Although physical development during early childhood is unmatched in terms of the height and weight,

motor development lags behind. The muscles that are responsible for movement are still growing and so
does eye-brain-muscle :-coordination. Young children are dependent also because their psycho-
emotional frame and cognitive development are far less developed to respond to life situations that
confront them every day. Language and communication is not perfect yet, thus, infants and toddlers
have difficulty of getting their messages across.
DISTRESS AMONG INFANTS AND TODDLERS
Because they depend much on adults, infants, and toddlers oftentimes become frustrated as they
cope with everyday life. Their lack of facility to communicate well and the failure among adults to
understand the message cause a lot of distress among infants and toddlers alike. Below are some verbal
and nonverbal signs that young children are distressed. Not all infants and toddlers though show the same
signs when stressed out.

Signs of Distress Infants Toddlers

-crease in crying or tantrums Crying Present
3eing sad, clingy, withdrawn or angry Present Present

Mostly on sleeping
:Mange in regular sleep and eating habits Present
habits
Anxious tics, coughs or body movements Not pronounced Present
Frequent reliance on habits such as thumb-
Not pronounced Present
sucking
Physical ailments, such as headaches or
None Present
stomachaches
Nightmares and fears at bedtime None Present
Change in bowel movements None Present

Toddlers have advantage over infants because many of them can already verbalize their needs
and feelings. However, others prefer nonverbal cues and caregivers must make sense of all these signals.
The following are signs of distress among this age group:

nSpeech difficulties (e.g. stuttering)

nAppearing withdrawn
nLack of eye contact
nTiredness
nAggression
nSquirming and whining
nToilet training difficulties
nNot playing creatively or no play at all

CRYING AS A SIGN OF DISTRESS IN INFANTS

Unlike toddlers, infants cannot voice out their feelings when they are anxious, uncomfortable, in pain,
hungry or cold. infant distress is more physical and/or of organic cause (i.e. illness or body malfunction).
Usually it is manifested as persistent crying. When crying becomes incessant, many a times the infant is
either: (1) hungry, (z) wet and cold, (3) feeling anxious, or (4) suffering from an illness that has still to
manifest signs. It is important to rule out the fourth cause of crying because when an infant is sick, it
warrants immediate medical attention.

RESPONDING TO A DISTRESSED YOUNG CHILD

You may have seen your younger siblings during infancy or when they were toddlers went into
marathon bouts of crying or temper tantrums. How did adults around respond to them? Patience is very
important in caring for distressed infants and toddlers. Study shows that what is more important is the
caregivers' response to the distress more than rewarding the good behavior when the child is happy
and content. Here are sensible ways of responding to a distressed infant or toddler (Nauert).

nStay composed and be patient. Find ways to cope with your own feelings so that you can display
objective sensitivity to the need of the child.
nBoth may be too young, but show empathy to the infant or the toddler through your soft voice, your
facial expressions, and your body gestures. Let him feel that you understand how he feels.
nRight timing is important. Respond on time to signs of distress and for a toddler, make him
understand that your response is because of his needs and not because of your own wants.
nSee things from the perspective of the child. "When mothers talk to their babies, even at six months,
about the baby's mental state and how the baby is feeling, infants respond to that verbalization."
(Nauert)

nDo not be obsessed with having a perfect child. Nobody is perfect. Expect the child to he anxious,
uncomfortable, in pain and stressed out sometimes. An obsession for perfection may cause stress
and the caregiver can no longer function effectively.

CAREGIVER ALERT!

Respond to a distressed infant or toddler appropriately. Make sense of what he is trying to tell
you nonverbally then apply the right approach to calm and console him.

CALMING A CRYING INFANT

Distress among infants is usually manifested as persistent crying. The special challenge posed by
babies is the lack of communication facility. As caregivers, you have to rely much on nonverbal cues.
Understanding these cues will help us calm and console a crying infant.

If the infant is not sick, not wet, nor cold or hungry, crying is caused by anxiety. Here are some
practical tips on how to calm a crying infant because of emotional insecurity:

nCarry and cuddle the baby. Feeling the warmth of your body reassures the crying infant. When crying
on the floor or in the crib, pick her up and move around cuddling her. Babies who feel deeply
familiar and comfortable with you will lesserrtheir crying.
nAccording to Honig, use gentle loving touches whenever possible." Do this while changing diaper or
feeding the young child. When putting the baby to sleep, you can also soothe her by rubbing her
back.
 nUse high pitched, happy tone of voice when calming a crying baby. A booming, low pitched voice
is threatening to a very young child.

nCroon lullaby melodies. The soothing voice of the caregiver and the body warmth while cuddling the
infant makes her feel safe and may put the baby to sleep.

CONSOLING A DISTRESSED TODDLER

Nobody wants to see an upset toddler, much worse, a distressed young one. Adults around him are
affected whenever the toddler is anxious, in pain or sick. When he has his temper tantrums, this also
affects the people around him, most especially the caregivers. As a rule, your response is to stay calm,
focused and be patient. Calming and consoling a distressed toddler depends primarily on two things:
(1) the age of the child and (2) what is causing the distress ("Is Your Toddler").

1. Try to find out why the toddler is distressed, because this affects how you
should respond and what will be most effective in trying to comfort him.
2. Listen carefully to what the child says, and also pay attention to what h. is not saying. Listen with
empathy and do not have preconceived biases against the child nor negative feelings about what he is
going to share wit-you.
3. Use simple statements that validate the child's emotions and signal to hi r-that you were listening and
heard what he said. Make the child understanc how he should handle things in his young life that
bother him.
4. Help the toddler develop coping mechanisms and tools to handle upsetting situations. Physical
activities give him opportunity to work through If distress.

SELF CHECK
Determine which of the following infants and toddlers show signs of distress. Indicate your answer by
ticking off the box with a check (✓) mark. If the child is not in distress, place an X inside the box.

