Caring for a sick child. Basic data when collecting information. oral care

When a couple has a child, mom and dad spend all their time on him, because without proper care, the baby simply cannot develop normally, and maybe even survive. What if the baby was born prematurely? Care for premature babies should be special, because sometimes such crumbs cannot even breathe and eat without outside help.

More recently, doctors did not undertake to resuscitate and save the life of a baby whose birth weight was less than a kilogram. Now everything has changed, and experts can give a chance to a baby who was born the size of a palm and weighs half a kilogram. We will talk about caring for premature babies in intensive care, after discharge and in other conditions in this article.

Premature babies: features

Full-term babies are those born between the 37th and 42nd weeks of pregnancy. If the baby was born earlier than expected, then it is considered premature. The main problem of such babies is the underdevelopment of internal organs, and the earlier the birth occurred, the more thorough care the child will need. Nursing care for premature babies begins from the first minutes of his life, the mother will be able to independently begin to take care of her child only after the permission of the pediatrician, but more on that later. So far, we are interested in the features of the physiology of an infant who was born prematurely. How fast can a mother hug her baby? It all depends on the degree of his prematurity. There are three degrees in total:

1. Extreme prematurity - weight less than a kilogram.
2. Deep prematurity - weight from a kilogram to one and a half.
3. Prematurity - weight from one and a half kilograms to two and a half.

The main features of a premature baby are:

• little weight;
• small stature (up to 46 cm);
• disproportionately folded body (large head, shortened legs, neck, navel displaced to the inguinal side);
• the shape of the skull is rounded, with a clearly visible fontanel and sutures;
• the auricles are pressed tightly against the head, very soft;
• the skin is very thin and wrinkled, all the veins can shine through;
• the surface of the body is covered with a small fluff;
• the fat layer is completely absent;
• nails may be underdeveloped on the arms and legs, or even absent;
• undescended testicles in boys and an open genital slit in girls.

It is worth noting that all the above features must be combined. Only in this case can we talk about the features of caring for premature babies. If one thing manifested itself, this indicates a pathology, and not prematurity.

Behavior of a premature baby

Newborns born at the wrong time also differ in behavior. They are inactive, there is a reduced muscle tone. Toddlers are drowsy (this is noticeable even against the background of the fact that full-term babies sleep almost constantly), they shudder for no reason and begin to move randomly. Particularly complicating the care of premature babies is the lack of a sucking reflex. The little one is hungry but doesn't know how to eat.

Briefly about the care of premature babies

We suggest considering the intricacies of caring for a baby, and then we will go through each item in more detail.

Nursing care for premature babies, as we have already written, begins from the first seconds of his life. First of all, it is taken in a warm diaper and, if necessary, ventilation is done. This is the most important procedure. The baby's breathing can be disturbed or stop altogether, as an early-born baby does not produce enough surfactant, the substance responsible for proper breathing. Therefore, the lung tissue cannot fully expand.

The second problem is that premature babies are completely unprepared for a physiological existence in this world, they have an insufficient layer of subcutaneous fat, so thermoregulation is imperfect. Babies quickly overcool and overheat, as the ambient temperature varies greatly from that which was in the mother's womb.

In the old days, this problem was solved by wrapping the baby in cotton wool or placing it on a warm stove. Now the problem of regulating the body temperature of a newborn is solved differently: a premature baby is placed in an incubator, or, in simple terms, an incubator. A sufficient amount of oxygen enters there, it is isolated from extraneous noise and light. The temperature and humidity in the incubator are regulated, creating conditions similar to those in utero.

There are no feeding problems either. Features of nursing care for premature babies are swaddling, monitoring the general condition and, of course, feeding. Medical personnel take the expressed milk from the mother, add the necessary vitamins, proteins and minerals to it. If a woman does not have milk, then infant formulas are used, designed specifically for babies born prematurely. Feeding the baby, if he has a poorly developed sucking reflex, is carried out with a syringe.

A baby with a well-developed reflex is given a bottle. If the weight of the child is so small that he cannot even swallow, a nasogastric tube is used or nutrients are administered intravenously. The probe is inserted through the nose of the crumbs, and milk in small doses enters his stomach. In any case, feeding a premature baby is fractional and in small portions, even if its weight is more than two kilograms. Organs are not yet developed enough to work fully. Nursing care for premature babies is essential. After all, the mother can overfeed.

