Hand in Hand Teaching together - Florida's Center for Child …centerforchildwelfare.fmhi.usf.edu/Training/2018cps... · 2018. 9. 10. · Presentation of the Pinellas County Substance

HAND IN HAND: TEACHING TOGETHER

Presentation of the Pinellas County Substance Exposed Newborn Taskforce

Presented by Elizabeth Adams, BSN, CLC, NTMC & Donna Wertheim MSN, ARNP, CPNP-PC & Amanda Moore-Krummerich MS

OBJECTIVES

• Identify at least three strategies of routine care for Newborns utilized in the hospital setting to be implemented within home visiting to promote continuity of care.

• Define Neonatal Abstinence Syndrome and identify symptoms used to diagnosis NAS in order to integrate and serve this population more effectively.

• Differentiate between routine care measures and comfort measures needed to assist babies with NAS in self- regulation in order to support parents within their home cope with additional stressors and reduce the risk of abuse & neglect

INFANT CARE:BACK TO BASICS

• Safe sleep

• Swaddling

•Bathing

•Kangaroo care

SAFE SLEEP

• “Sudden unexpected infant death (SUID) is the sudden and unexpected death of a baby less than one year old. These deaths often occur during sleep or in the baby’s sleep area. Some parents believe sleeping with their baby will protect their baby from SUID, but sleeping with a baby is dangerous and actually raises the risk of infant death.”

The Ounce of Prevention Fund of Florida, 2016

SAFE SLEEP• Infants should

sleep alone, on their backs, in their crib.

• Infants should NEVER sleep in an adult bed.

• Safe Sleep Video

• Babies who sleep with a parent are 3 times more likely to die than babies who sleep alone, in a crib.

• Babies should sleep in their parents room until 6m-1 yrof age.

USA Maternal/Child Health: B'More

Babies Safe Sleep Campaign Video,

2011, American Academy of

Pediatrics, 2016

https://youtu.be/yBBiG6e4xRw?list=PLwcl3VSUxLn9wwrVgydsKZ14r57qGnkc-

SAFE SLEEP

• Suffocation and strangulation in an adult bed is the leading cause of injury-related death for infants under one year of age in the state of Florida.

• Substance exposed infants have a higher risk of sudden unexpected infant death (SUID).

• Infants exposed to 2nd and 3rd hand smoke have a higher risk of SUID.

The Ounce of Prevention Fund of Florida, 2016

SAFE SLEEP

When you put me down to rest

Please know that on my back is best

Alone in my crib is where I should be

No extra blankets, toys or pillows with me.

If these tips in mind you keep –

Then I will have the safest sleep!

SAFE SLEEP

• What can we do?

• Reinforce the principles of safe sleep at discharge and every home visit

• Ask how the baby is sleeping

• Discuss where the baby is sleeping

• Assist parents with developing strategies for safe sleep

SAFE OR NOT SAFE

SWADDLING•Benefits:

• Boundaries

• Comfort

• Positioning

• Swaddle Video

https://youtu.be/7IFLrd8zudo?t=152

SWADDLING• A swaddled baby should not have

the blanket over their face.

• The baby’s hands should be placed up towards their face for self-soothing.

• Babies should not be swaddled after 2 months of age.

American Academy of Pediatrics, 2015

SWADDLED BATHINGHTTPS://WWW.HOPKINSALLCHILDRENS.ORG/ACH-NEWS/GENERAL-NEWS/SWADDLE-BATH-FOR-BABY

https://www.hopkinsallchildrens.org/ACH-News/General-News/Swaddle-Bath-for-Baby

SWADDLED BATHING

•Benefits

• Provides boundaries

• Keeps baby warmer

• Allows parents control in the bathtub

• Provides positive bonding experience for parents and baby

SWADDLED BATHING•Basic Bathing Safety Tips:

• Set water heater to 120˚F or lower

•Gather all supplies needed before starting bath

•Never, ever leave baby alone during bath

American Academy of Pediatrics, 2016

BREASTFEEDING• Decreases risk of ear infections, vomiting, diarrhea,

pneumonia, urinary tract infections, and certain types of spinal meningitis.

• Breastfed babies are at lower risk for childhood obesity and Type 1 and Type 2 diabetes.

• Breastfed babies are at a lower risk for SUIDS.

• Breast milk is easier to digest than formula.

American Academy of Pediatrics, 2011;

Office of Women’s Health, 2014

BREASTFEEDING• Breastfeeding is ok for:

• Ok for moms on Methadone and buprenorphine

• Mom with hepatitis C

• Breastfeeding is NOT ok for:

• Moms who are HIV positive

• Mom taking certain medications, alcohol, or illicit drugs.

Stronger Together: NAS Soothing

Techniques for Mommies and Babies, 2014

KANGAROO CARE

•Kangaroo care is a method of holding a baby that involves skin-to-skin contact. The baby, who is naked except for a diaper and a piece of cloth covering his or her back (either a receiving blanket or the parent's clothing), is placed in an upright position against a parent's bare chest.

