26.2 Newborn, Infant, and Toddler Health

National and Global Status of Newborn, Infant, and Toddler Health

Many statistics are gathered regarding newborn, infant, and toddler health. Beyond the infant mortality rate, the United States gathers other data that illustrate the health of this population. The CDC divides data into infants and children up to age 4. According to the National Center for Health Statistics (NCHS, 2023c), in 2022, 1.5 percent of children in the United States aged 0 to 4 years were in fair or poor health, and 97.5 percent of children in the United States aged 0 to 4 years had a usual place of health care. In 2021, 3,816 deaths occurred in children aged 1 to 4 years, which is 25 deaths per 100,000 (NCHS, 2023c). The leading causes of death in this population were accidents (unintentional injuries); congenital malformations, deformations, and chromosomal abnormalities; and assault (homicide) (NCHS, 2023c).

Globally, most data are provided for children aged 0 to 5, and various other statistics are used to provide a snapshot of the health of this population. These include (World Bank Group, 2023):

• Prevalence of anemia: 40 percent (2019)
• Prevalence of wasting (low weight for height): 6.8 percent (2021 and 2022)
• Prevalence of severe wasting (low weight for height more than 3 standard deviations below the median): 2.1 percent (2022)
• Prevalence of underweight (low weight for age): 12.3 percent (2022)
• Global mortality rate: 28 deaths per 1,000 live births (2021)
  • Males: 31 deaths per 1,000 live births
  • Females: 26 deaths per 1,000 live births

One outlier of the data collection is immunization rates, as this is reported in children aged 12 to 23 months. According to the World Bank Group (2023), 81 percent of this global population was immunized for diphtheria, pertussis, and tetanus (DPT) and 82 percent for measles in 2021.

According to the WHO (2023b), in 2018, 5.3 million children under age 5 died, nearly half of them in sub-Saharan Africa. Globally, this population’s leading causes of death are preterm birth complications, pneumonia, birth asphyxia, diarrhea, and malaria (WHO, 2023b). More than half of deaths in this age group result from preventable diseases that are treatable through simple and affordable interventions, such as vaccines and adequate nutrition, particularly early and continued breastfeeding. Nutrition-related factors contribute to about 45 percent of deaths in this population (WHO, 2023b). Data regarding immunizations and nutrition coverage worldwide can be viewed at the Maternal, Newborn, Child, and Adolescent Health and Ageing data portal.

Risk Factors Influencing the Health of Newborns, Infants, and Toddlers

Risk factors for this population are numerous, and the previous section discussed some of them. A lack of prenatal care, the lack of immunizations during pregnancy, and continuing to smoke or use alcohol are some behaviors of the childbearing client that will lead to an increased risk of health problems for their child. At the time of birth, if the delivery does not occur in a health facility with a skilled birth attendant, this is a risk factor. Other risks to child health include not breastfeeding, malnutrition, overcrowded conditions, unsafe drinking water and food, and poor hygiene practices. Finally, a lack of knowledge regarding safety and a lack of identifying and seeking appropriate care for illnesses in this population can lead to poor health outcomes (WHO, 2023b). While these may sound like risk factors for lower socioeconomic income regions, many are risk factors in the United States. Many risk factors for this population are often interconnected and can have cumulative effects on children’s health and development. See Social Determinants Affecting Health Outcomes for more risk factors for this population.

Educational Interventions to Promote Care in Newborns, Infants, and Toddlers

Educational interventions focus on this population’s parents or caregivers and target preventing their leading causes of death and morbidity and the risk factors previously identified. Nurses play a critical role by providing caregivers with education on preventing unintentional injuries or accidents in this population. Education may involve safe sleep, play, and medication administration; sibling interactions, family members, and other visitors; and motor vehicle safety. Other significant topics of education include:

• Immunizations
• Nutrition (including the promotion of breastfeeding and healthy foods and drinks in early feeding)
• Oral health care
• Avoidance of exposure to environmental hazards (including lead, secondhand smoke, access to drugs and alcohol, firearms, violence, and trauma)
• Importance of recognizing abnormalities or illness in newborns, infants, and toddlers
• Developmental milestones for the age group as well as developmental needs to promote the attainment of these milestones

At the toddler stage, nurses may provide some age-appropriate health education directly to the child. Education should focus on helping them develop healthy habits and understand basic health and wellness concepts. Table 26.5 provides some examples of age-appropriate health education topics for this population.