Inpatient care for premature babies may not be possible at first if there are health complications. In this case, the baby is transferred to the intensive care unit.

resuscitation care

Care for the first stages is taken over by the medical staff of the maternity hospital. Most often, immediately after birth, the baby ends up in the children's intensive care unit, and it's good if there is one in the maternity hospital. But it happens that the hospital does not have such a department.

First of all, the baby is examined by a cardiologist, neuropathologist, orthopedist, ophthalmologist, neurosonography (ultrasound of the brain), if necessary, ultrasound of all internal organs. In addition, urine and blood samples are taken. After the procedures, the baby is placed in an incubator.

What happens if the maternity hospital does not have its own intensive care unit? Is there really no chance to "pull out" the child? Nothing like this. All are equipped with the necessary equipment for caring for premature babies, there is a lung ventilator, an incubator, and special preparations designed to keep the baby alive, and a neonatologist, a specialist trained to care for babies born at the wrong time.

But still there is a problem: neonatologists not only look after premature babies, but are also required to be present at each subsequent birth. And this means that there will be less monitoring of premature babies and the neonatologist may miss the moment if it suddenly becomes necessary to save the baby.

Nurses and neonatologists work in the intensive care unit, whose duties include only nursing the children already in their department. In this case, the newborn will be constantly under vigilant medical supervision.

If the baby needs resuscitation, but there is none in the maternity hospital, then after stabilization of the condition, he will be transferred to another hospital where there is a necessary department. Transportation is carried out in a specialized car, where there are devices for ventilation of the lungs, an incubator and other necessary devices to support life.

When the baby is in intensive care, the mother can come to him at the appointed time, but "communicate" only through the glass of the incubator (incubator). There are departments where it is possible to visit the baby at any time of the day.

Feeding

Parents of babies born early need to know all the subtleties and features of caring for premature babies so as not to worry about the child. Many couples begin to worry too much about the life of the crumbs, they think that they will not be able to cope. Of course, it is very difficult to survive the period of such a difficult nursing, but progress does not stand still, and medical personnel are able to save even the smallest ones.

If the weight of the child reaches two kilograms and the sucking reflex is well developed, then there is the possibility of breastfeeding. Moms will often be able to hold the baby in their arms, feed and help the medical staff care for him. Only a nurse feeds from a bottle or syringe so that there are no problems with the esophagus. As already mentioned earlier, if the sucking reflex is absent or poorly developed, then the digestive organs cannot fully cope with their task and feeding should be fractional.

Premature babies need plenty of fluids. Ringer's solution, diluted 1/1 with 5% glucose, is usually used to maintain the body. In addition, vitamins are needed, in the first days riboflavin, vitamin K and E, ascorbic acid, thiamine are necessarily introduced. Focusing on the individual condition of the newborn, the doctor may prescribe other vitamins.

After a while, the nutrition of the baby will not be any different from the nutrition of peers. But at the first stages of nursing, special additives are needed so that the development and growth of the crumbs are accelerated.

As parents can see, there is no need to worry about nutrition. Soon your baby will take over and turn from a thin, weak baby into a cheerful, rosy-cheeked and active toddler.

Nursing in the maternity hospital

Care for premature babies in a hospital necessarily begins with the neonatal pathology department. Here the baby will be constantly under the supervision of nurses and doctors, the necessary procedures and examinations will be prescribed.

The transfer of an infant to a regular department can be made only when he gains a body weight of at least two kilograms, actively sucks milk, independently copes with the regulation of body temperature, and breathes well. The duration of stay in the incubator depends on the severity of the degree of prematurity, there are four of them:

• first degree - childbirth occurred at a period of 37 to 35 weeks;
• the second degree - from 34 to 32 weeks;
• third degree - 31-29 weeks;
• fourth degree - 28 or less.

If by the time the mother is discharged from the maternity hospital, the child has already reached the minimum parameters under which it is possible to care for a premature baby at home, then he is allowed to go home with his mother. If the need for resuscitation is no longer there, but there is any risk to health, the baby is transferred to the children's department. The mother herself decides how to proceed further: go to the hospital with the baby or come to the hospital for feeding.

In the hospital

A baby born prematurely is transferred to a specialized children's department according to the prescription of a pediatrician and neonatologist. Such a move is possible even if the baby is still fed through a tube and needs artificial respiration. All care for premature babies in this case is in the hands of the medical staff.