Cleveland Clinic Foundation, 2015

KANGAROO CARE

• The benefits of kangaroo care to the baby include:

• Improved (more regular) breathing pattern

• Gain in sleep time

• More rapid weight gain

• Decreased crying

• More successful breastfeeding episodes


KANGAROO CARE

• The benefits of kangaroo care to the parents include:

• Improved bonding, feelings of closeness with their babies

• Increased breast milk supply

• Increased confidence in ability to care for their babies

• Increased confidence that their babies are well cared for

• Increased sense of controlCleveland Clinic Foundation, 2015

KANGAROO CARE

• When to kangaroo

• Watch cues!

• Remember safety!

• Kangaroo care can be done after bath, before feeds, or when baby is calm and alert


NEONATAL ABSTINENCE SYNDROME

• -Neonatal Abstinence Syndrome (NAS) is the medical terminology used for narcotic withdrawal in infants.

• At birth, a baby no longer gets the drug(s) he or she was getting from the mother during pregnancy. When the effects of the drug(s) suddenly stop, the baby may develop symptoms called withdrawal.

• Not all babies go through withdrawal in the same way. It is not possible to predict which babies will have withdrawal or how long it will last.

Hamilton Health Sciences, 2012

NEONATAL ABSTINENCE SYNDROME

• “Withdrawal usually starts within 2 or 3 days of birth. Some babies start to have signs of withdrawal much sooner, while others may not have symptoms for a week or longer.”

• Babies may be discharged before all symptoms appear, and will still have some symptoms after discharge.


NAS - SYMPTOMS

• Trembling or shaking, even when sleeping

• Diarrhea

• Feeding poorly – weak suck

• Very sensitive to light, sounds and touch

• Trouble sleeping

• Yawning a lot

• Stuffy nose

• Sweating

• Fussines or Irritability

• Excessive sucking (after feeding)

• Large throw-ups


NAS - SYMPTOMS

•Caution!:

• Diarrhea

• Vomiting

• Poor eating

• No or low weight gain or weight loss

• Extreme irritability

• Seizure activity

NAS – COMFORT MEASURES

• Swaddling

• Swaddled bathing

• Kangaroo Care

• Breastfeeding


• Calm Environment

• Low lights

• Soft voices

• Slow approach

• Designated quiet spot

• Neutral smells

• Limit visual stimulation




• “Crescent Moon” position

• Lay baby on their side with chin to chest, back rounded and legs bent.

• Do this ONLY when baby is awake and supervised.

• Patting or Clapping

• Gentle pressure on bottom or lower back.

Crescent Moon Position



https://youtu.be/7IFLrd8zudo?t=256


• Vertical Rock• Hold baby facing away from you

• Rock up and down from head to toe

• This is more soothing to the nervous system than a side to side motion




• Calm Environment

• Some babies have a hard time tuning out noise, light, touch or smells.

• Babies may cry when stressed, but may also show that they are stressed by sneezing, hiccupping, or turning away.

• Swaddling and a quiet and dim environment can help decrease discomfort.

• New sensations should be introduced gradually.




• Comforting Baby• Babies CANNOT get spoiled

from too much attention.

• Letting a baby “cry it out” isn’t a good strategy.

• Babies need to feel trust that their needs will be met.

REFERENCES• American Academy of Pediatrics. (2016). American academy of pediatrics

announces new safe sleep recommendations to protect against, SIDS, sleep-related infant deaths. San Francisco.

• American Academy of Pediatrics. (2011). Breastfeeding Benefits your Baby's Immune System. Retrieved from HealthyChildren.org: https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Breastfeeding-Benefits-Your-Babys-Immune-System.aspx

• American Academy of Pediatrics. (2015, 11 21). Swaddling: Is it Safe? Retrieved from HealthyChildren.org: https://www.healthychildren.org/English/ages-stages/baby/diapers-clothing/Pages/Swaddling-Is-it-Safe.aspx

• American Academy of Pediatrics. (2016, 1 15). 5 Bathroom Safety Tips for Infants and Young Children. Retrieved from HealthyChildren.org: https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Bathroom-Safety.aspx

• Cleveland Clinic Foundation. (2015). Kangaroo Care. Retrieved from Cleveland Clinic Children's: http://my.clevelandclinic.org/childrens-hospital/health-info/ages-stages/baby/hic-Kangaroo-Care

REFERENCES• Hamilton Health Sciences. (2012). A guide for parents of babies at risk of neonatal

abstinence syndrome. Retrieved from http://www.hamiltonhealthsciences.ca/documents/Patient%20Education/NeonatalAbstinenceSyndromePlanningCare-lw.pdf

• Office on Women's Health. (2014, July 21). Breastfeeding. Retrieved from WomensHealth.gov: http://www.womenshealth.gov/breastfeeding/breastfeeding-benefits.html

• Stronger Together: NAS Soothing Techniques for Mommies and Babies (2014). [Motion Picture]. Retrieved from https://www.youtube.com/watch?v=7IFLrd8zudo&feature=youtu.be&t=152

• The Ounce of Prevention Fund of Florida. (2016). Safe Sleep for Your Baby.

• USA Maternal/Child Health: B'More Babies Safe Sleep Campaign Video (2011). [Motion Picture]. Retrieved from https://www.youtube.com/watch?v=yBBiG6e4xRw&feature=youtu.be&list=PLwcl3VSUxLn9wwrVgydsKZ14r57qGnkc-

Hand in Hand Teaching together - Florida's Center for Child …centerforchildwelfare.fmhi.usf.edu/Training/2018cps... · 2018. 9. 10. · Presentation of the Pinellas County Substance

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