Needs of the Newborn

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Needs of the Newborn

• Improving newborn survival will dramatically
  reduce infant mortality worldwide.
• Of the 7.1 million infants who die each year,
  approximately two-thirds die in the first 28 days
  after birth the neonatal period.

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• Of these deaths, two-thirds take place in the
  first week after birth.
• Ninety-eight percent of all neonatal deaths
  occur in developing countries. 
• There are basic needs of a newborn that can help
  ensure a healthy start in life. 

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Basic needs of a newborn that can help ensure a
healthy start in life.

• During labour and delivery, mothers and newborns
  need 
• Skilled attendance provide safe management of
  normal delivery and timely referral for
  complications. 
• Support and care promote family support and a
  baby and woman-friendly environment for birth and
  maternal and newborn care

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• Infection control ensure clean delivery,
  including clean surface, hands, blade, and cord
  tie. 
• Management of complications identify and manage
  complications, including bleeding, high blood
  pressure, prolonged labour, and foetal distress

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Following birth, newborns need 

• Air - stimulate and resuscitate infants who are
  not breathing at birth. 
• Warmth dry the baby at birth. Maintain warmth
  through skin-to-skin contact, warm ambient
  temperature, and head and body covering. Promote
  kangaroo care for low-birth weight infants. 
• Breastfeeding breastfeed within the first hour
  after birth. Continue exclusive breastfeeding on
  demand day and night for six months.

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• Care keep the newborn close to the mother,
  father, or other caregiver. Keep the mother
  healthy. 
• Infection control maintain cleanliness when
  handling the infant. Keep the cord clean. Provide
  prophylactic eye care. Promote early and
  exclusive breastfeeding. Immunize according to
  schedule. Treat infections promptly. 
• Management of complications recognize and
  respond urgently to serious and life-threatening
  conditions.

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The five measures of infant and child mortality

• Neonatal mortality, the probability of dying in
  the first month of life
• Postneonatal mortality, the probability of dying
  after the first month of life but before the
  first birthday (the difference between infant and
  neonatal mortality rates)
• Infant mortality (1q0), the probability of dying
  before the first birthday

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• Child mortality (4q1), the probability of dying
  between the first and fifth birthday
• Under-five mortality (5q0), the probability of
  dying before the fifth birthday.
• All of these rates are calculated per 1,000 live
  births, except for child mortality which is
  calculated per 1,000 children surviving to age
  one.

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Perinatalearly neonatalLate neonatalneonatalpo
st neonatalinfant Birth
1 wk 1 mon. 1 y
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IMP. Risk factors and Causes of infant child
deaths

• Developing Countries1- Prematurely/ low birth
  wt. Birth injuries and neonatal infections 2-
  Multipregnances with no spacing 3- Early or late
  pregnancy4- Resp. Infections5-GIT diseases

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• 6-Infectious disease / Malaria7- Poor in come
  and large families leading to poor nutrition
  education and living standards.8- Environmental
  factors live poor water supply , poor housing and
  air pollution9- Accidents (being first cause
  bet. Age 5-15 years)10-Congenital abnormalities

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Proportional Mortality amonglt5 yrs. WHO Report
2002/World Wide
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Causes of Infant and Child Mortality in Jordan

• The 3 leading causes of infant death were
• 1-Conditions originating in the perinatal period.
  
• 2-Congenital malformations.
• 3- Diseases of the respiratory system.

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• The leading cause of death in the neonatal period
  was conditions originating in the perinatal
  period, while in the post-neonatal period, it was
  congenital malformations.
• Prematurity was the leading contributory cause
  of infant death.
• .

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CONCLUSION

• This study showed that causes of infant mortality
  in Jordan tend to be similar to those prevailing
  in developed countries.
• Khoury SA, Mas'ad DF.
• Department of Family and Community Medicine,
  University of Jordan, Amman, Jordan. Saudi Med J.
  2002 Apr23(4)432-5.