The child will be placed in a heated bed or incubator. A more complete examination is carried out in the hospital, it is aimed at detecting pathologies and genetic diseases. The baby is examined by narrow specialists, the necessary tests and procedures are prescribed.

Positive dynamics usually begins to grow from the day of the expected birth, that is, from the date when the child was supposed to be born on time. The length of stay in stationary conditions depends on how quickly the baby gains weight, learns to suck and swallow, and on the presence of identified pathologies. Treatment in the hospital can last from a week to several months.

At home

When the baby is finally ready to go home, the doctor provides detailed care for a premature baby after discharge is very difficult, especially for couples who have had their first child. The difficulties lie in the fact that only nursing staff nursed the baby and parents may not even have a clue about how and what to do.

In any case, if the baby was born prematurely, patronage must be conscientious. If for some reason the pediatrician did not arrive on the scheduled day, call the clinic and demand a visit. Now we will consider in detail all the subtleties of a premature baby, which all family members living in the same room must know.

1. The first thing to watch for is the air temperature in the baby's room, it should be about +22 degrees. Do not forget that premature babies may have problems with thermoregulation.
2. For the first time, bathing a baby at home is after the permission of the local doctor. The bathroom warms up to 24 degrees, and the water should be close to body temperature. After washing, the baby is thoroughly dried with a soft towel and dressed warmly, as children born out of time can quickly become supercooled.
3. Walks are no different from those prescribed for full-term babies. In the warm summer time, you can go out for a breath of air immediately after discharge, and in the cold season - after a month. The first walks last no more than half an hour, time is gradually added.
4. Breastfeeding premature babies after discharge is most often impossible, as he will already be "spoiled" by the bottle and he will be too lazy to suckle the breast. Still, try to breastfeed or express milk as often as possible and feed it to your child, because mother's milk is the most important nutrient in the first year of life. If you don't have enough milk, or if it's completely gone after the stress of worrying about your baby's life, then buy formulas designed for premature babies.
5. Caring for premature babies at home necessarily includes constant monitoring! If the baby has become lethargic, weak, refuses to feed and spit up profusely, call the doctor immediately, these are very bad signs.

Caring for a premature baby in an outpatient setting

The plan for the examination of children born early is drawn up individually. Often premature babies suffer from diseases of the kidneys, eyes, neurological pathologies are observed. If there is any violation, then the baby is registered with the necessary doctor and he will need to be visited regularly, without missing the appointments.

If your little one is completely healthy, then only a monthly examination at the clinic and a round of narrow specialists, which are performed on the "Days of Healthy Children", will be required. Within a month, the district nurse will visit you to make sure that the child is well.

Development of premature babies

If a little man was born early, then in the first two months of his life he will sleep almost constantly, get tired quickly even with low activity. After the age of two months, the child will begin to develop faster, move more actively, which can lead to tension in the muscles of the limbs. It is easy to remove with special exercises.

We must not forget that the nervous system of premature babies is weak, so the baby can shudder for no reason, be frightened by sudden movements and sounds. Periods of restful sleep can change dramatically with bouts of arousal, again for no reason. Such children need peace and quiet, they do not tolerate meeting strangers and a change of scenery.

If the baby does not have pathologies, then it will develop and grow quite quickly. By the age of three months, he will catch up and even possibly surpass his peers in height, weight and development!

A sick child needs fresh air even more than a healthy one. It is necessary to systematically ventilate the room well in winter, warmly covering the child; in the summer you can keep the windows open all the time. It is often necessary to make the child's bed, shake out the blanket and sheets, especially if the child takes food in bed, make sure that the mattress lies flat, without forming bumps and folds. It is important to change your underwear as it gets dirty, but at least once a week. If a child suffers from involuntary urination, then regardless of the age of the child, his mattress must be covered with oilcloth, on which a sheet is placed. The child should be washed daily, before each meal, wash his hands, when sweating, carefully wipe the skin with a dry towel and change clothes. A sick child often has dry, parched, or cracked lips. You should lubricate them several times a day with butter or petroleum jelly.

oral care

The medical staff of a children's medical institution should daily ensure that children of preschool and school age, with a moderate and satisfactory general condition, observe oral hygiene. In the morning, teeth should be brushed with toothpaste or powder, and in the evening - only with a soft brush. After this procedure, the child should rinse his mouth well. The mouth should also be rinsed after each meal. Brushes washed after brushing your teeth should be stored in cups with the handle down.

