Pediatric Primary Care Case Studies (23 page)

   
Hygiene:
Caregivers’ should wash their hands with soap and water frequently, especially after diaper changes and before feeding the baby.

•   Infant care

   
Outings:
The newborn is susceptible to illness and needs to be protected from anyone with a cold or illness. Consider carefully the necessity of bringing the newborn on outings such as trips to the grocery store, faith-based activities, and restaurants in order to avoid persons with colds or flu.

   
Cord care:
Air dry the cord by keeping the diaper below the cord until the cord falls off (about 10–14 days). There may be some slight bleeding for a day or two when the cord falls off.

   
Prevent diaper rash:
Clean baby and air dry after each diaper change. Change diaper frequently.

   
Bathing:
Baby’s skin does not need to be washed daily with soap. Tell the mother to wipe the baby’s genital area with each diaper change and to avoid detergent-based soaps. Newborn infants need to be bathed every few days and as needed.

   
Cradle cap prevention:
Wash scalp (every other day to daily) with baby shampoo or mild soap such as Dove. Demonstrate washing the scalp to the parent to reassure and decrease fear of touching the “soft spot.”

   
Temperature taking:
Review the procedure of taking a temperature with the parents.

•   Feeding

   
Feeding times:
Feed the baby when hungry. Signs of hunger include sucking, rooting, fussing, and putting hand to mouth.

   
Burping and spitting up:
Burp baby by gently rubbing or patting their back while holding the baby against your shoulder and chest or supporting the baby in a sitting position on your lap. Burp midway through feeding and at the end of feeding. Babies can have “wet burps” up to 30 minutes after feeding.

Military Family Needs

The military family has unique needs based on deployment in times of war, training assignments, and potential reassignment to another base. Children of military personnel have universal access to Tricare, the military health insurance. Parents can then secure health care for their dependents in military facilities or through civilian options (Budzik, 2008).

Military deployments, whether to war torn areas or just for training sessions outside of their home base station, are often stressful times for these families, some of whom may be temporarily displaced when such assignments occur. The ability of a military family to acclimate to deployments and family separation may vary from those who have an affinity to cope well with the cycle of military moves and/or deployment to those whose lives are thrust into turmoil. Although, Ms. Calzada’s children are very young, the healthcare provider should be alert to potential problems that children may also experience. Research focusing on the effect of deployment in children reveals that children can be impacted by the separation caused by deployment for extended periods of time. Budzik (2008) noted that research conducted with military families during Operation Desert Storm demonstrated that children of deployed soldiers experienced increased symptoms of depression; however, their symptoms were rarely pathological. Lamberg (2004) noted that some children became more confident and independent during times of deployment for their parent. Gibbs and colleagues (2007) investigated the incidence of maltreatment of children of enlisted soldiers during times of deployment and noted an increase in the incidence rate during times of deployment. Thus, the implications of these studies clearly validate the need for families left behind, like the Calzadas, to receive the emotional, psychosocial, and sometimes financial support they need.

Ms. Calzada now has two children with a husband in Iraq and is awaiting help from her mother.
A study by Giles (2005) found that Army wives appear to suffer from high levels of stress, and their coping mechanisms were affected by constant turbulence and isolation. He noted that Army dependents require more support from their healthcare provider than the average civilian family.

Because of the isolation Ms. Calzada may feel, the healthcare provider needs to be alert for the development of postpartum depression and symptomatology of isolation. Assessing
for postpartum depression should be an integral part of well child visits during the next 6 to 12 months. Healthcare providers must be proactive in providing support and alternative services. In Ms. Calzada’s situation, you should discuss whether there are services on base for new mothers. She is currently using her church support system to help care for her children until her mother arrives. Additionally, when her husband returns in 4 months, the healthcare provider should encourage her to seek out military services that are available to them to promote a positive integration of the family after his experiences in Iraq. Proactive intervention can help the family better cope with “after effects” of potential postdeployment stressors. In addition, acknowledge Ms. Calzada’s decision to utilize resources such as her church family during the fourth trimester.