2.2 Infant Growth and Development Flashcards
Infant Growth/Development (Age 0-1)
Growth - Increase in size
Development - Growth in ability/functioning
- Milestones are usually measured until age 6 (measures averages)
Optimal Growth/Development (Infants)
- Weight gain 5-7 ounces per week
- By 6 months they will double their birth weight
- By 1 year they will triple their birth weight
- Height increases around 1 inch per month for the first 6 months
- 50% increase in length by age 1
- Growth is not gradual, they occur in spurts
Infant Body System Development
Respiratory - RR slows down and becomes more stable. High risk of respiratory illness due to immaturity.
Cardiovascular - HR decreases. Sinus Arrhythmias (abnormal pattern that increases with inspiration and decreases with expiration).
Hematologic - Fetal hemoglobin gets replaced with mature RBC’s. Maternal iron stores decrease at around age 4-6 months (which may lead to iron deficiency anemia).
Digestive Tract - Breastfed infants digest milk better, stools may be much more loose
Immune System - Maternal IgG is replaced with own bodies IgG.
Thermoregulation - Increases ability with thermoregulation. Skin will learn to contract and baby will learn to shiver
Renal Function - Kidneys are not fully mature until age 2 so they are at risk for dehydration/electrolyte imbalance.
- NORMAL OUTPUT IS 2 mL/kg/hour
Stool Patterns in Newborns
Meconium - Occurs 24-48 hours after birth (green-black in color)
Transitional Stools - Appears by 3 days (green-yellow in color)
Milk Stools - Appears by 4 days
Breastmilk Stool - Yellow, Seedy, Loose
Formula Stool - Darker and thicker stool
Infant Nutrition
FEEDINGS
- Breastmilk exclusive until 6 months
- Vitamin D supplements during first few days of life to prevent rickets
- Maternal iron stores last until 4-6 months. Iron supplements (iron fortified cereal) needed in breastfed children (formula already has iron)
- Fluoride supplements at 6 months of age
- Formula/Breast Milk - 20 kcal/oz
Do not feed baby cow’s milk or honey before 1 years old
(Cows milk has high solute load which is hard for immature GI tract to digest)
(Honey is not given to prevent Botulism)
BABY FOOD
- Solid food is usually started around 4-6 months to 12 months
- Start with vegetables first than fruit (if baby has fruit first they may not want vegetables due to sweetness of fruit) - This is done until 8 months then protein (meat) puree is started around 8-10 months
- Baby food is introduced 1 at a time. Give first food for 4-7 days to test for allergies or food intolerances (rash, constipation). If they do well then move onto next food
- General Guideline - 1 Tablespoon of food per year of age
Baby Teeth
- Teach parents to wipe teeth with gauze or small toothbrush
- Baby teeth start erupting around 12 months of age (6-8 teeth). Can start seeing them around 8 months.
- BMI TRACKING STARTS AT AGE 2 DUE TO INCREASED CHILDHOOD OBESITY AND DIABETES
Infant Primitive Reflexes
- Reflexes babies are born with (present for first few months of life)
Birth - 3-4 Months
- Rooting
- Sucking
- Palmar Grasp
- Moro “Startle”
- Tonic Neck “Fencer”
Parachute Reflex - 7-9 Months - Horizontal prone position infant extends hands and fingers to protect their fall
Landau Reflex - 6-8 Months and persists until 12-24 months. Horizontal prone position infant raises head and extends leg and spine.
Birth - 8 Months
- Plantar Grasp
Birth - 1 Year
- Babinski Reflex
Fine Motor Development
1-3 Month – Grasping Reflex (Strong Grasp)
2 Months – Grasp reflex starts to fade
3 Months – Grasp reflex absent
4 Months – Tries to reach objects but overshoots and grabs objects with both hands
5 Months – Grasp objects voluntarily (able to hold 1 cube at a time for a short period)
6 Months – Drops objects when another object is given. Grasp and manipulate small objects
7 Months – Transfer objects from one hand to the other
8 Months – Begins pincer grasp or releasing an object
9 Months – Crude pincer grasp
10 Months – Grasp handles
11 Months – Neat pincer grasp (Proximal distal)
12 Months – 2 block tower and can turn pages in a book many times
Gross Motor Development
2 Months - Head Lag (little neck muscles to baby cannot hold their neck up on their own)
3 Months - Baby can hold head more erect but still bobs forward
4 Months - Head Control (neck muscles are developed to hold their head) (Sit with support)
5 Months - Head Lag should be absent
6 Months - Infants can maintain sitting position if propped)
5-6 Months - Abdomen to back (5), Back to abdomen (6)
7-9 Months - Parachute Reflex (protective extension of arms forward)
8 Months - Sit erect without support
10 Months - Move from Prone to Sitting
Locomotion
- Cephalocaudal Direction
4 Months - Coordination of extremities (Can sit with support)
6-7 Months - Crawling (usually backwards)
8 Months - Sit steadily unsupported
9 Months - Creeping
11-12 Months - Pull to standing position
11 Months - Walking with both hands held or walk while holding furniture
12 Months - Walking with 1 hand held
Standing or sitting without assistance or taking steps is considered cephalocaudal
Psychosocial Development
Erikson - Psychosocial Development
Piaget - Cognitive Development
Erikson Psychosocial Development
Trust VS Mistrust (with caregivers during 1st year of life)
- It is very important for infants to feel their needs are being met during infancy
- Importance of consistency of care
Piaget Cognitive Development
Sensorimotor Phase (6 stages from birth to 24 months)
Birth-1 y/o - Reflex Stage (Children use reflexes to express themselves. They learn associations such as crying will get them fed or if they cry they get changed)
1-4 Months - Primary Circular Reactions (Replacement of reflexes with voluntary reflexes)
4-8 Months - Secondary Circular Reactions (Reasons for actions become very defined)
- Imitation, Play, Affect (emotions)
8-12 Months - Coordination of Secondary Schema (Increased motor skills to allow exploration of environment, Object Permanence - Infants understand if an object disappears the object is still there just not in front of them, they develop intellectual reasoning)
Social Development
Infants - Need connection and attachments
2 Months - Responds to sound by turning his head to side when sound is at ear level (also smile)
3 Months - Infants can recognize familiar faces and objects such as their own hand or feeding bottle
4-8 Months - Separation Anxiety (separation from parent)
6-8 Months - Stranger Anxiety
6-9 Months - Turn their head in a curving arc
- Parents are encouraged to room-in at the hospital overnight to reduce separation/stranger anxiety.