Severely ill children need outside help when caring for their oral cavity. After each meal, the nurse should wipe the child's teeth, tongue, and rinse the mouth. To do this, you need to clamp a cotton ball with tweezers or cocher, moisten it with a solution of soda (0.5%), borax (5%) or saline and wipe your teeth. Then, with a sterile cloth, grab the tip of the tongue and, slightly pulling the tongue out of the mouth, remove the plaque from its back with another moistened swab. The mouth should be rinsed with a syringe or a rubber balloon. For washing, use a weak solution of soda (0.5-1%), borax (2-3%), hydrogen peroxide (0.6%), a solution of potassium permanganate (1: 10,000) or sodium chloride (0.9%). While washing the mouth, the patient should be given a half-sitting position and tilt his head forward. Close the chest and neck with a diaper or oilcloth apron. At the bottom, you need to substitute a basin and, pulling the corner of the mouth with a spatula, rinse the gums first with a soft jet from a can or syringe, and then the oral cavity. Rinsing the mouth in sick young children is performed with an assistant. The child needs to be seated on the knees of an assistant, who should hold the child’s hands with his left hand, and press his head with his right hand, placing his palm on his forehead. The legs of the child must be fixed with the knees of the assistant. Having typed a 1% solution of soda or a weak solution (1:10,000) of potassium permanganate into a boiled rubber balloon, the nurse, holding a spatula in her left hand, needs to open the child's mouth and direct a light stream to the hard palate. During the procedure, the child's head should be tilted down and sideways to one and the other side. At the same time, water from the oral cavity should drain into a substituted tray or basin.

Rinsing the throat and pharynx is allowed for children only after 3-4 years. For rinsing, solutions of furacilin (1:5000), rivanol (1:2000), potassium permanganate (1:5000), alkaline solutions of soda and other mixtures, herbal infusions or decoctions (chamomile, sage, calendula, eucalyptus, etc.) are used. Preschool children should not be given irritating solutions for gargling. It is important to teach the child to hold the liquid during rinsing so that it partially falls on the back of the throat. With angina, it is advisable to gargle 5-6 times a day, with pharyngitis - 2-3 times. If your child has diarrhea, wash frequently.

Sick children are often irritable and capricious. Carrying out hygienic and medical procedures, feeding a child are difficult due to the resistance of the child, so the nurse needs to be patient and affectionate in dealing with children, try to injure the patient as little as possible.

Feeding a sick child

The patient's food should be complete, with the exception of certain diseases, in which certain restrictions are carried out. In all cases, food should contain a sufficient amount of vitamins. Particular attention should be paid to feeding children suffering from poor appetite. You can't overfeed. Feed a sick child should be leisurely, with interruptions.

In case of vomiting in a sick child, he must be planted and his head supported. When vomiting in a child of the first months of life, it must be turned on its side; for the little one - put a diaper on, and for the older one - put a basin on it. At the end of vomiting, you need to rinse your mouth and give 1-2 sips of cold water to drink. After vomiting, the child should be put to bed and covered with a blanket. If required, a heating pad is placed at the feet.

Pot or bedpan

A potty or bedpan used by a child should be thoroughly rinsed after each use. In case of an infectious disease or diarrhea of ​​​​any etiology, it is necessary to disinfect the pot and the discharge of the patient.

Body temperature measurement

The patient needs to measure the temperature twice a day: in the morning when the child wakes up and at 16-17 hours (after daytime sleep). If necessary (with fever), thermometry is carried out more often. An increase or decrease in the child's body temperature can be roughly determined by touch by placing a palm on the forehead or back. When determining skin temperature by touch, it is important that the hand is warm and dry. Normally, body temperature remains within the range of 36.5-36.8 °C. If you suspect significant temperature deviations from the norm, it must be measured with a thermometer. Body temperature in children is usually measured with a mercury maximum thermometer. To set the mercury column to the minimum mark, the thermometer must be shaken off. In older children, the temperature is measured in the armpit or in the oral cavity, in young children - in the inguinal fold or rectum, where the temperature is 0.2-0.4 ° C higher than in the armpit. Before measuring the temperature, moisture must be removed from the skin. When the thermometer is correctly installed, its cone-shaped cartridge with mercury should be completely covered by a skin fold, and the child's arm or leg should be fixed. Duration of temperature measurement - up to 10 minutes. In the oral cavity, the thermometer should be fixed between the cheek and gum or under the tongue with closed lips for 3 minutes. The measured body temperature of the child must be recorded. In children's hospitals, temperature indicators are recorded in the medical history, and a temperature graph is drawn. To identify a pathological process, it is important not only a one-time temperature measurement. It is necessary to observe its dynamics, and this can only be seen when maintaining a temperature sheet. Often the temperature rises slightly only at certain times of the day or has a regular character. In such cases, measurements should be taken every 3 hours during the day. The skin temperature in different parts of the body is not the same even in the normal state of the child's body. In the upper parts of the body, it is usually higher than in the lower parts, above the distal parts of the limbs it is lower than above the proximal parts. To measure skin temperature in various parts of the body, use the TEMP-60 electrothermometer (electrical medical semiconductor thermometer).

