DEEL 3: VERZORGING & OPVOLGING VD ONTW.
VH KIND
INHOUDSOPGAVE
deel 3: verzorging & opvolging vd ontw. vh kind ........................................................................................................................ 1
Eerste zorgen pasgeborene ...................................................................................................................................................... 11
Basisprincipes ........................................................................................................................................................................... 11
Warmteverlies bij pasgeborene komt tot stand door 4 fysische processen .................................................................................. 11
Voorbereiding eerste zorgen .................................................................................................................................................... 11
Methodiek eerste zorgen .............................................................................................................................................................. 11
Effectieve aanwezigheid pediater bij: ....................................................................................................................................... 11
Apgarscore: vragen? ................................................................................................................................................................. 12
Skin to skin ............................................................................................................................................................................... 12
Aandachtspunten bij de geboorte ............................................................................................................................................ 12
Afklemmen ............................................................................................................................................................................... 13
Apgarscore ............................................................................................................................................................................... 13
Betekenis apgarscore .................................................................................................................................................................... 13
Indien baby mindere start, verloopt het puntenverlies in deze volgorde: ..................................................................................... 14
Wat is asfyxie? .............................................................................................................................................................................. 14
pH-waarden: kennen! ................................................................................................................................................................... 14
Aspiratie ................................................................................................................................................................................... 14
Notapunten ................................................................................................................................................................................... 15
Afnavelen ................................................................................................................................................................................. 15
Cordring ........................................................................................................................................................................................ 15
Navelklem ..................................................................................................................................................................................... 15
Cordring vs navelklem ................................................................................................................................................................... 15
Controle navelstreng ................................................................................................................................................................ 15
Grondige observaties → inspectie vd pasgeborene is het belangrijkste onderdeel vh onderzoek ............................................ 16
Hoofd ............................................................................................................................................................................................ 16
Aangezicht .................................................................................................................................................................................... 16
Thorax ........................................................................................................................................................................................... 17
Hals ............................................................................................................................................................................................... 17
Abdomen ....................................................................................................................................................................................... 17
, Rug- en wervelkolom..................................................................................................................................................................... 17
Extremiteiten................................................................................................................................................................................. 17
Genitalia externa........................................................................................................................................................................... 17
Anus .............................................................................................................................................................................................. 17
Huid ............................................................................................................................................................................................... 18
Beknopt neurologisch onderzoek .................................................................................................................................................. 18
Bepalen geboortegewicht ........................................................................................................................................................ 18
Hemdje aantrekken .................................................................................................................................................................. 18
Navelstrengstompverzorging.................................................................................................................................................... 18
Controle lichaamstemperatuur/aandoen luier ......................................................................................................................... 18
Vitamine K ................................................................................................................................................................................ 18
VKDB (vitamine K-deficiëntiebloeding)..................................................................................................................................... 19
Konakion paediatric ................................................................................................................................................................. 19
Samenvattend ............................................................................................................................................................................... 19
Notapunt ....................................................................................................................................................................................... 19
Besluit ........................................................................................................................................................................................... 19
Bepalen lichaamslengte............................................................................................................................................................ 20
Identificatie en bovenkledij aandoen ....................................................................................................................................... 20
Meten schedelomtrek (SO) ....................................................................................................................................................... 20
Oogindruppeling = Crédé-methode .......................................................................................................................................... 20
Conclusie ....................................................................................................................................................................................... 20
Na de eerste zorgen ................................................................................................................................................................. 20
Nazorgen .................................................................................................................................................................................. 21
Wat rapporteren? ......................................................................................................................................................................... 21
Algemeen besluit...................................................................................................................................................................... 21
Observatie van de pasgeborene binnen de eerste 24 uur neonataal ........................................................................................ 22
Observatie ................................................................................................................................................................................ 22
Observaties door de kinderarts ................................................................................................................................................ 22
Algemeen onderzoek..................................................................................................................................................................... 22
Bekijken van de baby (inspectie) .............................................................................................................................................. 22
Afmetingen en waarden ........................................................................................................................................................... 22
Beluisteren van hart en longen ................................................................................................................................................. 22
Palpatie abdomen – observatie navelstrengstomp .................................................................................................................. 23
Bloedcirculatie .......................................................................................................................................................................... 23
Inspectie genitaliën ................................................................................................................................................................... 23
, Inspectie aars ............................................................................................................................................................................ 23
Dysplastische heupontwikkeling ............................................................................................................................................... 23
Inspectie onderste ledematen .................................................................................................................................................. 24
Inspectie thorax/hals ................................................................................................................................................................ 24
Inspectie bovenste ledematen, ogen, oren en mond ............................................................................................................... 24
Palpatie hoofd ........................................................................................................................................................................... 24
Bevoelen rug ............................................................................................................................................................................. 25
Evaluatie: spierspanning/elasticiteit ......................................................................................................................................... 25
Evaluatie uitwendige kenmerken (Duboswitz-score) ............................................................................................................... 25
Neurologisch onderzoek ................................................................................................................................................................ 25
Inspectie .................................................................................................................................................................................... 26
Eigenlijk onderzoek ................................................................................................................................................................... 26
Onderzoek van de ogen ............................................................................................................................................................ 28
Bewustzijn, omgeving ............................................................................................................................................................... 28
Observaties door de vroedvrouw ............................................................................................................................................. 28
Navelstrengstomp ......................................................................................................................................................................... 29
