Infant Mental Health for the Pediatric Nurse Practitioner
Sweet Dreams: The Importance of a Good Night’s Sleep to Your Child’s Health and Development
Dr. Sallie Porter, Certified Pediatric Nurse Practitioner
Preschool aged children need 11-13 hours of sleep each night. This means that children three to five years of age need to spend more time sleeping then the do learning, playing, and eating. Most children stop taking naps by age five, but some younger preschoolers still need naps. Without adequate sleep: children are more likely to be irritable, moody, overweight, accident-prone, inattentive, and oppositional.
One of the best things parent can do to promote quality sleep is to practice good sleep hygiene. Good sleep hygiene includes keeping a consistent bedtime and consistent wake-up time each day, the same quiet sleep area location each evening, and keeping the sleep area free of television and other media like computers. Developing a routine pre-bedtime ritual that includes reading a book, telling a story, or singing a quiet song shortly before sleep time also helps set-the-stage for a good night’s sleep.
Other environmental changes parents can make to help a child sleep better include avoiding bed sharing, keeping the sleep area free of cigarette smoke and other irritants, keeping the sleep area quiet and noise-free, making sure the sleep area is not brightly lit, and making sure the sleep area is cool and not too hot.
Children who have nighttime fears or are afraid of the dark may fall asleep more easily if they have their special stuffed toy or blanket to hold, or if there is a small night light nearby. Sleepwalking and night terrors are most common during the preschool years.
If your child has asthma, his or her sleep may be disrupted due to coughing or wheezing, so it is important to always give medications as prescribed by your child’s physician. Asthma triggers in the sleep area also need to be controlled including dust, smoke, insects, pets, and mold.
Here is a link to a guest blog post I did for thenerdynurse.com asking for petition signatures: http://thenerdynurse.com/2013/04/petition-petition-mandate-advanced-practice-registered-nurse-aprn-full-practice-authority.html
I am taking an online class about Babies, Learning and Movement: http://www.cehd.umn.edu/CEED/onlinecourses/movement.html Should be interesting!
Infant Mental Health Opportunities Abound in Pediatric Primary Care
At least one-quarter of pediatric outpatient visits are for routine infant and child health checks.
Number of visits for routine infant or child health check for children under 15 years old by gender: United States, 2008.
Routine infant or child health check
Number of visits in millions
Percentage of total visits
Data source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey.
What does that tell us as PNPs? That (literally millions of) opportunities do abound to include infant mental health assessment and guidance as part of well child/health supervision visits.
Encourage daily reading and bedtime books to parents of newborns.
Encourage lots of parent-infant interaction and less media time.
Point out to parents their infant's good qualities.
Bolster parent confidence with an observation about what they are doing right.
Institute universal screening of postpartum women for perinatal mood disorders.
Provide developmental surveillance at each health encounter and formal developmental screening at 9 months of age or at any time concerns warrant it.
Use a formal autism screening tool at 18 and 24 months or sooner if concerns exist.
Refer babies sooner rather than later for early intervention services.
Always ask yourself: are vision or hearing issues to blame for any problems?
Update your practice web site to provide links to Zero to Three http://www.zerotothree.org/ (There is a link to a free preview of their journal here: http://www.nxtbook.com/nxtbooks/zerotothree/201211/) and other infant mental health resources.
Thanks for reading!
Is it appropriate for PNPs to ask parents about gun ownership?
Safety and injury prevention is an important role for Pediatric Nurse Practitioners especially as unintentional injury is the leading cause of death for children over one year of age. When we think of (and address) safety and injury prevention, we likely think of things like appropriate car seat/seat belt use, safer storage of poisons and medications, and prevention of falls, burns, and drowning. Gun ownership should be addressed the same way.
It is important to ask parents about gun ownership. NAPNAP’s KYSS Assessment Questions for Parents of Older Infants and Toddlers asks about guns in the home (question 21) along with other questions about stress, smoking, trauma, sadness, and weight. PNPs can use a yes answer to ‘do you have guns in the home’ as an opportunity to explore and offer guidance about issues like responsible gun ownership, community violence, and school safety.
Often parents of young children believe their child to be less motor advanced than he or she ireally s (e.g., infant rolls off surface before parent thought him/her capable of rolling; opens a locked door and sneaks out of the house) and more cognitively/sensory advanced than he or she is (e.g., can cross street safety before at least age seven; recognizes what to do if they find a firearm). Therefore, anticipatory guidance remains important in all issues of safety and injury prevention.
What to do if a parent admits gun ownership and you have concerns about their mental health is another issue entirely.
AAP Statement of President Obama’s Gun Violence Prevention Recommendations: http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAPStatementPresidentObamaGunViolencePreventionRecommendations.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token
How to store guns safely in your home: http://www.foxnews.com/leisure/2012/04/26/how-to-store-guns-safely-in-your-home/
Interactive Map on Injury Prevention: http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2013/01/interactive-the-facts-hurt.html?cid=xtw_vphttp://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2013/01/interactive-the-facts-hurt.html?cid=xtw_vp
KySS Assessment Questions for Parents of Older Infants and Toddlers: http://www.napnap.org/Docs/KySSAssess.pdf
National Center for Children Exposed to Violence: http://www.nccev.org/violence/community.html