General environment

In the room where the sick child lies, it is necessary to create a calm environment. Getting enough sleep at night and during the day is very important. All observations of the nurse must be recorded. In hospitals and other children's institutions, for this purpose, a special nursing list is created for each child. In this sheet, the child's body temperature, his appetite, stools, nausea or vomiting, frequency and nature of urination should be recorded daily.

When a sick child is admitted to a hospital, it is important to create a calm, affectionate environment. In the waiting room of the children's hospital there should be toys that can attract the attention of the child. If there are no toys in the emergency room, it is acceptable to take clean and safe (without cutting edges) toys from the mother. The child is hospitalized with his mother or another person close to him. For seriously ill and very excitable children, it is necessary to ensure peace and quiet. If a mother is allowed to care for a child, one must strictly demand from her the exact implementation of the doctor's instructions, but at the same time treat her calmly, in a friendly way. The nurse should be present at the doctor's round, tell him in detail about the results of his observations and personally get acquainted with the appointments.

Injections and other inpatient procedures often frighten a child. The child should be invited to the treatment room when everything is ready for the injection or procedure.

In the wards of convalescent children, it is necessary to take care of their leisure. If possible, children are provided with toys, books, quiet games and activities are allowed.

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 needed, 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 regions, 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 followed:

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 consistency, 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.

The specificity of caring for sick children of different ages lies in the features of direct observation of a sick child, communication with him, methods of collecting material for laboratory research, and conducting medical procedures.

The creation of a hygienic environment for a sick child consists of general hygienic guidelines for the premises of children's hospitals, hygiene features of a newborn and an infant.

For young children, small chambers or boxes, closed and open, are needed. If an infectious disease is suspected, the child should be placed in an isolation room with special equipment. For mothers hospitalized with their children, a bedroom and a dining room should be allocated. For walks of sick children, a veranda or special rooms with constantly open windows are allocated.

Beds for infants should have high sloping or folding sides. A hard mattress made of horsehair, bast, sea grass is placed in the crib. Do not use mattresses made of fluff or feathers. A small flat pillow is placed under the head.

The air temperature in the ward for a premature baby is 22-26 C, depending on body weight, for a full-term baby - 20 C. Daily systematic ventilation of the wards is necessary at any time of the year.

Clothing should not hamper the movements of the child, but should be light and warm. For swaddling premature babies, it is convenient to use envelopes. Free swaddling is indicated for children with normal thermoregulatory function, regardless of their body weight, age and location (open incubator, bed).

The basis for caring for newborns (term and premature) is the observance of the strictest cleanliness, in some cases - sterility. Persons with acute and chronic infectious diseases are not allowed to care for newborns. Wearing woolen clothes and rings is unacceptable.

The staff is obliged to observe the rules of personal hygiene and, at the same time, strictly work in a gauze mask, which is changed every 3 hours. Every month, all employees of the department must conduct a study of mucus from the nose and throat for carriage of diphtheria bacilli, hemolytic streptococcus. Checking the absence of staphylococci in the washout of the hands is also done once a month.

Care of the umbilical wound requires special attention, which should be carried out under strictly aseptic conditions. Every day a newborn is toileted: the eyes are washed with a sterile cotton swab dipped in a solution of potassium permanganate (1: 10,000) or a solution of furacillin (1: 5,000), in the direction from the outer edge to the inner; the nose is cleaned with cotton wicks dipped in boiled vegetable oil (Fig. 122); the child is washed, the skin folds are lubricated; washed away after each act of defecation.

A daily examination of the pharynx of a sick child is necessary. Every day, temperature, body weight, quantity and quality of bowel movements, the presence of regurgitation, vomiting, coughing, asphyxia, and convulsions are recorded. Children are weighed in the morning, before the first feeding.