Ademhaling ................................................................................................................................................................................... 29
Controle baby met ademhalingsnood ...................................................................................................................................... 29
Factoren belangrijk bij de start (aanvang) en voortzetting ademhaling ................................................................................... 29
Hinderende factoren voor de ademhaling ................................................................................................................................ 29
Observatiesystemen ademhaling.............................................................................................................................................. 30
Verschijnselen bij ademhaling moeilijkheden .......................................................................................................................... 31
Observatiepunten ademhaling ................................................................................................................................................. 31
Braken ........................................................................................................................................................................................... 31
Spijsvertering ................................................................................................................................................................................ 31
Gewicht ......................................................................................................................................................................................... 32
Invloed op geboortegewicht ..................................................................................................................................................... 32
Ontlasting...................................................................................................................................................................................... 32
Urine.............................................................................................................................................................................................. 32
Lichaamstemperatuur ................................................................................................................................................................... 32
Huidskleur ..................................................................................................................................................................................... 33
Gedrag van het kind/activiteit ...................................................................................................................................................... 33
Hartslag......................................................................................................................................................................................... 33
Oedeemvorming/dehydratie ......................................................................................................................................................... 33
Houdingen en bewegingen ....................................................................................................................................................... 33
Hygiënische zorgen en tandhygiëne ......................................................................................................................................... 35
Hygiënische zorgen neonatus ................................................................................................................................................... 35
Algemene regels............................................................................................................................................................................ 35
Beginsituatie ................................................................................................................................................................................. 35
Actieplan bij ochtendverzorging dag 1.......................................................................................................................................... 35
Actie: voorbereiding ................................................................................................................................................................. 35
Actie: uitvoering ........................................................................................................................................................................ 36
Actie: nazorg ............................................................................................................................................................................. 36
Evaluatie ....................................................................................................................................................................................... 37
, Hoe het ook kan ............................................................................................................................................................................ 37
Aandachtspunten .......................................................................................................................................................................... 37
Hygiënische zorgen van de zuigeling......................................................................................................................................... 39
Actie: wat is anders ....................................................................................................................................................................... 39
Aandachtspunten .......................................................................................................................................................................... 39
Hygiënische zorgen van kind dat rechtop kan zitten ................................................................................................................. 40
Actieplan ....................................................................................................................................................................................... 40
Actie .............................................................................................................................................................................................. 40
Aandachtspunten .......................................................................................................................................................................... 40
Staalafname kind ..................................................................................................................................................................... 41
Algemeen ................................................................................................................................................................................. 41
Bloedafname ............................................................................................................................................................................ 41
Bloedafname metabole screening ................................................................................................................................................ 42
PKU test/Guthrie-test/hielprik .................................................................................................................................................. 42
Capillair of intraveneus ............................................................................................................................................................. 42
PKU-kaartje ............................................................................................................................................................................... 42
Bloedafname metabole screening (metabool = maagdarm moet al opgang zijn) .................................................................... 42
Aandachtspunten ...................................................................................................................................................................... 43
GVO PKU test ................................................................................................................................................................................ 43
Bloedafname glycemiebepaling .................................................................................................................................................... 43
Bloedafname veneus ..................................................................................................................................................................... 43
Aandachtspunten ...................................................................................................................................................................... 44
Urinestaal ................................................................................................................................................................................. 44
Aandachtspunten .......................................................................................................................................................................... 44
Steriele wisser .......................................................................................................................................................................... 45
Coprostaal ................................................................................................................................................................................ 45
Aandachtspunten .......................................................................................................................................................................... 45
Observaties latere neonatale en zuigelingenperiode ................................................................................................................ 59
Inleiding ................................................................................................................................................................................... 59
Observatiepunten in functie van de lichamelijke ontwikkeling en de groei van het kind .......................................................... 59
Hartslag......................................................................................................................................................................................... 59
Ademhaling ................................................................................................................................................................................... 60
Bloeddruk ...................................................................................................................................................................................... 60
Saturatiemeting ............................................................................................................................................................................ 60
Gewicht ......................................................................................................................................................................................... 61
Lengte ........................................................................................................................................................................................... 61
Schedelomtrek/hoofdomtrek ........................................................................................................................................................ 61
, Groei.............................................................................................................................................................................................. 62
Lichaamstemperatuur ................................................................................................................................................................... 62
Huidskleur ..................................................................................................................................................................................... 63
Ontlasting...................................................................................................................................................................................... 64
Normale ontlastingscyclus pasgeborene .................................................................................................................................. 64
Mictie ............................................................................................................................................................................................ 65
Braken ........................................................................................................................................................................................... 66
Observaties ............................................................................................................................................................................... 66
Hoe herken ik dehydratatie ........................................................................................................................................................... 66
Alarmtekens 1ste levensweken ....................................................................................................................................................... 67
Alarmtekens 2 weken tot 3 maand ............................................................................................................................................... 67
Alarmtekens na 3 maand .............................................................................................................................................................. 67
Observatiepunten van uiterlijke kenmerken van het kind ........................................................................................................ 67
Schedel en aangezicht ................................................................................................................................................................... 67
