Growth and Development of the Newborn/Infant (Chapter 4)

Newborn/neonatal (up to 28days) Infancy (up to 12months) Avg. weight (7lb 8oz) Avg. height (19-21 inches)

Organ System Maturation

Neurologic System (brain is still growing and myelinization of spinal cord is continuing) 6 states of consciousness in the newborn and progress slowly Reflexes (primitive protective) a. Primitive (S.R.MA.S.P.P.B) -step (up to 2months) -root (up to 3months) -moro and asymmetric tonic neck (up to 4months) -suck (up to 5months -palmar grasp (up to 6months) -plantar grasp (up to 9months) -Babinski (usually up to 12months b. Protective (righting and parachute reactions) Respiratory System Rate slows down from 30-60 breaths to 20 to 30 breaths (irregular/periodic pauses to regular/rhythmic) Due to anatomic differences (respiratory compromise) Due to lack of IgA (respiratory infections)

Cardiovascular (heart doubles in size over the 1st year) Pulse goes from 120-140 to 100 BP goes from 60/40 to 100/50 More susceptible to heat loss (peripheral capillaries are closer to the surface of the skin)

Gastrointestinal System Usually no teeth at birth (primary teeth around 6-8months) Digestive system not fully developed - Trypsin sufficient after birth - Amylase and lipase doesnt reach adult level until 5months Liver is immature at birth

1st stool is meconium (as result of digestion of amniotic fluid) black to dark green sticky -formula fed (peanut butter) -breast fed (seedy and looser in texture) -number of stools/day varies as long as BM is soft infrequency is normal -lack of maturity grunting, crying, straining during BM is okay

Genitourinary System More prone to dehydration and have a low specific gravity

Integumentary System Vernix caseosa in utero protects the skin (production stops after birth) Acrocyanosis- blueness of hands and feet are normal for 1st few days Mottling due to immaturity of circulation is normal for the 1st few months

Hematopoietic System HgbF HgbA (since HgbF has a shorter life span than HgbA infant may experience physiologic anemia at 2-3months) Infant got iron from mother that depletes around 9months (iron supplements)

Immunologic System Newborns get IgG from the placenta gives immunity for 1st 3-6months

Psychosocial Development
Erik Erikson (Trust v. Mistrust) If childs needs are met consistently they develop trust

Cognitive Development
Jean Piaget (Sensorimotor stage) -Object Permanence developed around 4-7months: if an object is hidden infants sight theyll search for it in the last place it was seen. (Important for self image) -By the 1st yr child should know they are separate from parents

Motor Skill Development

Gross Motor Skills (large muscles: head control, rolling, sitting, and walking) -cephalocaudal fashion (head to tail) Fine Motor Skills (hand and finger use) -proximodistal fashion

Warning signs: cant support head by 3-4months, reaches with one hand only, cant sit with assistance at 6months, cant crawl at 12months, cant stand supported at 12months

Sensory Development
Sight (nearsighted) Hearing (intact) Smell and taste (can differentiate between mothers breast milk at 7days) Touch (most important for newborn communication) Warning signs: doesnt respond to loud noises, doesnt focus on near objects, doesnt babble by 4months or turn to locate sound

Communication and Language Development

Basic reason for crying is unmet needs By 1-3months (coos) By 4-5months (simple vowels sounds, laugh, vocalizes in response to noise) By 4-7months (squealing, distinguish emotions based on tone) By 7-10months (babbling and string w/o meaning) By 9-12months (words with meaning)

Social and Emotional Development

First real smile at 2months 3-4months starts to mimic Stranger anxiety (around 8months infant clings and whiny when approached by strangers) Separation anxiety (later months of infancy) Temperament (affects the way they respond to the environment)

Promoting Growth and Development Through Play

Play develops gross and fine motor skills Prefers interacting with parents to toys Usually engages in solitary play

Promoting Safety
Most common cause of death between 6-12months in injury Car seats should face the rear in the center until infant is 12month and 20lbs (never placed in the front seat with an airbag)

Distance between crib slat should be 2-3/8 inches or less to prevent injury AAP does not recommend walkers Use of safety gates At risk for choking, suffocation (crib should not have pillows, comforters, stuffed animals) Ability to drown in small amounts of water.

Promoting Nutrition
Breast or bottle feeding is all that is needed until 4-6months Bottle feeding: only iron fortified formulas Always held when bottle feeding, dont microwave formulas or reheat/reuse partially used bottles. Learn cues for hunger (crying is a late sign) After 6months solids can be introduced (after disappearance of tongue extrusion reflex, use a spoon) 1st choice of solid food (iron fortified rice cereal) thin at first can be mixed to make thicker when infant is older Then can move on to pureed foods New food every 4-7days no added seasonings needed By 8months more textured foods Cups are 6-8months new sippy not good promotes sucking action

Promoting Healthy Sleep and Rest

Newborns sleep about 20hrs/day Beds should be away from A/C , open windows, heaters etc Sudden Infant Death Syndrome associated with prone position (place on back or side) Dont add cereal to evening bottle Establish a routine around 4months after 4months infant must learn to soothe self back to sleep

Promoting Health Teeth and Gums

Pre tooth eruption clean gum with damp cloth (no toothpaste needed for infant)

Colic: inconsolable crying that last 3hrs or longer per day for which the is no physical cause Spitting Up: Teach parent smaller amounts more frequent basis

Always burps 2-3x after feeding Keep upright for 30mins after dont lay on stomach Avoid excessive bouncing or activity When placing in crib elevate HOB

Thumb sucking, Pacifiers, Security items Self comfort

Teething Chew on frozen teething ring or rub ice cube wrap in a washcloth on gums Baby orajel Tylenol or ibuprofen may be given to relieve pain