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Prematurely and low birthHigher Morbidity and
Mortality rates

• 1- Respiratory distress syndrome2- Birth Trauma
  3- Hemorrhages.4-Feeding problems5-Infections6
  -Failure to thrive

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Infant Mortality in Jordan

• The infant mortality rate also declined from 82
  per thousand in 1976 to 22 in 2002, and reached
  19 per thousand in 2007, decreasing by 14 percent
  compared to 2002.

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• Drops in mortality, particularly infant
  mortality, have translated into an increased life
  expectancy for the population in 2002, life
  expectancy in Jordan was 68 years for males and
  71 years for females, increasing to 72 years for
  males and 74 years for females in 2007.

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Well Baby Clinic

• Infant and Child care

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Main Objectives

• A- Regular physical examinations
• B- Growth and Development (Growth charts)
• C- Nutritional assessment
• D- Vaccination
• E- Health Education

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WBC

• Baby examined at birth and followed through WBC
  at six weeks of age then at.
• Two months Four months Six months Nine months
  Fifteen months Eighteen months Two years
  Three years

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Welcome to the Brazelton Institute!

• The Brazelton Institute is dedicated to promoting
  the healthy development of infants and families,
  through research and education programs for
  people who care for children and their families
  in the first years of life. The Institute is
  based in the Department of Pediatrics at the
  Children's Hospital in Boston

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Understanding the Baby's Language

• While babies may not speak their first word for a
  year, they are born ready to communicate with a
  rich vocabulary of body movements, cries and
  visual responses all part of the complex
  language of infant behavior.

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The Neonatal Behavioral Assessment Scale

• First, infants, even ones that seem vulnerable,
  are highly capable when they are born. "A newborn
  already has nine months of experience when she is
  born," Dr. Brazelton notes. "She is capable of
  controlling her behavior in order to respond to
  her new environment."

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• Second, babies "communicate" through their
  behavior, which, although it may not always seem
  like it, is a rational language. Not only do
  infants respond to cues around them, like their
  parents' face, but they also take steps to
  control their environment, such as crying to get
  a response from their caregivers.

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• Third, infants are social organisms, individuals
  with their own individuality, ready to shape as
  well as be shaped by the caregiving environment.

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Assessing the baby's capabilities
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Vaccination

• See Vaccination Lecture

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Indicators to describe a ( childs well being)
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• Nutritional Causes
• Enviromental causes
• Socio-Economical causes

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1-Number of low birth weight babies2- Infant
mortality rate
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• 3- Childrens death rate (children in the age
  group (1-14 years) calculated per 100,000
  children.
• Rate of teen death (between 15-19 years) as a
  result of accidents and suicide

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5- Teen birth rate (measured per 1000 females in
the age of (15-17) teenagers pregnancy is a very
important issue in the developed countries.
Dealing with those girls indicates dealing with a
group of infant born to very young mothers who
didnt reach the optimum nutritional and physical
maturity.
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• Therefore their pregnancy is at a high risk of
  obstructed Labour, maternal death low birth
  weight baby, and long term disabilities affecting
  the baby.

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• 6-Percentage of teenagers school drop out
  Maternal education is a very important factor
  contributing to the health of children .So high
  percentages of school drop out indicate poorly
  educated future parents.
• 7- Percent of teens not attending school nor
  working

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• 8-Percentage of children whose parents dont have
  a full year employment. If you dont have a job
  you wont provide money needed to insure all the
  medical, nutritional , educational needs of a
  child.
• 9-Percentage of children in poverty.
• 10-Number of families with children headed by a
  single parent.

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Adolescence

• School Health

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Adolescence

• Adolescence that period in a persons life
  which extends from the onset of the physical
  changes of puberty until the achievement of
  adulthood and independence.

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Adolescence

• It is a period of rapid change and great turmoil,
  as the adolescent endeavors to come to terms with
  himself, his limitations and his potential, and
  with the world outside himself.

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• Adolescence def varies depending on whether it is
  biological, psychological, social, or economic ,
  legislative in nature
• WHO defines adol as individuals between the ages
  10-19 years.