Grote fontanel........................................................................................................................................................................... 67
Kleine fontanel .......................................................................................................................................................................... 67
Suturen schedel (5) ................................................................................................................................................................... 67
Cephaal hematoom ................................................................................................................................................................... 68
Caput succedaneum .................................................................................................................................................................. 68
Vervorming schedel en aangezicht ........................................................................................................................................... 68
Kneuzingen facies → kan… veroorzaken .................................................................................................................................. 68
Verwondingen ........................................................................................................................................................................... 69
Congenitaal schedelhuiddefect................................................................................................................................................. 69
Zweten aan het hoofd ............................................................................................................................................................... 69
Ogen .............................................................................................................................................................................................. 69
Subconjunctivale bloeding ........................................................................................................................................................ 69
Oedeem oogleden .................................................................................................................................................................... 69
Obstructie van het traankanaal ................................................................................................................................................ 69
Conjunctivitis ............................................................................................................................................................................ 69
Blauwe sclerae .......................................................................................................................................................................... 69
Glaucoom of groene staar ........................................................................................................................................................ 70
Cataract of grijze staar .............................................................................................................................................................. 70
Pseudostrabismus ..................................................................................................................................................................... 70
Sunsetting sign .......................................................................................................................................................................... 70
Neus .............................................................................................................................................................................................. 70
Mond ............................................................................................................................................................................................. 70
Pars villosa ................................................................................................................................................................................ 70
Strak tongriempje/lipbandje ..................................................................................................................................................... 70
Parels ven Epstein ..................................................................................................................................................................... 70
Solitaire epitheliale parels ........................................................................................................................................................ 71
Spruw ........................................................................................................................................................................................ 71
Ranula ....................................................................................................................................................................................... 71
Vlezige aanhangsels .................................................................................................................................................................. 71
Tong uit de mond ...................................................................................................................................................................... 71
Scheve schreimond ................................................................................................................................................................... 71
Tanden bij de geboorte en erna................................................................................................................................................ 71
Doorbreken tanden ................................................................................................................................................................... 71
Schisis ........................................................................................................................................................................................ 72
, Geluid ............................................................................................................................................................................................ 72
Stem/type schrei ....................................................................................................................................................................... 72
Hikken ....................................................................................................................................................................................... 72
Huilen ........................................................................................................................................................................................ 72
Oren .............................................................................................................................................................................................. 73
Hals ............................................................................................................................................................................................... 73
Thorax ........................................................................................................................................................................................... 73
Abdomen ....................................................................................................................................................................................... 74
Huid ............................................................................................................................................................................................... 75
Vernix caseosa of huidsmeer .................................................................................................................................................... 76
Lanugo....................................................................................................................................................................................... 76
Milia of grutum neonatorum .................................................................................................................................................... 76
Miliaria cristallina en miliarie rubra .......................................................................................................................................... 76
Erythema toxicum of netelkoorts ............................................................................................................................................. 76
Desquamatie of vervelling ........................................................................................................................................................ 76
Collodiumkind ........................................................................................................................................................................... 76
Cutis marmoracea of marmerhuid ............................................................................................................................................ 76
Harlekijnfenomeen ................................................................................................................................................................... 76
Atopisch eczeem of dauwworm................................................................................................................................................ 77
Seborreïsch eczeem of melkkorstjes of berg ............................................................................................................................ 77
Geboortevlekken....................................................................................................................................................................... 77
Bacteriële huidinfecties of pyodermie ...................................................................................................................................... 78
Genitaliën ...................................................................................................................................................................................... 78
jongen ....................................................................................................................................................................................... 78
meisje ........................................................................................................................................................................................ 80
Hemaphroditisme of tweeslachtigheid ..................................................................................................................................... 80
Aars ............................................................................................................................................................................................... 80
Ledematen .................................................................................................................................................................................... 81
Nagels ........................................................................................................................................................................................... 82
Detectie en preventie ............................................................................................................................................................... 83
Kind en gezin ............................................................................................................................................................................ 83
Kind boekje .............................................................................................................................................................................. 83
Gehoor ..................................................................................................................................................................................... 83
Cijfers in Vlaanderen ................................................................................................................................................................ 83
Wat?.............................................................................................................................................................................................. 83
Doelgroep ...................................................................................................................................................................................... 83
Voorbereiding ............................................................................................................................................................................... 84
Verloop .......................................................................................................................................................................................... 84
Resultaat screening ....................................................................................................................................................................... 84
Doorverwijzing .............................................................................................................................................................................. 84
Resultaten Vlaanderen .................................................................................................................................................................. 84
Ogen......................................................................................................................................................................................... 85
, Cijfergegevens in Vlaanderen........................................................................................................................................................ 85
Wat?.............................................................................................................................................................................................. 85
Waarom? ...................................................................................................................................................................................... 85