Jo does not eat and cries continuously for no clear reasons

Lily always hits her older sister with her pair of bedroom slippers for no apparent reasons

Mark sends his parents to work every day with a kiss and a promise to behave well with Nana Connie

Marvel has woke up in the middle of his sleeps terrified by unseen "monsters and ghosts"

Fernando initiates creative play with his two-year-old twin brother Lorenzo

Maribel appears shy and withdrawn when her cousins visit her home to play bahay-bahayan

Rafael cannot stop squirming and whining while inside the toy store--even when inside the church

Alexia takes afternoon naps regularly and plays with older siblings upon finishing her afternoon glass of
milk
Barry two-year-old thumb sucker whose habit becomes pronounced whenever his father leaves him
home

Pam giggles happily while playing with her toys.

RESPONDING APPROPRIATELY TO DISTRESSED INFANTS AND TODDLERS

Make a compilation of interesting stories of caregivers you know who have

winning ways in taking care of infants and toddlers. Focus on their unique ways of achieving the
following:

n Identifying nonverbal cues to respond to distress children

n Calming and consoling a distressed infant or toddler

working in a team of three, upload your stories either to a blogging and/or a

social network site. To add personal touch to your upload, include pictures and a
short video of the caregiver in action. Invite your classmates to visit your site and like your page.
LESSON 3

Picking up the baby or the toddler and cuddling him help in calming and
consoling the distressed child. Although young bodies are pliant, this does not warrant caregivers to be
less careful in picking up a child. There are differences on how to pick up infants and toddlers. However,
in all instances, the caregiver should protect the neck and the head. In young children the neck muscles
are not fully developed yet so the child may hyperextend the neck causing injury.

PICKING UP AN INFANT LYING FLAT

1. The infant must be on a smooth surface enough to slide him comfortably. Moving the baby
closer to you is better to avoid stress on your back from leaning over and lifting. Reach your
hands under the body and neck and scoot the baby's body closer to you.
2. Support the neck and head with one hand. Support the buttocks and spine with the other.
Ensure your hands are stable under the baby.
3. Bend your knees and lift the baby into your arms. At this point, you can move your lower hand
under the baby along the buttocks, spine, neck and head, while you rest the baby in the crook of your
arm. To place the baby upright against your body, simply lift and keep your hand supporting the
baby's neck and head when it is upright.

PICKING UP A TODDLER
There is no safer way to pick up a toddler than under his armpits. A lot of adults are tempted to pick
up young children by lifting them through the forearms. This may cause strains (damage to tendons
and muscle fibers) or even dislocations.

1. Place each of your hands under the child's armpits. Do this gently
as too much pressure may compress the ribs.
2. Lift the child in one smooth movement and encourage him to lean his upper body on one of your
shoulders for support.
3. Slowly and alternately transition your hands from supporting his upper body to moving them to hold
up his lower body. The dominant hand supports the buttocks to carry him. The other hand provides
support to the lumbar area protecting the spine.
4. For older toddlers, do not carry the child by separating his legs apart and having each wrapped
around your body for support. This may cause permanent deformity resulting to a poor gait.
HOLDING AND CUDDLING THE YOUNG CHILD
A lot of studies have concluded that protecting and caressing a young ch ip within a warm embrace
affects his or her emotional and intellectual development

Many of these children who have been cuddled grow up happy, less anxious, an intelligent. The following
are some ways of holding a young child affectionately:

1. Cradle Hold. This is one the most natural way to hold a young child. Place the child's head in
the crook of your arm, and your other arm around the baby or underneath him or her. This
also works well when feeding the child.

2. Shoulder Hold. The child's head rests against your shoulder. Your dominant arm holds
the lower back and bottom and your other arm stabilizes the head.

3. Lap Hold. Lie on your back, facing up, with your legs propped up. Place the young child on
top of your lap, with his or her head resting on your knees and his or her feet on your
stomach. This works best for playtime with the child.

4. Belly Hold. This is perfect for babies with colic or abdominal gas. Have the young child
lie chest down over one of your forearms or on your lap. Use your other arm to hold him or
her securely. This is also a great burping position.
 Each of the following two items is followed by four descriptions. Determine Which descriptions refer
correctly to the item by shading the box before it.

1.Picking up a child

Always move the infant closer to you to avoid hurting yourself from over reaching.

The body needs more support than the head because many infants can maintain their heads up.

To exercise toddlers and stretch their muscles, lifting them up may be done by grabbing both
forearms.

You have to move closer to the person when picking up a baby from another to avoid dropping the
infant.

2.Cuddling a child

In holding the child on your shoulder, stabilize the head with the
dominant hand and cradle to lower back and bottom using your
other hand.
When feeding the child, the best cuddling procedure involves nestlingthe infant's head in the
crook of the arms.

Children with abdominal gas may find relief by having the child lie chest down over one of your
forearms.

Lap hold may be done while you are sitting, placing the infant tummy down on your lap to belch.

ACTIVITY

PERFORMING CORRECTLY PROCEDURES IN PICKING UP

AND CUDDLING INFANTS AND TODDLERS

In groups of three members each, produce an instructional video showing the correct procedure
in picking up and cuddling infants and toddlers. Present your video embedded in a PowerPoint (PPT)
presentation about the same topic. The number of PPT slides should be ten or less.
LESSON 4.
BASIC INFANT CARE

Because of their dependent nature, infants need lots of special care from their parents and
caregivers. It is important for caregivers to be familiar with normal growth of infants so they will be able to
address the physical needs that come with these rapid bodily changes. Some basic infant care that caregivers
should know includes feeding and nutrition, bathing and dressing, and putting the baby to sleep. These important
topics are taken up in the succeeding chapters.

TOOLS AND EQUIPMENT FOR THE NEEDS OF INFANTS AND TODDLERS

Safety to the young child must always be the main concern of all caregivers. While ensuring safe
environment is vital, the choice of tools and equipment is as important as well. Here are few of the basic
caregiving tools and equipment needed by infants and toddlers.

