Infancy

by Ellennor F. Abrigo
. . .
Growth and Development of an Infant
weight: doubles by 4-6 mos. (2lbs/mo.), triples by 1 year (1 lbs/from 6th-12th mo.)
average weight: boy--10kg, girl--9.5kg

height: increases height by 50% (20"-30"/50.8-76.2cm)

head circumference: 2/3 of adult size

body proportion: abdomen is protuberant

body systems: heart rate--from 120-160 bpm to 100-120 bpm

RR--from 30-60 bpm to 20-30 bpm
GIT is immature; liver is immature
extrsion reflex lost @ 3-4 mos, to prevent ineffective feeding

Developmental Milestones
Childhood is a time of tremendous growth and learning. How very exciting to be a baby...or a
two-year-old... or get on a school bus for the first time. There's so much to know, and we all
come into the world like small waiting sponges, ready to absorb what's around us.

We're all different, too, another of life's little marvels. We're a spectrum of colors with differing
talents, interests, and physical make-ups. So it comes as no surprise that we also develop at
different rates. Some children speed along, practically running before they walk. Others take
their time--or need more time. And still others may ultimately need four wheels to get around.

Parents, siblings, grandparents, daycare providers, teachers, and friends watch eagerly for each
new step and progression in a child's skills. If a skill is not learned "on time," they may worry.
Juana's not sitting up yet, but the baby next door is. Hannah should be talking in full sentences
by now! Frank and Ahmed aren't learning to read as easily as the rest of the class. But what's
"on time?" What's "normal?" Surely "normal" has a range?

Not only do new moms and dads anxiously (and exhaustedly) await the time when baby sleeps
all through the night, but the earliest years are filled with a wonderland of firsts—the first smile,
first laugh, first steps, and first word. When do all these miraculous firsts usually occur?

Excerpted below are just a few of many milestones a typically developing child reaches in the
first year of life.

By 3 months of age * lift head and chest when lying on his

stomach

* turn head from side to side when lying

Motor Skills on his stomach

* follow a moving object or person with his

eyes
* lift head when held at your shoulder
 * grasp rattle when given to her * move toys from one hand to another

* wiggle and kick with arms and legs * pull up to a sitting position on her own if
you grasp her hands

* sit with only a little support

Sensory and Thinking Skills
* roll over

* bounce when held in a standing position

* turn head toward bright colors and lights

* turn toward the sound of a human voice

Sensory and Thinking Skills
* recognize bottle or breast

* respond to your shaking a rattle or bell

* open his mouth for the spoon

* imitate familiar actions you perform

Language and Social Skills

Language and Social Skills

* make cooing, gurgling sounds

* smile when smiled at

* babble, making almost sing-song sounds
* communicate hunger, fear, discomfort
(through crying or facial expression) * know familiar faces

* usually quiet down at the sound of a * laugh and squeal with delight
soothing voice or when held
* scream if annoyed

* smile at herself in a mirror

By 6 months of age

By 12 months of age
Motor Skills

Motor Skills
* hold head steady when sitting with your
help

* reach for and grasp objects * drink from a cup with help

* play with his toes * feed herself finger food like raisins

* help hold the bottle during feeding * grasp small objects by using her thumb
and index or forefinger
* explore by mouthing and banging
objects * use his first finger to poke or point
 * put small blocks in and take them out of sight (such as a spoon that falls under the
a container table)

* knock two blocks together

* sit well without support Language and Social Skills

* crawl on hands and knees

* pull himself to stand or take steps * babble, but it sometimes "sounds like"
holding onto furniture talking

* stand alone momentarily * say his first word

* walk with one hand held * recognize family members' names

* try to "talk" with you

Sensory and Thinking Skills * respond to another's distress by showing

distress or crying

* show affection to familiar adults

* copy sounds and actions you make
* show apprehension about strangers
* respond to music with body motion
* raise her arms when she wants to be
* try to accomplish simple goals (seeing picked up
and then crawling to a toy)
* understand simple commands
* look for an object she watched fall out of

Play

Type of Play: Solitary--have to play with own bodies

Age-appropriate type:

1. mobiles

2. rattles

3. musical box

4. squeeze toys

5. teething rings
 6. textured balls

7. large, soft, cuddly toys

Purposes:

1. to practice motor skills

2. to gain coordination

3. to relate to object and people

Stranger anxiety--greatest fear of infants that begins @ about 7 mos. of age

The Nursing Role in Health Promotion of an Infant and Family

Promoting Achievement of Developmental Task: Trust VS Mistrust

Erikson (1993)--proposed infant periodas sense of trust

•when hungry: must feed and make infant comfortable

•when cold: must hold and warm the infant

Trust = love (by handling, feeding, talking to, holding =to love and recognize that they are
loved)

Promoting Nutritional Health of an Infant

Breastmilk
•best food during 12 mos.
•mother with adequate diet, needs no supplements necessary

Non BF-commercial, Iron-Fortified Formula

•cow's milk is difficult to digest (with Vit.c and Iron to make up for the deficiency of the
components in cow's milk)

A. Recommended Dietary Reference Intakes

> first year--extreme rapid growth--must increase protein and calorie intake

B. Introduction of Solid Food

> get infant ready when he/she is taking >32oz. of formula/day and nursing
vigorously 3-4 hours/day
>biting movements begin @ approx. 3 mos.
>chewing not @ 7 mos.