Verloop .......................................................................................................................................................................................... 85
Doorverwijzing .............................................................................................................................................................................. 85
Resultaten Vlaanderen .................................................................................................................................................................. 86
Wiegendood en veilig slapen .................................................................................................................................................... 86
Definitie ......................................................................................................................................................................................... 86
Evolutie sterfgevallen Vlaanderen ................................................................................................................................................ 86
Etiologie(oorzaak wiegendood) -pathofysiologie ......................................................................................................................... 86
Etiologie .................................................................................................................................................................................... 86
Pathofysiologie = veranderingen ih lichaam die een invloed hebben op wiegendood ............................................................ 87
Slaaponderzoek ............................................................................................................................................................................. 87
Preventiemaatregelen → belangrijkste taak voor vroedvrouw eerste lijn en K&G ...................................................................... 88
Slaaphouding ............................................................................................................................................................................ 88
Rookvrije omgeving .................................................................................................................................................................. 88
Controle/toezicht houden ........................................................................................................................................................ 88
Veilig materiaal (kinderbedje en materiaal) ............................................................................................................................. 88
Temperatuur tijdens het slapen ............................................................................................................................................... 89
Geneesmiddelen ....................................................................................................................................................................... 89
Gemoedstoestand (rust en regelmaat) ..................................................................................................................................... 89
Veiligheid bij kinderen .............................................................................................................................................................. 89
Veiligheidsopvoeding .................................................................................................................................................................... 89
Leefomgeving veilig maken........................................................................................................................................................... 89
Keuken ...................................................................................................................................................................................... 89
Advies ............................................................................................................................................................................................ 90
1ste weken – maanden ............................................................................................................................................................... 90
Vanaf 4 maand .......................................................................................................................................................................... 90
Van 6 – 10 maand ..................................................................................................................................................................... 90
Van 10 – 13 maand ................................................................................................................................................................... 90
Kindermishandeling ................................................................................................................................................................. 91
Definitie(s) ..................................................................................................................................................................................... 91
Veilig klimaat ................................................................................................................................................................................ 91
Alarmsignalen ............................................................................................................................................................................... 91
Vormen van kindermishandeling .................................................................................................................................................. 92
Lichamelijke mishandeling ........................................................................................................................................................ 92
Lichamelijke verwaarlozing ....................................................................................................................................................... 92
Emotionele verwaarlozing ........................................................................................................................................................ 93
Seksueel misbruik ..................................................................................................................................................................... 93
Cijfers in Vlaanderen ..................................................................................................................................................................... 93
Gevolgen van mishandeling .......................................................................................................................................................... 93
Preventie ....................................................................................................................................................................................... 94
Taak vroedvrouw .......................................................................................................................................................................... 94
, Vertrouwenscentrum kindermishandeling .................................................................................................................................... 94
Stimuleren van hechting........................................................................................................................................................... 95
Definitie ................................................................................................................................................................................... 95
Hechting van de pasgeborene .................................................................................................................................................. 95
Lichaamstaal ............................................................................................................................................................................ 95
Oogcontact.................................................................................................................................................................................... 95
Afstand .......................................................................................................................................................................................... 95
Houding ......................................................................................................................................................................................... 95
Gebaren......................................................................................................................................................................................... 96
Gezichtsuitdrukkingen................................................................................................................................................................... 96
Stemtaal ........................................................................................................................................................................................ 96
Aanrakingen .................................................................................................................................................................................. 96
Innerlijke lichaamstaal .................................................................................................................................................................. 96
Verborgen boodschap in geluid .................................................................................................................................................... 97
Geur .............................................................................................................................................................................................. 97
Uiterlijk .......................................................................................................................................................................................... 97
Stimuleren van de hechting ...................................................................................................................................................... 97
Video-interactiebegeleiding ..................................................................................................................................................... 98
Take home message ................................................................................................................................................................. 98
Ontwikkelingsonderzoek Van Wiechen .................................................................................................................................... 98
Achtergrond en doel................................................................................................................................................................. 99
Onderzoeksthema’s....................................................................................................................................................................... 99
Materiaal.................................................................................................................................................................................. 99
Uitvoering .............................................................................................................................................................................. 100
Onderzoek (ontwikkelingsonderzoek) .................................................................................................................................... 100
Invullen van het VWS ............................................................................................................................................................. 100
Codering ................................................................................................................................................................................. 101
Beoordeling ............................................................................................................................................................................ 101
Alarmsignalen ........................................................................................................................................................................ 102
Interpretatie ........................................................................................................................................................................... 102
Opvolging ............................................................................................................................................................................... 103
Items 4 weken ............................................................................................................................................................................. 103
Items 8 weken ............................................................................................................................................................................. 103
, Items 12 tot 16 weken................................................................................................................................................................. 103
Items 6 maanden ........................................................................................................................................................................ 103
Items 9 maanden ........................................................................................................................................................................ 104
Items 12 maanden ...................................................................................................................................................................... 104
Toepassing ............................................................................................................................................................................. 104
linken ..................................................................................................................................................................................... 104