Feeding Tools and Equipment

Feeding bottle, 8 oz or 250 ml

Feeding Bottle, 4 oz or 125 ml
Teats/rubbe3r nipple
Ring top
Cap
feeding bottle and pacifier
Bottle Brush
Plastic Spoon and Knife
Plastic Funnel
Measuring cup
Sterilizer
Bib
Plastic Plate
Plastic glass with lid
Plastic spoon and fork
Plastic bottle (4 oz) with straw

Infant feeding chair

Bathing Supplies and Tools

Soap

Baby bathtub

Baby shampoo

Baby hairbrush

Soft towels and washcloths

Soft hooded baby towels

Grooming and Healthcare Tools

Baby brush

Baby swabs

Cotton buds

Nail clippers

First aid kit

Thermometer

Nasal aspirator

Diapering supplies and tools

Disposable diapers
Cloth diapers with clips
Diaper cream or ointment
Baby wipes
Diaper pail

Nursery Equipment and tools

Crib and crib sheets

Bassinet and shits
Mattresses
Mobile
Baby bedding
Breathable bumpers
Dresser and hamper
Changing pad and cover
Transport equipment and tools

Stroller
Baby sling
Infant car seat

SELF CHECK
Listed below are caregiving tools and equipment for infants and toddlers. Classify them
according to purpose. Use the Venn diagram in classifying the tools equipment.

mattress crib bathtub .

high chair sterilizer soft towel

baby wipes breathable bumper plastic plates

DEMONSTRATING BASIC INFANT CARE ACCORDING TO PROCEDURE
Form groups with five members each. Create a one-minute TV advertisementnt. promoting any
caregiving tools and equipment for infants and toddlers. These may fall under any of the following general
categories:

nFeeding tools and equipment

nGrooming and healthcare tools
nDiapering supplies and tools
nNursery equipment and tools
nTransport equipment and tools

KEY CONCEPTS
n Knowledge of growth and development among infants and toddlers is important for caregivers to
support the special needs of this age group.
n Be patient and stay calm and focused in responding to non-verbal cues of distress. Always rule out
medical condition causing the distress.
n Always prevent injuring theyoung child in picking up infants and toddlers. Cuddling young children
reassures them and the warmth of the body calms an anxious child.
n Caregiving tools and eguipment used for infants and toddlers must support their growing needs
and complement their development towards becoming a happy young child.
CHAPTER 2
BATHING AND DRESSING INFANTS AND TODDLERS

LESSON 1

Because of the young children's difficulty of expressing what they need and feel, It is a challenge
for caregivers to assess well their physical condition. Ensuring that the child is healthy must always be
the concern of the caregiver. Always remember -that when a child is sick, bathing him may cause more
harm than good. Before you bathe an infant or a toddler, you must determine first his vital signs.

The child's age and size, as well as knowledge of underlying health conditions, I affect the
caregiver's analysis of the vital signs. Vita/signs include the temperature, heart (pulse) rate, respiratory
rate, and blood pressure. There is greater fluctuation in what is considered normal among infants and
toddlers, so it is important to count heart rate and the respiratory rate for a full minute. A crying or a
restless child presents a challenge. Vital signs should be taken when the child is quiet. This is best ne
when he is asleep or by distracting him.

TEMPERATURE
A normal temperature in children is about 36.4°C but this differs slightly from child
to child. A fever is usually considered to be a temperature of over 37.5°C. Temperature in
children is measured as it is in adults. A glass, electronic, or digital thermometer may be
used (Table 1.); however, digital thermometer is preferred for infants and toddlers.
("Thermometers")

TAB LET. Different types of thermometers and their specifications

Type 1 Description Advantages Disadvantages.

- Digital Uses electronic heat Can be used in the Reading is affected
sensors to record mouth, armpit or by food or drink in
. rectum; fast reading- the mouth; difficult
body temperature
often in a minute or for veryyoung
less; appropriate for
infants who are
infants and toddlers mouth breathers
-. Digital ear Uses infrared ray to Quick and comfort- Cannot be for infants
thermometer measure the temper- able for young less than 6 months
ature inside the ear children; for infants old; earwax or a
older than 6 months small, curved ear
canal (also referred
canal may interfere
to as tympanic)
with accuracy
.-L. Digital pacifier Child sucks the Child does not notice Child must hold the
thermometer thermometer similar about the procedure pacifier still in the
to a pacifier at all; therefore, the mouth for about 3---5
least intrusive minutes
 2. Forehead Uses infrared Fast and are easily More expensive tha
thermometer scanner to measure tolerated; provides others
the temperature of accurate readings for
young infant; most
the temporal artery
accurate alternative to
(also called temporal
rectal digital
artery thermometer) thermometers

3. Glass or Uses mercury Cheap and readily May break and allo
mercury encased in glass to available mercury—which is
thermometer measure body toxic—to escape
temperature .

The routes for taking the infant's and the toddler's temperature are summarized below (Fig. 3.) As to usual
and common practice, the measurement of the tympanic temperature is the most accurate if done
appropriately. However, as the caregiver you must use the least invasive route acceptable by both the child
and the parents. According to Ricci and Kyle, the following are the common routes of taking children’s
Temperature (948)

1. Note the age of the child. If younger than 3 years, pull :— earlobe
back and down.
Tympanic how was it
Route done? 2. Insert the thermometer gently into the ear canal --
the beam directed toward the center of the tympanic membrane.
3. Push the button to take the temperature and hold until reading is
obtained.

Temporal how was it 1.Measure temperature on the exposed side of the head
Route done? 2. Slide the sensor tip externally in a horizontalline midway between the
` hairline and the eyebrows, ending at temple.
. 3.Hold in position until the device registers the tempera reading.

Auxiliary how was it 1. Works well for uncooperative and neurologically impaired children
Route Done? 2. Place the tip of the thermometer in the axil la or armpit. Make sure that the tip is in place and not
just , , between the arm and the child's side.
3. Hold the thermometer parallel to the child's side, keeping the arm pressed down until the thermometer
registers.

Figure 3. Routes for taking the child's temperature

 When the infant or toddler is febrile, you cannot bathe the child because the temperature difference
between his body and the water may precipitate benign convulsions. It is important to know as
caregivers that the conditions below result to increase in body temperature among young children. When
the child feels warm because of these conditions, it is advisable to bathe him for comfort.

nWarm room on a hot day

nThick and layered clothes

nRecent feeding with warm milk

nBulky blanket covering the child
n Poor air circulation in the child's room

HEART RATE
Always assess the heart rate when the child is resting or sleeping. The young id's heart rate is
much faster than older children. The table below (Table z.) shows comparison of heart rates and
respiratory rates among infants, toddlers, and older children (Ricci and Kyle 951).

