear made of hygroscopic cotton fabrics is used, outerwear is made of flannel or woolen fabrics.

The set of linen for the day for swaddling a child of the first 3–4 months includes a thin vest (8–12 pcs), a warm vest or blouse (4–6 pcs), a diaper (24 pcs), a thin diaper 80x80 cm (24 pcs), a diaper flannel 100x100 cm (12 pcs), flannel blanket (2 pcs), wadded blanket (1 pc), oilcloth (1–2 pcs), thin cap, hat or scarf (1–2 pcs).

After three months of age, the child is not swaddled, but dressed in button-down vests, with open tassels and sliders. Up to 15 sliders are allowed per day for a child, the calculation of the rest of the linen, with the exception of diapers, remains the same. The number of diapers after 3 months is reduced by almost three times. For walks, the child is dressed in accordance with the season and the air temperature outside. The last quarter of the year is marked by increased physical activity of the child, in connection with this, sliders can be partially replaced with tights, knitted woolen socks can be used, and by the year booties.

Breastfeeding rules.

The ideal food for a child is his mother's breast milk, as it is related to his tissues. Breast milk has all the substances and trace elements necessary for feeding the baby in the optimal ratio and form, adapted to the characteristics of the baby's digestive system. Milk is species-specific, its composition changes as the child grows, in accordance with changing needs.

Breastfeeding rules:

The child is fed immediately after birth on demand, and not according to the schedule with the gradual formation of the regime - with sufficient, established lactation in the mother.

The duration of feeding is not limited, but no more than 15-20 minutes, at the request of the child, he is fed at night.

It is undesirable for a child to give a pacifier or a pacifier.

· You can not supplement the child in between feedings.

It is necessary to observe the rules of personal hygiene and strictly follow the technology of proper feeding.

Breastfeeding technique:

· The mother should wash her hands with soap, wash her breast with boiled water, dry it without rubbing the area of ​​the nipple and areola.

· When carrying out feeding, the posture of mother and child should be comfortable.

· The baby should not twist or stretch his neck to reach the breast. You can not hold the child by the head. The baby's face is turned to the breast, the nose is at the level of the nipple, the belly is to the mother's belly.

The breast must be inserted into the child's open mouth, so that the grip is full and deep, so that the nipple and part of the areola are deep in the mouth, touching the hard palate.

Breastfeeding control.

Signs on the basis of which hypogalactia can be suspected: a small increase in the weight of the child per month (on average, the monthly increase in the first half of the year is 800 g), the child does not swallow milk after a large number of sucking movements, a rare (less than 6 times) number of urination per day, as well as restlessness and crying after feeding.

Objectively, hypogalactia can be confirmed by conducting control feeding (the dynamics of changes in body weight before and after feeding the child). Control feeding must be carried out at least three times a day.

How to store and consume expressed breast milk.

At home, when taking milk from one perfectly healthy woman, correct and hygienically competent decantation, proper storage, you can feed it with milk that has not been subjected to heat treatment. The duration of storage of milk in a dark place at a temperature of 18–20 0 С is up to 24 hours, in a refrigerator at a temperature of +4 0 С - 72 hours, in a freezer at a temperature of -18 0 С - up to 4 months

Features of feeding a baby from a bottle with a nipple .

Mixture or milk should be given to the child heated to a temperature of 37-40 ° C. To do this, before feeding, the bottle is placed in a water bath for 5-7 minutes. The water bath (pan) must be labeled "For heating milk". Each time it is necessary to check whether the mixture has warmed up enough, whether it is too hot.

· When feeding, the bottle should be held so that its neck is filled with milk all the time (prevention of aerophagia - air swallowing).

· The position of the child - as when breastfeeding, or in the position on the side with a small pillow placed under the head.

During feeding, you can not leave the baby, you need to support the bottle, watch how the baby sucks. Can't feed a sleeping baby .

After feeding, thoroughly dry the skin around the baby's mouth; gently lift the baby and move it to a vertical position to remove the air swallowed during feeding.

Stool in infants .

Age features of feces in children are presented in table.1.

Age features of feces in children of the first year of life

Age	Name	External Features
Color	Consistency	Smell
1-3 day	Meconium	dark green	Thick, homogeneous	-
3-5 day	transitional	Plots of different colors - white, yellow, green	Liquid, watery, with lumps (English lump, clot), mucus	Gradually becomes sour
From 5-6 days to 6 months.	Normal Natural feeding Artificial feeding	golden yellow light yellow	Type of liquid sour cream	Sour putrid, pungent
After 6 months	Regular (decorated)	Brown	Dense (shaped)	Ordinary (natural, natural)

Development and prevention of skeletal deformities in infants.

Skeletal deformities occur if the child lies in the crib in one position for a long time, with tight swaddling, if the bed is soft, the pillow is high, if the child's position in the arms is incorrect.

Prevention of skeletal deformities:

· Thick mattress stuffed with cotton wool or horse hair.

· For children of the first months of life the pillow is not used.

The child in the crib must be laid in different positions, periodically picked up.

· When swaddling, it is necessary to ensure that diapers and vests loosely fit the chest. Tight swaddling and tightening of the chest can lead to deformation of the latter and impaired aeration of the lungs.

· Given the weakness of the musculoskeletal apparatus, children under 5 months of age should not be placed. If the child is picked up, then the buttocks should be supported with the forearm of the left hand, and the head and back should be supported with the other hand.

Practical skills on the topic

1. Admission of a sick child to a hospital, examination of the skin and hair to exclude infectious diseases and pediculosis.

2. Treatment of a child with pediculosis.

3. Monitoring the appearance and condition of a sick child.

4. Weighing, measuring height, head and chest circumference in children.

5. Change of underwear and bed linen for the child.

6. Swaddling children, choosing clothes and dressing children of different ages depending on the season.

7. Daily toilet of newborns.

8. Distribution of food and feeding of children of various ages, including infants.

9. Physiological and medical tables for children of different ages, rules for feeding children and methods for processing dishes.

10. Feeding young children. Warming formulas for feeding. Processing of bottles, nipples and utensils.

11. Evaluate and note in the history of the disease the stool in young children, plant it on a potty.

12. Toilet umbilical wound.

13. Treatment of the oral cavity in children of the first year with thrush.

Class equipment

1. Study tables, computer presentations.

2. Phantom of an infant.

3. Diapers, blankets.

4. Gauze napkins, cotton balls, cotton sticks.

5. Scales, stadiometer, measuring tape.

The lesson is held on the basis of the pediatric department.

Literature to prepare for the lesson

1. General child care. Educational and methodical manual, ed. V. V. Yurieva, N. N. Voronovich. -SPb: GPMA. -Ch.I. -2007. -53 p.

2. General child care. Educational and methodical manual, ed. V. V. Yurieva, N. N. Voronovich. -SPb: GPMA. - Part II. -2007. -69s.

3. Mazurin A. V., Zaprudnov A. M., Grigoriev K. I. General care for children. -M. -1998 -292 p.

4. Zaprudnov A. M., Grigoriev K. I. General care for children: textbook. allowance. - 4th ed., revised. and additional -M. : GEOTAR-Media, 2009. - 416 p.

5. Shamsiev F. S., Erenkova N. V. Ethics and deontology in pediatrics. -M: University book. -1999. -184 p.

State budgetary educational institution of higher professional education

"St. Petersburg State Pediatric Medical Academy"

Ministry of Health and Social Development of the Russian Federation