VH KIND
INHOUDSOPGAVE
deel 3: verzorging & opvolging vd ontw. vh kind ........................................................................................................................ 1
Eerste zorgen pasgeborene ...................................................................................................................................................... 11
Basisprincipes ........................................................................................................................................................................... 11
Warmteverlies bij pasgeborene komt tot stand door 4 fysische processen .................................................................................. 11
Voorbereiding eerste zorgen .................................................................................................................................................... 11
Methodiek eerste zorgen .............................................................................................................................................................. 11
Effectieve aanwezigheid pediater bij: ....................................................................................................................................... 11
Apgarscore: vragen? ................................................................................................................................................................. 12
Skin to skin ............................................................................................................................................................................... 12
Aandachtspunten bij de geboorte ............................................................................................................................................ 12
Afklemmen ............................................................................................................................................................................... 13
Apgarscore ............................................................................................................................................................................... 13
Betekenis apgarscore .................................................................................................................................................................... 13
Indien baby mindere start, verloopt het puntenverlies in deze volgorde: ..................................................................................... 14
Wat is asfyxie? .............................................................................................................................................................................. 14
pH-waarden: kennen! ................................................................................................................................................................... 14
Aspiratie ................................................................................................................................................................................... 14
Notapunten ................................................................................................................................................................................... 15
Afnavelen ................................................................................................................................................................................. 15
Cordring ........................................................................................................................................................................................ 15
Navelklem ..................................................................................................................................................................................... 15
Cordring vs navelklem ................................................................................................................................................................... 15
Controle navelstreng ................................................................................................................................................................ 15
Grondige observaties → inspectie vd pasgeborene is het belangrijkste onderdeel vh onderzoek ............................................ 16
Hoofd ............................................................................................................................................................................................ 16
Aangezicht .................................................................................................................................................................................... 16
Thorax ........................................................................................................................................................................................... 17
Hals ............................................................................................................................................................................................... 17
Abdomen ....................................................................................................................................................................................... 17
, Rug- en wervelkolom..................................................................................................................................................................... 17
Extremiteiten................................................................................................................................................................................. 17
Genitalia externa........................................................................................................................................................................... 17
Anus .............................................................................................................................................................................................. 17
Huid ............................................................................................................................................................................................... 18
Beknopt neurologisch onderzoek .................................................................................................................................................. 18
Bepalen geboortegewicht ........................................................................................................................................................ 18
Hemdje aantrekken .................................................................................................................................................................. 18
Navelstrengstompverzorging.................................................................................................................................................... 18
Controle lichaamstemperatuur/aandoen luier ......................................................................................................................... 18
Vitamine K ................................................................................................................................................................................ 18
VKDB (vitamine K-deficiëntiebloeding)..................................................................................................................................... 19
Konakion paediatric ................................................................................................................................................................. 19
Samenvattend ............................................................................................................................................................................... 19
Notapunt ....................................................................................................................................................................................... 19
Besluit ........................................................................................................................................................................................... 19
Bepalen lichaamslengte............................................................................................................................................................ 20
Identificatie en bovenkledij aandoen ....................................................................................................................................... 20
Meten schedelomtrek (SO) ....................................................................................................................................................... 20
Oogindruppeling = Crédé-methode .......................................................................................................................................... 20
Conclusie ....................................................................................................................................................................................... 20
Na de eerste zorgen ................................................................................................................................................................. 20
Nazorgen .................................................................................................................................................................................. 21
Wat rapporteren? ......................................................................................................................................................................... 21
Algemeen besluit...................................................................................................................................................................... 21
Observatie van de pasgeborene binnen de eerste 24 uur neonataal ........................................................................................ 22
Observatie ................................................................................................................................................................................ 22
Observaties door de kinderarts ................................................................................................................................................ 22
Algemeen onderzoek..................................................................................................................................................................... 22
Bekijken van de baby (inspectie) .............................................................................................................................................. 22
Afmetingen en waarden ........................................................................................................................................................... 22
Beluisteren van hart en longen ................................................................................................................................................. 22
Palpatie abdomen – observatie navelstrengstomp .................................................................................................................. 23
Bloedcirculatie .......................................................................................................................................................................... 23
Inspectie genitaliën ................................................................................................................................................................... 23
, Inspectie aars ............................................................................................................................................................................ 23
Dysplastische heupontwikkeling ............................................................................................................................................... 23
Inspectie onderste ledematen .................................................................................................................................................. 24
Inspectie thorax/hals ................................................................................................................................................................ 24
Inspectie bovenste ledematen, ogen, oren en mond ............................................................................................................... 24
Palpatie hoofd ........................................................................................................................................................................... 24
Bevoelen rug ............................................................................................................................................................................. 25
Evaluatie: spierspanning/elasticiteit ......................................................................................................................................... 25
Evaluatie uitwendige kenmerken (Duboswitz-score) ............................................................................................................... 25
Neurologisch onderzoek ................................................................................................................................................................ 25
Inspectie .................................................................................................................................................................................... 26
Eigenlijk onderzoek ................................................................................................................................................................... 26
Onderzoek van de ogen ............................................................................................................................................................ 28
Bewustzijn, omgeving ............................................................................................................................................................... 28
Observaties door de vroedvrouw ............................................................................................................................................. 28
Navelstrengstomp ......................................................................................................................................................................... 29