Infant Toddler Preschooler School-age adolescents

HEART RATE
80-150 80-140 80-130 75-120 70-100

RESPIRATORY 20-40 20-40 20-30 16-22 15-20

RATE
Source: Ricci, Susan S. and Tern Kyle. Maternity and Pediatric Nursing. Philadelphia: Wolters and Lip

-pincott, 2009

In older children the pulse rate is taken rather than the heart rate. However, this is not
commonly done among infants and toddlers. The heart rate of young children is determined by placing a
stethoscope over the point where the heartbeat can be heard most distinctly. The heart rate is taken for
a full minute. Unless the young child is suffering from an acute illness, the heart rate is of less clinical
significance. When as caregiver you suspect that the infant or the child is sick, any change in the heart
rate warrants further medical attention.

Respiratory Rate
The same as the heart rate, the respiratory rate should be taken when the child is quiet and comfortable.
This is usually done before the other vital signs are measure The respiratory rate is affected when the child
is active, distressed, or sick. It should be taken for a full minute and caregivers should note that infants
normally display an uneven or irregular breathing pattern with short pauses between some breaths This
is usually accentuated when the infant is ill.
Infant's respiration is diaphragmatic so breathing is usually counted by looking at the abdomen.
Respiration becomes thoracic by 1 year old so the chest movement is counted among toddlers. Table 2
compares the respiratory rate of children among different age groups. The respiratory rate is important before
bathing an infant or toddler. Difficulty of breathing is usually manifested as shallow and rapid breathing
Abnormal respiration may be a sign of respiratory infection or bronchial asthma. As the caregiver, you
should not bathe the child in both conditions.
BLOOD PRESSURE
It is not routine to measure the blood pressure among infants and toddlers. The National Heart, Lung and
Blood Institute (USA) recommends measurement of blood pressure among children less than 3 years old if
they have the following risk factor (Ricci and Kyle 951).

nHistory of prematurity, very low birth weight or other neonatal intensive care complication

nCongenital heart disease

nRecurrent urinary tract infection, blood and protein in the urine, family history of congenital renal
disease

nMalignancy, bone marrow transplant or solid organ transplant

n Increased intracranial pressure

The measurement of the blood pressure is frightening to the young child. You role as caregiver is to
explain well the procedure and its purpose. The right cuff size should be used in taking a young child's blood
pressure. Too narrow cuff results to higher reading; a wider cuff yields low blood pressure reading.

CAREGIVERS ALERT!
Before you bathe an infant or a toddler, check the vital signs. They may lot be normal and, thus,
preventyou from giving the young child a bath.

nTemperature beyond 37.5°C

nHeart rate beyond iso beats per minute
nRespiratory rate beyond 40 breaths per minute

SELF CHECK

A. Analyze each of the following statements. Determine whether it is the correct manner or the
wrong way of determining children's vital signs. Write C on the line if it is correct; otherwise,
write W.

_____1. Respiratory rate among toddlers is better reflected in the abdomen rather than as
thoracic cage excursion.

_____2. When using digital thermometers, check whether the thermometer is well-calibrated and its
power supply, adequate.
______3. It is advisable and more accurate to take the heart rate of infants using the stethoscope than
palpating for the pulse rate.
_____4. Explain very well the procedure in taking the blood pressure because the
sphygmomanometer looks frightening to the child.

______5. Under no circumstance is the heart rate taken when the infant or toddler is not in a quiet
state—preferably when sleeping.

______6. For better cooperation from the child, it is advisable to take the respiratory rate last among the
four vital signs.
______7. Always close the windows and allow minimum ventilation only when taking the child's body
temperature.
______8. For lack of a child blood pressure cuff, the adult cuff may be used instead.

B. Match column A with column B by writing the letter of the correct answer on the line. Column A
enumerates features of thermometers that are listed in column B.

Column A Column B

Features of Thermometers Types of thermometers

a. glass
1. The last intrusive thermometer for babies b. forehead
2. May break and allow mercury to escape
3. As accurate as the rectal thermometer c. tympanic
4. Quick alternative temporal thermometer d. digital oral
5. Difficult for infants who are mouth breathers
e. digital pacifier

ACTIVITY

CHECKING VITAL SIGNS BEFORE BATHING INFANTS AND TODDLERS

Working in a team with four members each, secure the necessary tools and equipment for taking the vital
signs—i.e. digital thermometer, stethoscope, and sphygmomanometer. Practice taking vital signs on each
other as you would be doing in young children.
 When a young child gets sick, she has lots of complaints. These may include difficulty of breathing,
abdominal pain, and toothache. These are symptoms that are subjective because they all depend upon the
patient complaining. When a caregiver looks for verifiable evidences of the complaints, she is looking for signs.
One sign of difficulty of breathing is shallow and rapid respiration. A sign for abdominal pain is
tenderness when the affected area is touched and swelling and redness near the affected tooth may
be a sign of toothache. Signs are objective and verifiable evidences of the symptoms.

There are unusual signs and symptoms a caregiver must know about infants and toddlers because these
may need medical attention. Each one may be related to the signs of inflammation which are heat, pain,
redness, swelling, and loss of function (Tracy). The following illustration shows some signs and symptoms
that infants and toddlers may experience.

THE HEAD, THE NECK, AND THE FACE

Symptoms: crying, pain, headache, toothache, sore throat

Signs: sunken fontanel, swelling, red or yellow conjunctivae, ear and

nasal discharges, mouth ulcers, white Et furry tongue, swollen gums,

face rashes, palpable neck lymph nodes

THECHEST AND THE ABDOMEN

Symptoms: difficulty of breathing, chest tightness, abdominal pain

Signs: discoloration and/or rashes increased respiratory and/or heart rate,

distended abdomen, tenderness in the abdominal area, bowel movement changes,

changes in fecal smell and consistency, urine color

THE UPPER AND LOWER LIMBS Symptoms: weakness and pain

Signs: warm skin, rashes, tenderness when moved, loss of hand grip, unable to stand or