When developing education for toddlers, the nurse should consider their short attention spans and recognize that they cannot understand complex health concepts. Ways to provide simple and interactive education may include songs, games, role-play with dolls or stuffed animals, and storytelling. Separation from parents or caregivers may cause anxiety, so this should also be considered (UCSF Benioff Children’s Hospital, 2023a).

Healthy People 2030 Goals for Newborns, Infants, and Toddlers

Childhood, particularly the early years, is a critical period for growth and development. Experiences, behaviors, and health problems can have long-term impacts during the infant and toddler years. Healthy People 2030 focuses on directly and indirectly improving health, safety, and well-being during this time. These include timely developmental screenings and recommended health services and the development of positive health behaviors, such as getting enough sleep and nutrition, to prevent diseases and injuries. Unfortunately, there are racial/ethnic and income disparities in the United States that impact these behaviors. To address these disparities, it is necessary to focus health promotion and prevention strategies on families, early childhood education programs, and neighborhoods.

Health Promotion and Disease Prevention Activities to Improve the Health of Newborns, Infants, and Toddlers

Health promotion activities are necessary to improve the health and well-being of this population. The nurse should encourage people to breastfeed their newborns exclusively for the first six months of life, as breast milk provides all the necessary nutrients and antibodies for optimal growth and development (U.S. Department of Agriculture, 2020). Nurses should also ensure that children in this age group receive all the recommended immunizations to protect against serious infectious diseases and all the recommended screenings to identify health issues early. Various genetic, endocrine, and metabolic disorders; hearing loss; and critical congenital heart defects screenings are provided to newborns before discharge home after a hospital or birthing-center birth (CDC, 2021n). Nurses should encourage caregivers to maintain regular checkups with a health care provider for their child throughout this time frame to monitor their growth and development and address any health concerns or developmental delays.

Nurses should promote safe infant sleep practices to prevent sudden unexpected infant death (SUID). SUID is the umbrella category that describes all sudden, unexpected infant deaths from known causes, such as injury or accident, and those from unknown causes (Eunice Kennedy Shriver NICHHD, n.d., para. 2). Sudden infant death syndrome (SIDS) is defined as the sudden death of a baby younger than 1 year of age that does not have a known cause even after full investigation (Eunice Kennedy Shriver NICHHD, n.d., para. 3). About 3,400 babies in the United States die from SUID annually, including those from SIDS, accidental suffocation in a sleeping environment, and other deaths from unknown causes (CDC, 2022h).

Once the child is older and eating solid foods, nurses should encourage caregivers to provide a nutritious diet to promote healthy growth and development. Encourage physical activity to promote motor skills development and reduce the risk of obesity. Promoting oral health includes brushing teeth twice a day and scheduling regular dental checkups. Finally, the nurse should support caregivers in positive mental health practices, such as providing a safe and nurturing environment, fostering positive relationships, and seeking help if needed (CDC, 2022j).

Injury prevention education is imperative to reduce the risk of accidents and injuries in the infant population (CDC, 2022a). The CDC has a variety of fact sheets on safety in the home and community for infants and toddlers. These include carbon monoxide poisoning prevention, child passenger safety, safe places for childcare, emergency preparedness, food safety, medicine safety, sun safety, and water safety.

Health promotion activities for this population should also include education on preventing physical, sexual, and emotional child abuse and neglect, incorporating the following strategies (CDC, 2022a):

• Interventions that can assist parents in strengthening household financial security
• Family engagement
• Referral to quality childcare agencies that are licensed or accredited
• Education regarding parenting skills and family relationships
• Behavioral parent training programs

Abusive head trauma (AHT), which includes shaken baby syndrome, is a preventable, life-threatening form of physical child abuse that injures an infant’s or child’s brain and can lead to serious brain injury or death (National Center for Chronic Disease Prevention and Health Promotion, 2022a). AHT typically occurs when a caregiver forcefully shakes or jerks an infant or young child. Infants’ vulnerable neck muscles and large, heavy heads make them particularly susceptible to injury. AHT can happen in a matter of seconds, even with seemingly minor force. Injuries that can result from AHT include subdural hematomas (bleeding between the brain and its protective coverings), diffuse axonal injury (widespread damage to nerve fibers in the brain, disrupting communication between brain cells), retinal hemorrhages (bleeding in the retina, which lines the back of the eye), cerebral edema (swelling of the brain), and/or skull fractures. These injuries can lead to long-term consequences such as developmental delays, intellectual disabilities, seizures, and even death.