Ademhaling ................................................................................................................................................................................... 29
Controle baby met ademhalingsnood ...................................................................................................................................... 29
Factoren belangrijk bij de start (aanvang) en voortzetting ademhaling ................................................................................... 29
Hinderende factoren voor de ademhaling ................................................................................................................................ 29
Observatiesystemen ademhaling.............................................................................................................................................. 30
Verschijnselen bij ademhaling moeilijkheden .......................................................................................................................... 31
Observatiepunten ademhaling ................................................................................................................................................. 31
Braken ........................................................................................................................................................................................... 31
Spijsvertering ................................................................................................................................................................................ 31
Gewicht ......................................................................................................................................................................................... 32
Invloed op geboortegewicht ..................................................................................................................................................... 32
Ontlasting...................................................................................................................................................................................... 32
Urine.............................................................................................................................................................................................. 32
Lichaamstemperatuur ................................................................................................................................................................... 32
Huidskleur ..................................................................................................................................................................................... 33
Gedrag van het kind/activiteit ...................................................................................................................................................... 33
Hartslag......................................................................................................................................................................................... 33
Oedeemvorming/dehydratie ......................................................................................................................................................... 33
Houdingen en bewegingen ....................................................................................................................................................... 33
Hygiënische zorgen en tandhygiëne ......................................................................................................................................... 35
Hygiënische zorgen neonatus ................................................................................................................................................... 35
Algemene regels............................................................................................................................................................................ 35
Beginsituatie ................................................................................................................................................................................. 35
Actieplan bij ochtendverzorging dag 1.......................................................................................................................................... 35
Actie: voorbereiding ................................................................................................................................................................. 35
Actie: uitvoering ........................................................................................................................................................................ 36
Actie: nazorg ............................................................................................................................................................................. 36
Evaluatie ....................................................................................................................................................................................... 37
, Hoe het ook kan ............................................................................................................................................................................ 37
Aandachtspunten .......................................................................................................................................................................... 37
Hygiënische zorgen van de zuigeling......................................................................................................................................... 39
Actie: wat is anders ....................................................................................................................................................................... 39
Aandachtspunten .......................................................................................................................................................................... 39
Hygiënische zorgen van kind dat rechtop kan zitten ................................................................................................................. 40
Actieplan ....................................................................................................................................................................................... 40
Actie .............................................................................................................................................................................................. 40
Aandachtspunten .......................................................................................................................................................................... 40
Staalafname kind ..................................................................................................................................................................... 41
Algemeen ................................................................................................................................................................................. 41
Bloedafname ............................................................................................................................................................................ 41
Bloedafname metabole screening ................................................................................................................................................ 42
PKU test/Guthrie-test/hielprik .................................................................................................................................................. 42
Capillair of intraveneus ............................................................................................................................................................. 42
PKU-kaartje ............................................................................................................................................................................... 42
Bloedafname metabole screening (metabool = maagdarm moet al opgang zijn) .................................................................... 42
Aandachtspunten ...................................................................................................................................................................... 43
GVO PKU test ................................................................................................................................................................................ 43
Bloedafname glycemiebepaling .................................................................................................................................................... 43
Bloedafname veneus ..................................................................................................................................................................... 43
Aandachtspunten ...................................................................................................................................................................... 44
Urinestaal ................................................................................................................................................................................. 44
Aandachtspunten .......................................................................................................................................................................... 44
Steriele wisser .......................................................................................................................................................................... 45
Coprostaal ................................................................................................................................................................................ 45
Aandachtspunten .......................................................................................................................................................................... 45
Observaties latere neonatale en zuigelingenperiode ................................................................................................................ 59
Inleiding ................................................................................................................................................................................... 59
Observatiepunten in functie van de lichamelijke ontwikkeling en de groei van het kind .......................................................... 59
Hartslag......................................................................................................................................................................................... 59
Ademhaling ................................................................................................................................................................................... 60
Bloeddruk ...................................................................................................................................................................................... 60
Saturatiemeting ............................................................................................................................................................................ 60
Gewicht ......................................................................................................................................................................................... 61
Lengte ........................................................................................................................................................................................... 61
Schedelomtrek/hoofdomtrek ........................................................................................................................................................ 61
, Groei.............................................................................................................................................................................................. 62
Lichaamstemperatuur ................................................................................................................................................................... 62
Huidskleur ..................................................................................................................................................................................... 63
Ontlasting...................................................................................................................................................................................... 64
Normale ontlastingscyclus pasgeborene .................................................................................................................................. 64
Mictie ............................................................................................................................................................................................ 65
Braken ........................................................................................................................................................................................... 66
Observaties ............................................................................................................................................................................... 66
Hoe herken ik dehydratatie ........................................................................................................................................................... 66
Alarmtekens 1ste levensweken ....................................................................................................................................................... 67
Alarmtekens 2 weken tot 3 maand ............................................................................................................................................... 67
Alarmtekens na 3 maand .............................................................................................................................................................. 67
Observatiepunten van uiterlijke kenmerken van het kind ........................................................................................................ 67
Schedel en aangezicht ................................................................................................................................................................... 67