walk (for toddlers), swelling of the lower limbs, dark nail beds

Crying among infants can be both a symptom and a sign. When a young child cries, she is most
likely in pain after ruling out hunger. Pain among infants is manifested as persistent crying. Pain in the
extremities and gas in the abdomen also cause the infant to cry. She also refuses to feed when the
abdomen is distended with gas. Toddlers who can express themselves may complain of pain and
caregivers must not disregard this as being childish. Check the pain by gently palpitating for tenderness
in the affected area. Young children will cry if there is tenderness; however, some toddlers may only
show a facial grimace.
Besides elevated temperature and increased respiratory rate, another important -signs
caregivers should look are rashes and skin discolorations. Some viral illnesses such as rubeola (measles)
and rubella (German measles) which are both common -among infants and toddlers, usually present as
skin rashes. When there are rashes. And you think of viral illness as the cause, it is not advisable to bathe
the young child. usually there is fever accompanying the skin rash. Furthermore, seek medical help
if the young child manifests red or yellow conjunctivae and also in darkening of the nail beds. All of them
are signs of serious illnesses.
A very common wrong practice among parents is to attribute fever in young
children to a "pilay" which in medical language roughly translates to a dislocation.
Although a dislocation may result to a fever, it manifests more as loss of function
And swelling of the affected limb. If the fever is accompanied with cough and nasal `charge, the pilay is
allegedly in the chest and parents ask the traditional hilot to the pilay back in place. This is a dangerous
practice that may lead to death of the young child. Fever is most of the time caused by infection.

SELF CHECK

Differentiate whether each of the following items refers to a sign or a symptom. Of the circle
before each item number, write SYN for sign and SYM for symptom.
1. Three-year-old Joaquin complains toothache to Nanay Mila, his care provided.
2. Nanay Mila notices that Joaquin's gum around the lower left molars is swollen
3. There are dental caries over the swollen gum on the left which is tender when touched.
4. Joaquin's mother tells Nanay Mila that the young boy feels warm and he may be suffering from
fever.
5. Using the thermometer, Nanay Mila verifies the mother's fear because Joaquin's body
temperature reading is 38.9°C.
6. Listening at her day care ward, two-year-old iosie, Teacher Rose suspects the young girl is sick.

7. Feelinglosie's forehead, theyoung girl feels warm and complains of headache and dizziness.

8. The teacher's suspicion is validated when Josie's oral temperature reading is at 39.5°C, indicative of
fever.

9. Other children tell Teacher Rose that)osie has vomited the morning snack of mongo meatballs and
rice.

10. On close examination, the teacher finds red flat rashes scattered all over Josie's upper extremities

ACTIVITY
EXPLAINING UNUSUAL SIGNS AND SYMPTOMS EXPERIENCED
BY INFANTS AND TODDLERS

The class will do a research work for this activity. Choose a sign of a health problem associated with
any of the four vital signs that you have learned. Consult your choice with your teacher for approval. Once
approved, do a research of its cause/s and the process of its development. Present your explanation using the
most appropriate graphic organizer.
LESSON 3

Adults take shower to refresh and keep themselves clean. Infants and toddlers need to be
comfortable and clean too. Since they are still very young to do it on their own, young children need
caregivers to bathe them. The following are the basic paraphernalia that are prepared for bathing
infants and toddlers ("A Baby Checklist").
Bath Equipment Description

The baby bath tub is shaped to accommodate the

young child's body. It is made of plastic to prevent
injury to the child and for easy storage because of
its light weight. Some bath tubs have drains. Others
have one end that is built up so the caregiver can
lay an infant back against the elevation, while
washing

Baby bath tub him with water from lower down in the tub.
Basically, it is used to hold water where the child is

Usually made of foam, the bath support is shaped

to the contour of the young child's body. It will
support a reclining child comfortably and safely
allowing the caregiver to use both hands in washing
the child. It has a non-slip base and is light for easy

Bath support cleaning and storage.

The non-slip rubber mat for older children may be

. . .
equivalent to the bath support for infants. The rub-
ber mat covers the entire bottom of the tub so that
.
no slippery tub surface is exposed. It has a pebbled
- .. top surface that allows better foot traction. On the re-
verse are rubber suction cups that allow it to adhere
firmly to the bath tub surface. It is made of rubber
Non-slip rubber mat
with no chemicals harmful to the child. It gives young
children the freedom to splash in the bath without
the risk of slipping.
A baby bath thermometer is similar to a laboratory
thermometer that measures temperature of boiling
water. However, a baby bath thermometer usually
, looks like a toy with a sturdy frame housing the
thermometer. It prevents infants and toddlers from
scalding injury. Ideal water temperature for bath is
Bath thermometer around 37°C.
 Similar to adults, infants and toddlers need bath supplies too. The following are the more important
bath supplies that should be readily available for young Children.

Bath Supplies Description

Baby bath soaps are not different from adult

soaps in composition. However, they are milder
with fewer additives such as antimicrobial,
Baby bath soap fragrances, or abrasives. The whiter the bath soap is
and the less fragrant it is, the lesser the chemical
additives are.

Therefore, the best baby bath soap is white and non-

Baby shampoos are similar to baby soap in charac-
teristics. They are mild, colorless, and with no strong
Baby shampoo fragrance. Using shampoo too often and
massaging it vigorous on the young child's scalp
deplete the hair of its natural oils that may cause
irritation and itchiness on the child's scalp.

A bath sponge is a tool or cleaning aid consisting of

porous material. Because bath sponges are especially
Bath sponge good at absorbing water and water-based substances
such as soap and shampoo, they are usually used

in cleaning impervious surfaces like ayoung child's

body during his regular bath.
Comforters include toys that comfort the young child
whenever he is distressed, anxious, or in pain. During
Bath comforters bath time, toys are made available floating in the

tub to lessen the fear of the baby as he is slowly im-

mersed into the water.
After the infant or the toddler has taken a bath, the caregiver sees to it that he s comfortable and
well-groomed. Here are some of the basic after-bath care and grooming tools and supplies.

Tools for after bath care Description

Hooded baby robe The hooded baby robe is similar to an adult terry
robe. The hooded baby robe is fluffy, giving the
young child a warm cuddly feel. Because it absorbs
skin moisture better, it leaves the child dry and
feeling refreshed. The robe is considered one of the
infant comforters because of the soft warmth it pro
vides the young child.
Towels and washcloths Bath towels for infants and toddlers are soft and made of
non-irritant materials. They are readily absorbent so they
dry the skin fast. Caregivers should darn torn parts in
 the towel. The young child's finger or toes may get
caught in the hole and might be strangulated causing
irreparable damage to the digits.