1 Years Old - Children start acting out when they know their parents will leave.
Language Development
- Crying is the first verbal form of communication
6 Weeks - Vocalizations
2 Months - Demonstrates social smiles and vocalizes to familiar voices
3-4 Months - Coo, Laugh, Gurgle
6 Months - Combine syllables such as dada
6 Months - Imitate Sounds, Add Consonants
9-10 Months - Comprehend “No”
10-11 Months - Ascribe Meaning to Words
1 Years Old - 3-5 Words with Meanings
Promoting Sleep for Infants
First 3-4 Months - 9-11 Hours
Total Daily Sleep - 15 Hours
SIDS (Sudden Infant Death Syndrome)
RISKS
- Infants with 1+ BRUE (Brief Resolved Unexplained Events, Such as period of APNEA or Respiratory Issues requiring CPR)
- Preterm Infants who experienced APNEA at time to discharge
- Siblings who were SIDS victims
- History of Central Hypoventilation (respiratory distress during birth)
- LBW, Low APGAR Scores, Recent Viral Illness, Male Babies, Native/African American
Ways to Decrease Risk of SIDS
- Avoid smoking during pregnancy time period
- Breastfeeding
- Supine sleep position (sleep on back)
- Avoid soft, moldable blankets and pillows
- Avoid bed sharing
- Avoid overheating during sleep
BACK TO SLEEP CAMPAIGN
- Goal of decreasing risk of SIDS in America
SAFE SLEEP ACRONYM
A - Alone
B - Back
C - Crib
Injury Prevention of Infancy
- Leading Cause of Mortality/Morbidity
Know a child’s developmental level to learn what they are at risk for
Infants - Congenital Abnormalities
ALL OTHER AGE GROUPS - Injuries/Accidents
Pediatric Population as a Whole - Respiratory issues is leading cause of morbidity (illness)
Car-Seat Safety
- Safest position is rear-facing in the center back-seat
- REAR FACING IS A MUST UNTIL AGE 2
- Rear-facing seats can be used until 35 pounds
- CAR SEATS SHOULD NEVER BE PUT IN FRONT SEATS (due to airbags)
- After car-seats, you can move to booster seats that face frontwards. They can be used until 65 pounds.
- All children should sit in back seats until they are teenagers due to risk of airbag injury
Primitive Reflex
- Rooting
- Palmar Grasp
- Moro
- Tonic Neck
Extended Reflexes
- Plantar Grasp
- Voluntary Palmar Grasp
- Babinski
- Parachute
- Pincer Grasp
First Year of Life Milestones
2 Months
- Hold Objects for a few moments before dropping it
3 Months
- Head lag is minimal
- Infants can reach for objects but usually over-reach
4-6 Months
- Head control is well developed
5 Months
- Infants can grasp objects voluntarily
6 Months
- Infants can roll from front to back
- Infants can better manipulate objects with their hands
7 Months
- Infants can bare their whole weight on their feet
- Infants can transfer objects from hand to hand
- Infants can drop one object when they are handed another
8 Months
- Infants can sit without support
8-10 Months
- Infants advance from using a crude pincer grasp to a neat pincer grasp
10 Months
- Infants can move from prone to sitting position without assistance
- They can grasp finger foods and place it in their mouth
11 Months
- Infants can walk while holding onto something
- Infants can place objects into a container
12 Months
- Infants can stand momentarily without assistance
- Infants can build a 2 block tower usually without success
Questions
12 Month old Baby Play - Large push-pull toy
2 Month Old Baby Crying - Children need love and cuddles at this age, pick them up it will not spoil them
4 Month old to introduce to rattle
2 Months old they can play with music box
4 Month Old Vaccine - Polio, Pneumococcal and Rotavirus
In order for an infant to make an attachment with another human being they need to achieve object permanence and discriminate between self and invididuals
Flouride supplements may be needed at 4 months if they do not drink fluoride waters.
6 Month - Babies usually have 2 teeth