Grote fontanel........................................................................................................................................................................... 67
Kleine fontanel .......................................................................................................................................................................... 67
Suturen schedel (5) ................................................................................................................................................................... 67
Cephaal hematoom ................................................................................................................................................................... 68
Caput succedaneum .................................................................................................................................................................. 68
Vervorming schedel en aangezicht ........................................................................................................................................... 68
Kneuzingen facies → kan… veroorzaken .................................................................................................................................. 68
Verwondingen ........................................................................................................................................................................... 69
Congenitaal schedelhuiddefect................................................................................................................................................. 69
Zweten aan het hoofd ............................................................................................................................................................... 69
Ogen .............................................................................................................................................................................................. 69
Subconjunctivale bloeding ........................................................................................................................................................ 69
Oedeem oogleden .................................................................................................................................................................... 69
Obstructie van het traankanaal ................................................................................................................................................ 69
Conjunctivitis ............................................................................................................................................................................ 69
Blauwe sclerae .......................................................................................................................................................................... 69
Glaucoom of groene staar ........................................................................................................................................................ 70
Cataract of grijze staar .............................................................................................................................................................. 70
Pseudostrabismus ..................................................................................................................................................................... 70
Sunsetting sign .......................................................................................................................................................................... 70
Neus .............................................................................................................................................................................................. 70
Mond ............................................................................................................................................................................................. 70
Pars villosa ................................................................................................................................................................................ 70
Strak tongriempje/lipbandje ..................................................................................................................................................... 70
Parels ven Epstein ..................................................................................................................................................................... 70
Solitaire epitheliale parels ........................................................................................................................................................ 71
Spruw ........................................................................................................................................................................................ 71
Ranula ....................................................................................................................................................................................... 71
Vlezige aanhangsels .................................................................................................................................................................. 71
Tong uit de mond ...................................................................................................................................................................... 71
Scheve schreimond ................................................................................................................................................................... 71
Tanden bij de geboorte en erna................................................................................................................................................ 71
Doorbreken tanden ................................................................................................................................................................... 71
Schisis ........................................................................................................................................................................................ 72
, Geluid ............................................................................................................................................................................................ 72
Stem/type schrei ....................................................................................................................................................................... 72
Hikken ....................................................................................................................................................................................... 72
Huilen ........................................................................................................................................................................................ 72
Oren .............................................................................................................................................................................................. 73
Hals ............................................................................................................................................................................................... 73
Thorax ........................................................................................................................................................................................... 73
Abdomen ....................................................................................................................................................................................... 74
Huid ............................................................................................................................................................................................... 75
Vernix caseosa of huidsmeer .................................................................................................................................................... 76
Lanugo....................................................................................................................................................................................... 76
Milia of grutum neonatorum .................................................................................................................................................... 76
Miliaria cristallina en miliarie rubra .......................................................................................................................................... 76
Erythema toxicum of netelkoorts ............................................................................................................................................. 76
Desquamatie of vervelling ........................................................................................................................................................ 76
Collodiumkind ........................................................................................................................................................................... 76
Cutis marmoracea of marmerhuid ............................................................................................................................................ 76
Harlekijnfenomeen ................................................................................................................................................................... 76
Atopisch eczeem of dauwworm................................................................................................................................................ 77
Seborreïsch eczeem of melkkorstjes of berg ............................................................................................................................ 77
Geboortevlekken....................................................................................................................................................................... 77
Bacteriële huidinfecties of pyodermie ...................................................................................................................................... 78
Genitaliën ...................................................................................................................................................................................... 78
jongen ....................................................................................................................................................................................... 78
meisje ........................................................................................................................................................................................ 80
Hemaphroditisme of tweeslachtigheid ..................................................................................................................................... 80
Aars ............................................................................................................................................................................................... 80
Ledematen .................................................................................................................................................................................... 81
Nagels ........................................................................................................................................................................................... 82
Detectie en preventie ............................................................................................................................................................... 83
Kind en gezin ............................................................................................................................................................................ 83
Kind boekje .............................................................................................................................................................................. 83
Gehoor ..................................................................................................................................................................................... 83
Cijfers in Vlaanderen ................................................................................................................................................................ 83
Wat?.............................................................................................................................................................................................. 83
Doelgroep ...................................................................................................................................................................................... 83
Voorbereiding ............................................................................................................................................................................... 84
Verloop .......................................................................................................................................................................................... 84
Resultaat screening ....................................................................................................................................................................... 84
Doorverwijzing .............................................................................................................................................................................. 84
Resultaten Vlaanderen .................................................................................................................................................................. 84
Ogen......................................................................................................................................................................................... 85
, Cijfergegevens in Vlaanderen........................................................................................................................................................ 85
Wat?.............................................................................................................................................................................................. 85
Waarom? ...................................................................................................................................................................................... 85