Grooming tools and supplies Description

Brush and comb set The baby brush and the comb must be made of
non-toxic materials. The comb has teeth that are
set far apart from each other. This prevents fine
hair from getting entangled that may hurt the child.
The bristles of the brush are soft to protect the
scalp. They are also made of non-toxic materials
that cannot easily be pulled out from where they
are inserted.

Baby nail clippers and scissors Nail clippers and scissors for young children are a
lot safer to use than the adult nail cutters. The nail
clipper is as sharp as that for adults but is safer
and more stable to handle because of the added
hole in the handle where one can

secure firmly his finger while clipping the child's

nail. The nail scissors, which have blunt ends, serve
the same purpose but are more difficult

to control. This may result to cutting the child's

fingertip.
Cotton buds Baby cotton buds consist of a small wad of cotton
wrapped around one or both ends of a short rod,
usually made of plastic. After his bath, the swab is
used to clean his ears and his navel or umbilicus.

CAREGIVERS ALERT!
Prepare the bathing paraphernalia ahead of time. Make sure all the bathing tools and equipment
are safe to use. Look for tears and breaks that may hurt the young child. The bathing supplies should
be available and easily accessible. Do not substitute baby bath toiletries with adult soap and shampoo.

SELF CHECK
A. cclassify each of the listed bathing paraphernalia below whether it belongs to (i) bathing
equipment and tools, (2) bathing supplies, or (3) grooming tools and materials. Write your answer
inside the appropriate box.
bath support bath tub bath shampoo
non-slip mat nail clippers baby powder
baby soap brush and comb comforters

Bathing Equipment Grooming Tools and

Bathing Supplies
and Tools Materials
B. Give the best specification for each of the following bathing equipment, tool! and supplies. Encircle
the word that refers to the best feature the item must have.

Item Best feature

Baby bath soap No- tear formula hypoallergenic Non-scented

Non-slip mat Good traction non-toxic adequate size

Bath comforters Water proof age appropriate non-toxic

Bath sponge Very porous small size heavy duty

Bat support Comfortable non-slip easy storage

ACTIVITY
CATEGORIZING BATHING SUPPLIES AND MATERIALS ACCORDING
TO THEIR SPECIFICATIONS

Look fora partner to work with in this activity. Identify at leastio bathing supplies nd materials advertised
either on radio, TV, or print ads. Determine the best feature Dr each identified brand of bathing supply or
material. In a classification graphic Organizer, categorize these items as highly recommended,
recommended, and not dvisable. Refer to the following format and example:

Brand of bath supply or Highly recommended Recommended Not advisable

material
Phoenix baby
bath soap Best feature: no-tear formula, hypoallergenic, and the lowest priced baby
soap available in the market.
 LESSON 4

WATER TEMPERATURE REQUIREMENT WHEN BATHING

Caregivers must always be concerned as to the temperature of the water for a young child's bath.
Young children's skin is thinner and can get burned easily. Because of lesser subcutaneous fat, young
children easily get cold too. The ideal water temperature for a bath is between 36°C and 38°C. In the
absence of a bath thermometer, you may use your elbow to determine the relative temperature of the hater.
In checking for water temperature, mix well the hot and the cold water. Always remember not to add the
hot water when the child is already in the tub.

When preparing for a bath, you should not only ensure that the water is warm. Check also if the water is
not too cold. If the water is too cold, it may cause the child to have problems maintaining his body
temperature and get chilled. Make sure the room you bath the baby is free of light winds and comfortably
warm, somewhere between 24°C and 27°C.

PROCEDURES IN GIVING INFANT BATH

Unless the infant becomes very active as to be crawling all around, there is no need to give her a daily
bath. Washing the face often and cleaning the body folds and creases with soft and moist washcloth is enough.
Baby bath is best done using a tub with stand. If there is no stand, the tub can be placed in the sink away from
plumbing fixtures that can hurt the baby. Below are the steps in giving infant bath ("Bathing").

1. Gather all necessary bath supplies, and lay out a towel or a bath comforter, a clean diaper, and clothes.
Make sure the room is comfortably warm so the baby does not get chilled.
2. Fill the tub with about 3 inches of water that feels warm but not hot—around 37°C—or a few degrees warmer.
Test the water by dipping your elbow in to make sure it is warm enough.
3. Bring the baby to the bath area and undress him or her completely. Undressing him or her should be
the last thing you do or he or she may be getting cold as you prepare the tub. Never leave the infant all by
himself or herself.

4. Gradually slip the baby into the tub feet first, using one hand to support the neck and head.
Slowly ease the baby into the water, whether you are using a bathtub or a bath support. Make sure the
baby is relaxed and comfortable. Pour cupfuls of bath water over him or her regularly during the bath so
he or she does not get cold.
5. Wash the baby with soap. Make sure you use a mild, no-tear baby soap that will not irritate the
baby's skin. Some people like to use baby shampoo for the hair, but it is perfectly fine to use regular
soap on the baby's head. Here is how you wash the baby:
 a. Using your hand or a soft washcloth, wash the baby from top to bottom both on its front and back.
b.Wash the baby's scalp with a soapy wet cloth. If shampoo is used, lather the shampoo in
your hands and then massage it gently into the scalp.
c.Gently clean the baby's eyes and face with a cloth that is free of soap. Even a tear-free
soap may irritate the baby's eyes.
d.As for the baby's genitals, a routine washing is all that is needed.

6.Rinse the baby thoroughly with cupfuls of clean water, and wipe him or her with a clean washcloth.
Wrap the baby in a hooded towel or bath comforter and pat him or her dry. The bath comforter keeps
him or her warm and absorbs water off his or her skin. If the baby's skin is dry, or has a trace of diaper
rash, apply a mild cream after bath.

PROCEDURES IN DRESSING/UNDRESSING INFANTS

After the bath, the baby should be dressed comfortably. Comfort among infants mean
dressing him or her in clothes that give him or her warmth. Infant clothes should help the baby
maintain a core body temperature of 37°C. Clothes should not be too thick and bulky that they
elevate the temperature nor should they be fashionably covering less causing the young child to
get cold.