When assigning a walk, take into account body weight, the age of the child, the time of year and local climatic conditions. Premature babies can be taken out for a walk over the age of 3-4 weeks in the spring-summer period when they reach a weight of 2100-2500 g, in autumn-winter - when they reach a weight of 2500-3000 g. The first walk of these children in winter should not exceed 5- 10 min, in summer - 20-30 min. Full-term babies from 2-3 weeks of age are allowed to walk in winter at an air temperature of -10 C in the absence of wind. If the child has increased cyanosis, cough, pallor, anxiety, the walk stops.

The organization of feeding a sick child requires special clarity, consistency and skill from the staff. Difficulties in feeding may be due to underdevelopment of the sucking reflex, the presence of congenital deformities, the child's refusal to eat, unconsciousness, etc. In such cases, feeding is carried out through a gastric tube, through a pipette, from a spoon; used parenteral and rectal nutrition.

Collecting material from children for laboratory research is difficult and requires special skills. Children under 5-6 years old do not cough up sputum. Therefore, at the moment when the child coughs, with a spatula, holding the root of the tongue, sputum is removed with a sterile swab, which is then inserted into a sterile test tube. In infants, sputum is removed from the stomach using a probe inserted into the stomach on an empty stomach.

Blood sampling for serological, biochemical and other studies is carried out by venipuncture. Excrements for bacteriological examination are collected with a glass tube, melted at both ends, which is sterilized and inserted into the anus. The tube filled with feces is closed at both ends with sterile cotton wool, lowered into a test tube and sent to the laboratory. Feces for research on worm eggs are collected in cleanly washed small glassware. With a cleanly planed stick, feces are taken from 5-6 different places, then the dishes are tightly covered with clean paper.

Unfortunately, sometimes there are situations when a child needs to be admitted to the hospital for observation and treatment under the round-the-clock supervision of doctors, in order to avoid complications and threats to health and life. If hospitalization is unavoidable, then parents need to prepare themselves and the child for this period of time.

At what age does a child lie in the hospital alone without parents?

When registering a child in a hospital, parents often face the refusal of medical personnel in the presence of someone close to the child. Even for older children, the hospital environment can cause discomfort and stiffness, and for toddlers, being in a hospital without a loved one can be a real stress.

Important! Under the Family Code, a child is a person under the age of 18.

Russian law states that one of the family members has every right to be next to the child in the hospital throughout the treatment without paying for the provided bed and food, but ...

But under the following conditions:

1. Staying with children under the age of 4.
2. Staying with children over the age of 4 if medically indicated.

The hospital management has no right to charge for food and bedding from the parent, but is not obliged to provide conditions for cohabitation. This means that, at the discretion of the management, the mother or father may be provided with bed and board free of charge, for a fee, or denied provision of conditions.

Important! The legal representative has the right to be near the child at any time, regardless of the age, condition of the patient and the equipment of the hospital with places for the parents to stay.

At the same time, not only the father or mother, but also grandmother, grandfather, older sisters and brothers and other relatives can be persons who are in the hospital with the child and provide care.

The main reasons for refusing free joint stay are:

• The lack of opportunities to provide the parent with round-the-clock stay conditions, most often in the form of the absence of an extra bed.
• Inclination to use paid services, including paid individual ward.
• A special regime for the admission of strangers to the department due to quarantine and increased sterility (surgery, resuscitation, burns or infectious diseases).

But even after reaching the age of 4, many babies still cannot take care of themselves on their own, even in observance of elementary hygiene rules. Left without the support of relatives in the hospital walls, the baby can get serious psychological trauma for life.

From the practice of Russian mothers, in the absence of conditions for living together, one of the family members simply sleeps with the child on the same bed, and the food is provided from the products that the relatives gave. Some children stay in the wards, usually at an older age - after reaching the age of 12-14.

Making a sick leave certificate for relatives who are with the child in the hospital

In accordance with the law, a sick leave is issued to a person who stays with a child in a hospital and cares for him, regardless of the degree of relationship. It may not necessarily be moms and dads - if a grandmother, grandfather, even an aunt or uncle is in the hospital with a child, a sick leave is issued in any case.

The exceptions are situations in which sick leave is NOT granted:

1. Caring for a child who is in a hospital and has reached the age of 15, except for cases of caring for a disabled child.
2. Care during periods of recovery and remission.
3. If a relative caring for a child does not need to be released from work (unemployed, pensioners, parents on leave at their own expense or, childbirth and caring for a child under 3 years old).