C. Loss of Extrusion REflex

 > on anterior 3rd of tongue--automatically extruded
> life-saving reflex--prevents swallowing or aspirating foreign objects that touch the
mouth
> fades @ 3-4 mos.

D. Techniques for Feeding Solid Food

> offer new foods @ a time for 1 week--helps detect food allergies
> feed in paren't arm as if breast feeding or both
> distinct taste preferences--spit out food they don't like
> when extrusion reflex fades, infant can still spit up food because their tongues
are pressed against nipples or bottles when sucking milk

E. Quantities and Types of Food

> newborn: stomach can hold approx. 2 lbs. (30 mL)
1 year: approx. 1 cup (240 mL)
> cereal--rich in Iron
--should be mixed with enough liquid to make the mixture fairly liquid
--first cereal is rice cereal
> vegetables and fruits especially green and yellow vegetables should be given @ 7
mos.
--should be blended, strained or grinded
--fruits like raw mashed banana and blended peaches should be given @ 8
mos.
> meat and eggs @ 9 mos.
meat: beef and pork have more Iron than chicken meat
egg yolks: should be given @ 8 mos. contain bulk of Iron
egg whites: contain bulk of protein
--egg yolks are better better than white because egg whites can induce
allergy and can be difficult to digest
> table foods--3-day meal pattern
--home-made than commercially prepared

F. Establishment of Healthy Eating Patterns

> giving food to others is interpreted as giving love as well as refusing food means
refusing love
> the parents should not force infants to eat if not hungry
if infant refuses to eat: ask parent what foods they are offering
inadequate intake: ask parent's methods of feeding

G. Weaning
> infants can approximate their lips to cup so they can drink effectively @ 9 mos.

H. Self-Feeding
> @ 6 mos. of age--infants are interested in handling spoon and they are beginning
to feed themselves
> coordination has not developed; handle spoon but still spill food
> if no longer hungry, he/she squeezes food or dabs it into hair

I. Adequate Intake with a Vegetarian Diet

> vegetables cause more frequent nad loose stool so change diapers frequently to
avoid rahes
> examples are avocados, potatoes, broccoli; fruits--apples, prunes (high in Fe) and
bananas

Promoting Infant Development in Daily Activities

1. Bathing--bathing can cause seborrhea-a scaly scalp condition (also called cradle cap)
--bathing is not necessary everyday except in hot weather
--bath time is essential for development e.g. poking bubbles, learn different textures
and sensations
--teach parents not to leave infants alone

2. Diaper-Care Area--change diapers frequently about every 2-4 hours

--it's a good practice to interrupt sleep whne changing diapers (can develop
rash from sleeping with wet diapers)

3. Care of Teeth--must be cared with fluoride @ 6 mos. to 12 years

--brushing by rubbing a soft wash cloth over the gum pads
> baby bottle syndrome: bottle is filled with sugar, water, formula. milk or fruit juice and
parent put their baby in bed with bottle that demineralize tooth enamel until it decays
--initial dental check-up by 2 or 2.5 years

4. Dressing--clothes should not be binding due to the gross body movements

--soft-soled shoes or sock to warm feet

5. Sleep--10-12 hours @night and one or more naps during the day
--no pillows to avoid suffocation
--lying on back to prevent SIDS

6. Exercise--carriage/strlloer for sunlight for VIt. D

--sun is intense bet 10 am-3 pm, so early mornings and late afternoons are the
recommended time to be outside

Promoting Infant Safety

1. Falls-- raise crib rails, never leave alone on open raised surface, place barriers @ stairs,
restrain in carriage, hish chair, infant seat

2. Suffocation--remove all plastic materials, pillows, string, bibs, etc. fromreach, never leave
alone in bath

3. Burns--check temperature of bath water, keep got liquid, lighted cigarettes, hanging table
cloth out of reach, appliances, fire place, cover electrical outlets with plastic guards and keep
electric wires out of reach

4. Aspiration--remove objects that can fit into mouth, watch closely when offering finger foods,
avoid fuzzy toys

5. Poisoning--ensure that painted surfaces are lead-free, remove plants, medicines and
cleaning fluids out of reach, place tel. no. of poison control center or emergency phone list use
syrup of ipecac prn, give only prescribed medication

6. Motor Vehicle--restrain in securely fastened approved rear facing seat