Changing the Diaper

The most important clothing item any infant has is the diaper. There is no one best way to
change a diaper. However, there are important points caregivers must consider ("Diapering Your
Baby"). Always change the baby's diaper in a clean, flat and comfortable surface. In places
where there are diaper changing stations, do not forget to strap the infant on the table. The straps
prevent the baby from falling when she squirms. The following are the steps in changing
disposable baby diaper.

1. Prepare a new diaper and place the back half under the baby (still on the old
diaper). See to it that the top of the back half comes to the baby's waist.

2.Remove the soiled diaper by unfastening the tabs -and sticking them back so that they will not stick
either on the baby or the new diaper.
 3.Pull down the front half of the dirty diaper. If there is fecal material in the diaper, use the front half of
the diaper to wipe the bulk of it off the baby's bottom.

4.Lift the baby off the table holding on to the ankles and fold the old diaper under him. This protects the
new diaper from the baby's dirty bottom.

5.Using a soft and moist cloth, clean the baby's front. If the baby pooped, be sure to clean his bottom
well specially inside the skin folds. For a baby girl, move the damp cloth by passing it from front to
back to avoid contaminating the perineal area.

6.Remove the dirty diaper and set it aside. Pull the front half of the clean diaper up to the baby's
abdomen. For a boy, be sure to point the penis down so he is less likely to pee over the top of the
diaper.

7.Spread evenly and wide the material in between the legs. Bulking of the diaper around , this part
causes skin irritation and chafing that are both uncomfortable to the baby.

8.Secure the diaper in place by fastening the tabs. Check if both tabs neither stick nor the diaper pinch
on any part of the baby's skin. Dress the baby appropriately for comfort.

Hanging the Cloth Diaper

Changing a cloth diaper is not very different from changing a disposable diaper. For the first step, instead
of placing the new diaper under the soiled one, lay the clean diaper close by. Proceed accordingly as in
changing a disposable diaper. On the tenth step, gently lift the baby's bottom and place underneath the
new and clean cloth diaper. Proceed accordingly. Always remember to use diaper clips and not safety pins .r
securing cloth diapers.
SELF CHECK

A. Listed below are steps in giving an infant bath ("Gearing Up"). Understand each of
them and determine the chronological arrangement as these steps are performed.
Number each step accordingly by placing 1 on the line for the first step, z for the
second, and so on.

_______ Wash the baby's arms and legs.

_______ Dry the baby using a soft towel.

______ Wash her face. Use a very small amount of soap.

______ Once you've washed the front of the baby, it's time to clean the bac

______Clean around the belly button, and finally, the diaper zone then rins this area
thoroughly.

_______Wash the baby from the head down to her feet giving special anent' to areas within skin folds.

_______Using a soothing voice, reassure the child as you cradle her in yo arms and slowly dip her into
the tub.
_______Pick the child slowly out of the bath tub by placing both hands firm under each axilla or
underarm.

B. The following are steps in changing an infant's diaper. They are not in t right order. Analyze how
they should be arranged correctly. Number each step accordingly by placing 1 on the box for the first
step, 2 for the second, and so on.

Unfasten the tab of the dirty diaper.

Remove the dirty diaper and discard it.

Place the back half of the new diaper under the baby.

Clean the baby's front with moist baby wipes or cloth.

Pull the front half of the clean diaper and fasten it in place.

Pull down the front half of the soiled diaper and fold it clean side under the baby.
ACTIVITY

DEMONSTRATING THE PROCEDURES IN DRESSING

OR UNDRESSING INFANTS
Working with a partner, practice changing diapers. Ask from your teacher checklist of the to-do list
for changing both a disposable and a cloth diaper.
LESSON 5

INFANTS' CLOTHES AND UNDERWEAR

Every parents and caregivers goal is to dress an infant comfortably as well as making the young child
look charming. The following are the basic infant clothes and their purposes.

1. Body Suits and T shirts. A body suit is a one-piece, t-shirt-like baby garment that has snaps at the
-

crotch to keep it from riding up and exposingthe baby's tummy. It is usually short-sleeved and does
not cover the baby's legs. Body suits range in style from simple, white, undergarment versions to
colorful, patterned, and embroidered types. There is a kimono style body suit that is great for
umbilical cord care. Both body suits and t-shirts can be used as infant's daily wear, T-shirts give the
infant more comfort during hot days. Body suits can also be worn as underwear to keep the baby
comfortable during cold weather.

body suit kimono body suit

2. Pajamas and Booties. Infants sleep, on average, 18 hours per day. It is essential that they are
comfortable. For warmer weather, cotton, one-piece pajamas are recommended. For colder
weather, choose heavier-weight footy pajamas or blanket sleepers. Because infant extremities easily
get cold, booties are essential. They are small, soft shoes designed to fit on the feet of infants.

warm weather pajama cold weather pajama

 3. Accessories. Infant accessories include shoes (booties), socks, and hats. When parents go
out, they want their baby's feet warm, and their heads protected from any kind of weather, be it
warm or cold. The infant's first pair of shoes must be warm, soft-soled, slip-on, and can be worn
with or without socks. When choosing socks, choose for cotton. It is a natural product and soft on
the infant's skin. Warm weather head protection should include baseball caps, sun hats, or
cotton beanies, while colder weather wear should have ear flaps and tie or button closures to
make sure they stay put and provide maximum protection from the elements.

CAREGIVERS ALERT!
It is important to keep infants and toddlers warm during cold weather. Should they be wearing gloves
and socks, wear them both with the right side in or inside out. There may be threads used in sewing these
items that can get entangled with the young child's fingers and toes causing strangulation leading to poor
blood circulation to the digits.