How to prepare a child for the hospital: the rights of the baby and the rules of conduct

There are situations when it is not possible to be near the child in the hospital, for example, if younger brothers and sisters remain at home, or because of the health of the parent, who will not be able to provide full-fledged care. When sending a child to the hospital alone, each parent should be aware of the rights of small patients and tell in advance about the rules of conduct in the hospital.

The right to decide on medical intervention

Until the age of 15, all decisions for medical intervention are made by the legal representatives of the child, most often the parents. After 15 years, independent decision-making about treatment by the patient is allowed.

Right to information

One of the main rights granted to the parents of children or directly to the patient is full information about the treatment, procedures and medications used. The child or his legal representative always has the right to ask a question about his diagnosis, the results of the analysis and to find out any other information regarding his treatment.

Right to visit relatives

If the child is alone, he has the right to visit relatives at any time. Most often, the schedule of visits is set by a medical institution. Visiting a child under certain conditions is possible even when he is in surgery or intensive care.

Behavior rules

Before hospitalization for the first time, if it is not carried out on an emergency basis, the child must be told about the basic rules that he must follow for a speedy recovery and return home.

Basic Rules:

1. Compliance with the regime and daily routine . Rise, time for meals and visits to procedures and examinations must be respected even if the child is used to a different routine at home. If at first the little patient is confused or confused in the regimen, he can always get acquainted with it at the information stand or ask the medical staff.
2. Following orders from the doctor and nurses, taking medications and attending procedures . It is important to make it clear that taking medications and all medical procedures must be performed without fail and without whims, even if it is not very pleasant, in order to recover as soon as possible and not get complications.
3. Compliance with basic hygiene rules . From childhood, a child should be accustomed to obligatory hygiene procedures: brushing teeth, washing, combing and washing. If almost any kid over 4 years old can wash and brush his teeth, then washing away can cause difficulties. To solve this problem, you can suggest using wet wipes.
4. Peace and quiet in the department . Loud screaming and running around the hallways can disturb other patients who need peace. Therefore, it is important to convey that with active games it is better to wait until returning home.

You can talk about the rules of behavior in a playful way. The main thing is that during the conversation the child is calm and able to perceive the information.

What to take to the hospital with a child: a list of necessary things

Regardless of whether the child goes to the hospital alone or with a parent, you need to take the necessary minimum things:

• Personal hygiene products: toothbrush, toothpaste, soap in a soap dish, 2 towels for face and hands, comb, wet wipes.
• Underwear (panties, T-shirts) 2-3 sets.
• Clothes for the ward: any comfortable home clothes (t-shirts, trousers, overalls, tracksuit) and shoes (slippers, sandals), socks or tights 2-3 pairs.
• Eating utensils: mug and spoon.
• Leisure items: favorite toy, book or magazine, pencils, felt-tip pens, plasticine - everything that the child is fond of and that will help him brighten up his stay in the hospital.

If a child is hospitalized with a parent , then you can take a tablet or laptop with you in order to watch cartoons or listen to music in your free time or during an unpleasant procedure (for example, during a dropper).

If the child is hospitalized without relatives , then you can put him a mobile phone with a charger, if he already knows how to use it, to maintain constant communication.

It is better to take a few clothes and ask relatives to pick up dirty sets each time and bring clean ones. Other things and products can also be transferred by relatives during the visit.

What can be passed on to the child if he was admitted to the hospital?

Hospitalization for a child is a great stress caused by a change of scenery and illness.

In order to brighten up the time of his stay in the hospital, you can send pleasant little things:

1. Hobbies: objects for drawing, modeling, constructors, puzzles - toys that will distract you from sad thoughts for a while and take time.
2. Favourite things: in addition to toys, it can be personal favorite things, such as a pillow, plate or mirror.
3. Goodies, healthy sources of vitamins, and any doctor-approved favorite food for your child: homemade soups and broths, boiled meat, fresh vegetables and fruits, juices and compotes, yoghurts, curds and other fermented milk products.

When a child is hospitalized, it must be remembered that this measure is necessary to preserve health and life. The doctor can prescribe treatment in a hospital, foreseeing the possible consequences and complications of the course of the disease. When staying in a hospital, it is important for parents to remain calm and positive, which are transmitted to the patient and are the key to a speedy recovery.