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• Important milestones include
• Late childhood, puberty, early adolescence, late
  adolescence are often cited as important
  milestones within the 10-19 category.

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Adolescents matter because 1. They are a
demographic forceAdolescents comprise one
fifth of every community population, or 1.2
Billion people world wide (Adolescents in the
Arab world in 2000 were 31 millions . In 2020, it
is expected to be 41 millions).2- They are an
economic forceAdolescents contribute
significantly to their families and communities
through paid and unpaid labor3-They are the
future healthAdolescents is a formative stage
which presents a unique opportunity to shape
young peoples health behaviors and social
attitudes.
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CHANGES DURING ADOLESCENCE1- PHYSICALa.
Secular changesPuberty norms and
variationsPsycholgocial aspect of biological
change2- PSYCHOLOGICAL DEVELOMENTa. Cognitive
and value system development At the age of 12
years , young people first become capable of
formal operations that is the ability of
systematic and rational abstract thinking.B-
Identity formation
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d. Social factors in adolescent developmentI.
Transitional societiesII. New stressesIII
Modern life- styleIV. Urbanization and
migrationV. New directions versus traditional
societiesVI. Lack of economic or educational
opportunity in a society where increasingly
complex demands are made on young people and
traditional family support is weakened.
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Adolesence relationship with adults and peers

• 1- Generation Gap
• 2- Parents Guideness

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D-. SOCIAL FACTROS AND CHANGES AFFECTING
ADOLESCENTS HEALTHI. DemographicII.EconomicIII
.PoliticalIV.LegalV. ReligiousVI.
EducationalVII. Technological and Scientific
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Health and health-related issues of concern to
adolescents1- Life- Style and risk tailing
behaviora. Smoking -One of the greatest
health Hazards of modern times as well as the
major cause of avoidable death.
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b. Use of drugs-Experimentation and risk
taking-The problem exists in all societies and
socioeconomic groups- Multiple drug use has
become more common- Drug taking reflects self
destructiveness.-Danger of HIV leading to AIDS
as well as suicide and accidents-Damage of
adolescents life including their relationships
with people, performance at school and recreation.
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c. Use of alcohol-Alcohol consumption has
increased in quantity and frequency and the age
at which drinking starts has declined-Lead to
Problems of road accidents , physical
disorders, Crime, arrest for drunkenness,
aggressiveness, Malnutrition, loss of (friends,
family health Self esteem, and means of
support).
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• -The consequences for adolescents include under
  attainment of developmental tasks, social decline
  , educational loss and unemployment.
• -Accessibility plays a major role in the use of
  alcohol by adolescents.

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d. Accidents- It is one of the major causes of
death in adolescents throughout the
world-Costing lives , leave many disabled-Many
accidents have a behavioral component that may
increase the risk of a harmful outcome-Adolescent
s lack life experience and needs
supervision-Adolescents should participate in
activities that provide them with healthy outlets.
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e. Suicide?68 of adolescents (males and
females)usually or even always have a feeling of
loneliness. ? 53 of these try to get rid of
such feeling through bad friends, alcohol or
drugs, and getting indulged in out-of-law acts.
? Out of these 30 (males) and 33( females)
think of suicide, 10 did try practically to put
an end of their lives.
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• ? (In Russia, reports show that 125,000
  individuals, male and females , committed
  suicide). ? Suicide is one of the first 3
  killers of adolescents in the USA. ?Also, it is
  one of the main causes of what is called
  (compulsory death ) non-natural in all age
  groups of the American society .90 of
  adolescents who committed suicide were suffering
  nervous diseases or psychic problems (mental
  health problems).

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2- EMOTIONAL PROBLEMSI. Adolescents subjected
to special stresses a- Individual
Uncertain times Competition with peers
Social taboos b- Social Conflict by new
opportunities Conflict by new frustrations
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II. Vulnerable or High-Risk Groups?Those who
have experienced significant loss, bereavement ,
disrupted homes or parental rejection and
those in institutional care. ? Those suffering
from physical or intellectual Impairment due to
chronic illness and or disability
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• ? Those whose parents suffer from chronic
  physical or Mental illness ? They were poor, the
  unemployed ? Victims of physical, emotional or
  sexual abuse ? Pregnant adolescents and teenage
  parents ? Racial and ethnic minorities etc.