4. Infant Outerwear. Infant outerwear includes both tops and bottoms. Outerwear is
one of the most difficult areas of infant clothing to figure out. Choosing the right outerwear is a
learning experience. Layers are important when it comes to outerwear. A degree or two in
temperature is often the difference between a very happy baby and a very frustrated baby.
There is a variety of styles of infant outerwear to choose from. For warmer weather, zip-up,
hooded sweatshirts or thin cotton shirts are easily layered, so your baby can stay comfortable all
day long. And in the summer, comfy bottoms, swimwear, sunglasses, and hats are a must.

cotton sundress boy's outerwear set

5. Everyday Wear. Simplicity is important for everyday wear. Look for items that will give
you easy access for diaper changes, like slip-on pants, side snap shirts, and coveralls. These make cleaning
 the infant easy, without constantly having to pull clothes over their heads. Everyday wear also includes
both tops and bottoms.

TYPES AND USES OF TODDLER CLOTHES

Clothes for toddlers are classified similar to that of older children. The classification is
usually by kind which also reflects each of their specific purpose. There are only two discernable seasons
in the Philippines, so the choice of what to wear is between clothes for dry season and clothes for wet
season. The young child's comfort will always dictate the choice of what clothes to wear regardless of the
season. Clothes made of natural fabric are the most comfortable and safest way of ensuring that the child is
comfortable and healthy. Some common types of young children's clothing are:

1. Dress Shirt. Children shirts come in different colors and may be short sleeved or long
sleeved. Another variety is the polo shirt. It is usually made of cotton and polyester that are
worn during formal occasions. The short or half sleeved shirts are popular among toddlers
because they are more comfortable. Although incorrect, long sleeved shirts are worn by children as
jackets during cold weather.
2. Young Girls' Dress. It is a one piece feminine cut dress intended for young girls. They are usually
made of cotton and adorned with colorful girlie items that are very attractive to young girls. Dresses
are usually worn for formal occasions and events.

3. Children T-shirt. This is a type of casual shirt without a collar or button that is usually made of
cotton and short-sleeved. Some t-shirts for older boys have cut-off shoulders or arms. They are
worn usually as everyday wear being the most comfortable of all the top outerwear.

4.Denim Pants. Denim pants or jeans are popularly known as "rnaong" pants in the Philippines.
They are made of tough material so they are not very comfortable to young children. However,
the newer styles, which are colored ones, are softer and appeal more to children. Usually they are
worn by children during special occasions instead of dress pants because of their more casual
appeal.

5.Children Trousers. These are the formal counterpart of denim jeans. They are often made of polyester
and cotton and are not the favorite among toddlers. They are worn during special occasions and are
the choice of pants for the traditional barong Tagalog. Young school boys wear trousers as
uniform.

6.Shorts. A pair of shorts is the most favorite bottom outerwear among young children. It is usually made
of cotton and allows the child more freedom of movement while keeping him comfortable. Both
young boys and girls wear shorts. It is multipurpose and can serve as sportswear and a sleepwear
as well.
DRESSING UP INFANTS AND TODDLERS
In as much as we always like infants and toddlers to look cute when dressed up, comfort should
always be the first consideration in dressing them up. Just like changing the diaper, there is no single best
way to put on the infant's or the toddler's clothes. The following are practical tips in making young children
not only look adorable but also feeling comfortable.

Putting On a Shirt
Most young children hate having clothing pulled down over their heads, and will let you know by
either howling or crying. The first few times can be difficult. Caregivers should always have to support the
infant's head while gently easing the shirt down. Stretch it as far as you can before attempting to put it on.
Once it is down over his head, put his arms into the armholes. Since a baby won't stick his hand and arm
down a shirt sleeve, it is best to reach and pull his hand through. It is a lot easier and simpler to assist
toddlers in putting on a shirt:

1.First, pull the shirt over the toddler's head.

2.Ask the young child to push his right arm up the sleeve.

3.Follow the same step for the left arm. Assist the child if he has difficulty in doing the last two
steps by reaching out the arm and pulling his hand through.

4.Pull the front and back part of the shirt down.

Putting On a Pair of Socks

This is the trickiest part of dressing up a young child. When adults put on a
sock, you point your toes. When you put on a sock on an infant or a toddler, he
curls his toes. Stick both your thumbs deep into the sock so you can snug it up
against his toes and then pull it the rest of the way up.

Keeping the young child from being too hot or too cold can be a challenge. Infants have little ability to
regulate their own temperature and can chill easily. Caregivers may be tempted to bundle up the baby at
bed time, but overheating can be a serious problem. To keep the infant comfortable:

n Keep the room temperature between 24 and 27°C.

n Dress him in a diaper, an undershirt, and a one-piece pajama.

n Only use a thin knit blanket to cover him, and tuck it in at the edges of the mattress so it does not
come loose and get wrapped around
SELF CHECK

A. Identify the following clothes and underwear usually worn by infants and toddlers. Complete their
names by filling in the missing letters.

_ _ _ _’s _n____ _ _ _ y
_ _e _ _ ____I__ _ u _ _

b. Match each child's clothes in column B with the appropriate occasion in column A when it is worn.
Write the letter of the answer on the line.

Column A Column B

1. Church service a. PE uniform

Christmas party Raincoat and boots

2. b.
3. School day activity c. Long dress with sleeves
 4. Old brother's wedding d. Pair of shorts and t-shirt
5. Beach picnic on a
Saturday e. Ninja Turtle costume
f. Barong Tagalog

ACTIVITY

DRESSING INFANTS AND TODDLERS ACCORDING TO PROCEDURE

Invite to class the school nurse and a mother who has experience with young children. Request
both invited guests to demonstrate dressing infants and toddlers. Observe, ask questions, and make comments. Then in
a graphic organize'r as shown below, write reflections by completing the prompts. Give at least three
realizations, which as shown, must be related to each other.

On dressing young children, I I have realized after the This realization is important
did not know before that… demonstration that… because…

KEY CONCEPTS

nVital signs are important in assessing the infant's and toddler's current physical health and
condition. Do not bathe a young child when his body temperature is elevated beyond 37.5°C.
nSymptoms coming from young children are to be taken seriously. Caregivers must look for signs
that verify the symptoms.

nGiving an infant or a toddler his bath must be a happy moment for both the young child and the
caregiver. The caregiver's thorough preparation and comprehension of the procedure will make
the young child enjoy the experience.
nA young child's skin can burn easily. Caregivers should ensure that water temperature during bath
is between 36°C and 38°C.
nThe young child's comfort is the prime consideration in selecting clothes to wear for infants and
toddlers.