Verloop .......................................................................................................................................................................................... 85
Doorverwijzing .............................................................................................................................................................................. 85
Resultaten Vlaanderen .................................................................................................................................................................. 86
Wiegendood en veilig slapen .................................................................................................................................................... 86
Definitie ......................................................................................................................................................................................... 86
Evolutie sterfgevallen Vlaanderen ................................................................................................................................................ 86
Etiologie(oorzaak wiegendood) -pathofysiologie ......................................................................................................................... 86
Etiologie .................................................................................................................................................................................... 86
Pathofysiologie = veranderingen ih lichaam die een invloed hebben op wiegendood ............................................................ 87
Slaaponderzoek ............................................................................................................................................................................. 87
Preventiemaatregelen → belangrijkste taak voor vroedvrouw eerste lijn en K&G ...................................................................... 88
Slaaphouding ............................................................................................................................................................................ 88
Rookvrije omgeving .................................................................................................................................................................. 88
Controle/toezicht houden ........................................................................................................................................................ 88
Veilig materiaal (kinderbedje en materiaal) ............................................................................................................................. 88
Temperatuur tijdens het slapen ............................................................................................................................................... 89
Geneesmiddelen ....................................................................................................................................................................... 89
Gemoedstoestand (rust en regelmaat) ..................................................................................................................................... 89
Veiligheid bij kinderen .............................................................................................................................................................. 89
Veiligheidsopvoeding .................................................................................................................................................................... 89
Leefomgeving veilig maken........................................................................................................................................................... 89
Keuken ...................................................................................................................................................................................... 89
Advies ............................................................................................................................................................................................ 90
1ste weken – maanden ............................................................................................................................................................... 90
Vanaf 4 maand .......................................................................................................................................................................... 90
Van 6 – 10 maand ..................................................................................................................................................................... 90
Van 10 – 13 maand ................................................................................................................................................................... 90
Kindermishandeling ................................................................................................................................................................. 91
Definitie(s) ..................................................................................................................................................................................... 91
Veilig klimaat ................................................................................................................................................................................ 91
Alarmsignalen ............................................................................................................................................................................... 91
Vormen van kindermishandeling .................................................................................................................................................. 92
Lichamelijke mishandeling ........................................................................................................................................................ 92
Lichamelijke verwaarlozing ....................................................................................................................................................... 92
Emotionele verwaarlozing ........................................................................................................................................................ 93
Seksueel misbruik ..................................................................................................................................................................... 93
Cijfers in Vlaanderen ..................................................................................................................................................................... 93
Gevolgen van mishandeling .......................................................................................................................................................... 93
Preventie ....................................................................................................................................................................................... 94
Taak vroedvrouw .......................................................................................................................................................................... 94
, Vertrouwenscentrum kindermishandeling .................................................................................................................................... 94
Stimuleren van hechting........................................................................................................................................................... 95
Definitie ................................................................................................................................................................................... 95
Hechting van de pasgeborene .................................................................................................................................................. 95
Lichaamstaal ............................................................................................................................................................................ 95
Oogcontact.................................................................................................................................................................................... 95
Afstand .......................................................................................................................................................................................... 95
Houding ......................................................................................................................................................................................... 95
Gebaren......................................................................................................................................................................................... 96
Gezichtsuitdrukkingen................................................................................................................................................................... 96
Stemtaal ........................................................................................................................................................................................ 96
Aanrakingen .................................................................................................................................................................................. 96
Innerlijke lichaamstaal .................................................................................................................................................................. 96
Verborgen boodschap in geluid .................................................................................................................................................... 97
Geur .............................................................................................................................................................................................. 97
Uiterlijk .......................................................................................................................................................................................... 97
Stimuleren van de hechting ...................................................................................................................................................... 97
Video-interactiebegeleiding ..................................................................................................................................................... 98
Take home message ................................................................................................................................................................. 98
Ontwikkelingsonderzoek Van Wiechen .................................................................................................................................... 98
Achtergrond en doel................................................................................................................................................................. 99
Onderzoeksthema’s....................................................................................................................................................................... 99
Materiaal.................................................................................................................................................................................. 99
Uitvoering .............................................................................................................................................................................. 100
Onderzoek (ontwikkelingsonderzoek) .................................................................................................................................... 100
Invullen van het VWS ............................................................................................................................................................. 100
Codering ................................................................................................................................................................................. 101
Beoordeling ............................................................................................................................................................................ 101
Alarmsignalen ........................................................................................................................................................................ 102
Interpretatie ........................................................................................................................................................................... 102
Opvolging ............................................................................................................................................................................... 103
Items 4 weken ............................................................................................................................................................................. 103
Items 8 weken ............................................................................................................................................................................. 103
, Items 12 tot 16 weken................................................................................................................................................................. 103
Items 6 maanden ........................................................................................................................................................................ 103
Items 9 maanden ........................................................................................................................................................................ 104
Items 12 maanden ...................................................................................................................................................................... 104
Toepassing ............................................................................................................................................................................. 104
linken ..................................................................................................................................................................................... 104