Preventing AHT requires a multifaceted approach involving education, awareness, and support. Nurses should identify at-risk families and provide appropriate intervention and support services, including information about the dangers of shaking infants and alternative strategies for soothing a crying baby. Offering resources and support for caregivers, including stress management techniques, counseling services, and parenting classes, can help reduce frustration and improve coping mechanisms. It is mandatory that any suspected case of child abuse is reported to the appropriate services (National Center for Chronic Disease Prevention and Health Promotion, 2022a).

A variety of information for caregivers of infants and toddlers (aged 0 to 3) can be found at the CDC (2022a) Parent Information website. This website discusses the above topics in greater detail and provides schedules for developmental milestones, growth charts, and immunizations.

In addition to the strategies to prevent congenital disorders and prenatal infections discussed in this section, other newborn concerns include jaundice and vitamin K deficiency. As the child moves out of the newborn stage, other diseases and conditions, such as developmental delays, developmental disabilities, and infections, are a concern. Nurses should educate caregivers on how to prevent or detect these diseases and conditions early to mitigate complications (CDC, 2022f).

A child with a developmental delay has not gained the skills or reached the milestones that experts expect of children their age. Most developmental delays resolve independently over time (Cleveland Clinic, 2023b). Examples include delays rolling over, sitting up, crawling, and walking; trouble with fine motor skills; difficulty understanding or communicating with others; or a lack of age-appropriate social skills. Nurses should encourage caregivers to speak to their pediatrician immediately if they suspect a developmental delay or deviation from expected milestones (CDC, 2022f). Developmental screening can detect delays early, ensuring the child has early intervention services and allowing them to catch up to their peers and reach their full potential. A referral to an appropriate health care provider, such as an audiologist, speech therapist, developmental pediatrician, neurologist, physical therapist, occupational therapist, or another provider of early intervention services, may also be necessary. Early intervention is the best way to prevent long-term developmental delays or disabilities. If the child is eligible, a care team will develop an Individualized Family Service Plan (IFSP) based on the child’s and family’s particular needs.

Developmental disabilities are “a group of conditions due to an impairment in physical, learning, language, or behavior areas, which begin during the developmental period, may impact day-to-day functioning, and usually last throughout the lifetime” (CDC, 2022f, para. 1). They often begin before birth, but some can occur after birth due to injury, infections, or other factors. The cause of some developmental disabilities is unknown. Still, they are believed to be caused by a combination of factors, including genetics, parental health and behaviors during pregnancy, complications during birth, maternal infections during pregnancy, infant infections early in life, and exposure of the pregnant person or child to environmental toxins (CDC, 2022f). About one in six, or 17 percent, of children aged 3 through 17 years have one or more developmental disabilities, according to the CDC (2022f). These occur among all racial, ethnic, and socioeconomic groups. Examples include attention deficit hyperactivity disorder (ADHD), autism spectrum disorder, cerebral palsy, fragile X syndrome, Tourette syndrome, hearing loss, intellectual disabilities, learning disabilities, and vision impairment.

Infectious disease prevention in this population is very similar to any infectious disease prevention. Nurses should encourage caregivers to limit visitors during the newborn stage, especially those who are sick. Children younger than 2 are at especially high risk of developing complications from infections such as influenza, respiratory syncytial virus (RSV), or COVID-19 (CDC, 2022l). Anyone with cold-like symptoms should be taught to avoid close contact, follow cough etiquette, wash their hands often with soap and water for at least 20 seconds, and clean frequently touched surfaces. Avoiding infection can prevent complications such as pneumonia, myocarditis, and sepsis.

Integration of Sociocultural and Linguistically Responsive Interventions for Newborns, Infants, and Toddlers

Ensuring that health promotion and disease prevention interventions are culturally and linguistically appropriate can positively impact the overall well-being of this population. Cultural and linguistic diversity itself impacts child development. Language and culture shape a child’s cognitive, social, and emotional development. Because of this, the nurse should understand the importance of building relationships with the child and their caregivers, recognize cultural and linguistic diversity, and value family involvement.

The National Center on Parent, Family, and Community Engagement (2020), part of the HHS Administration for Children and Families, has recently focused on learning how understanding families’ cultural perspectives can help build positive relationships. Nurses who work with families in this way can strengthen family engagement efforts. Family engagement is the process used to build genuine relationships with families to promote strong parent-child relationships, family well-being, and better outcomes. Understanding families’ cultural beliefs, values, and priorities is the key to the family engagement process. The distinct family cultures provide meaning and direction to the lives of children. The various factors influencing families’ cultural beliefs will inform decisions about the child and the family, including health care and education decisions.

The Public Education Foundation (2015) video Literacy, Early Learning & Family Engagement provides another glimpse of collaboration between families, educators, and health care professionals.