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3- Biological and Medical Problems A. Common
medical problems of adolescence ?The
adolescents growth spurt ?Growth development
image (height , body size, breast size)
?Menstrual disorders(2nd amenorrhea, delayed
menarche ,Dysmenorrhoea) ?Acne ?Scoliosis
?Slipped upper femoral epiphysis ? Dental
caries and bad oral hygiene.
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B- Nutrition related disorders ?The problems of
under and over nutrition in adolescents and youth
are important ?Boys double their body weight
between 10-16 years of age ?Pregnancy and sport
increase nutritional needs
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• ?Malnutrition constitutes a particular risk
  factor for pregnancy in a adolescents ? Food
  faddism and extreme diets ? Fast food ? Obesity
  , nutritional disorders such as iron deficiency
  anemia

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• Two reports have outlined the results of
  screening adolescents for mental health problems
  within primary care. Donovan McCarthy (1988)
  invited all 1617 year olds registered with their
  practice to attend to discuss "any medical or
  general problems".
• Depression, acne and obesity were the most common
  problems reported.

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4- Chronic And Disabling ConditionsPhysical
handicaps Chronic
disease -Dwarfism
- Epilepsy - Cerebral palsy/paresis
- Asthma cystic
fibrosis-Visual, hearing , or speech defects
-Diabetes Juvenile - Spine bifida/ other
Genetic disorders - Rheumatoid arthritis-Facial
deformity -
Cardiovascular disorders- Marked obesity
- Malignancy

- Neurological infectionIntellectual
HandicapsLearning disordersMental retardation
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IV. Global School base Student Health
SurveyGSHS is a school based survey conducted
primarily among students aged 13-15 years. GSHS
provides data that can help countries develop
priorities establish programs , and advocate for
school and youth health resources.
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V. School Health Index This is a popular self-
assessment and planning tool for schools is now
online and addresses safety .In addition to
physical activity , health eating, and tobacco
prevention programs and polices.
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• It measures behaviours and protective factors
  related to the leading causes of mortality and
  morbidity among youth and adults in Jordan
• Alcohol and other drug use
• Dietary behaviours
• Hygiene

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• Mental health
• Physical activity
• Protective factors
• Sexual behaviours that contribute to HIV
  infection.
• Tobacco use
• Violence and unintentional injury

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School health services that should be provided at
no cost to students include Health physicals
(routine, school and sports physicals)Immunizati
onsAdministration of prescriptions for routine
medicationsHealth educationCare for acute
illness and injuryCare for common adolescent
physical problemsFollow-up as requested by
physicianNutrition counseling
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• Social, emotional ,and mental health
  counselingFamily counselingDrug and alcohol
  counselingSocial service assistancePregnancy
  check-upsAbstinence counseling and family
  planning informationReferral services

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RECOMMENDATIONS1. Building a database and
indicators for adolescents in the Arab and Gulf
States.2- More effort should be done to build
personalities having a great deal of awareness to
assist the community in dealing with such group
(adolescents) and strengthening the type of
relation both at home and in the school.
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• 3- Integrating health education , preventive and
  sexual education in the educational curricula
  where the school is a safe environment providing
  sound and scientific information in these fields

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4. Organization of orientation courses for
parents, teachers , social counselors in the
educational institutions, and societies which are
interested and active in the field of
adolescence health.5. More in depth studies of
early marriage , late marriage and building
relations and strong links
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• 6. Conduction of national as well as regional
  studies about adolescents with special needs.
• 7. Governmental and non- governmental agencies
  should sponsor such studies especially those
  concerned with research work directed to the Arab
  girls.
• 8- Counseling Via Schools or Youth Centers.