Growth and Development of Infants Flashcards
Neonate Age
Birth to 1 month
Infancy period
1mo-12mo
Rapid motor, cognitive and social development
Establish trust in the world starting with caregiver
Psychosocial development of Infant 1mo-12mo
Erikson’s trust V mistrust
Acquire sense of trust of self, of other, of the world
Trust that feedings, comfort stimulation and caring needs will be met
Must overcome a sense of mistrust with emphasis on parents nurturing ability, visual and physical contact
Positive nurturing 1mo-12mo
Develop trust, optimism, confidence, and security
1mo-12mo Needs not met
Development of mistrust in world, feeling of insecurity
Piagets Sensory and Motor Phase Birth -24mo
Primitive reflexes are replaced by voluntary actions
Infants separate themselves from other objects and discriminate persons
Object permanence (9-10mo)
Infant Weight development
Rapid
By 6mo wt doubles birth weight (5-7 oz a week)
By 1 yr wt triples (average: 9.75kg or 21.5lb)
Average birth weight
7-8lb
Infant Height development
Increases 1 in monthly for first 6 mo
6mo Height average
25.5in
65cm
1yr Height average
29on
74cm
Infant Head Growth
Rapid
OFC: increases 1.5cm monthly for first 6mo, then 0.5cm monthly from 6-12 mo
OFC is measured…
Above the ears and eyebrows, on the widest part of the head
Average 6mo OFC
43cm
17in
Average 1yr OFC
46cm
18in
In hospital OFC measurement
Done routinely up to 3yr, and >3yr if child has brain problem (hydrocephalus, increased ICP)
Posterior Fontanel Closes
6-8week of age
Anterior Fontanel Closes
12-18mo
Average at 14 mo
Premature closure of fontanels
Craniosynostosis (inhibits perpendicular growth of skull and head is distorted, but brain growth is normal)
Anterior Fontanel Shape
Dimond
Posterior Fontanel Shape
Triangle
Documentation of normal fontanel
Soft and flat and open/closed
Sunken fontanel
Dehydration (notify provider)
Bulging fontanel
Bleeding in skull, fluid accumulation/overload from hydrocephalus, or infection (meningitis)
Growth chart used Birth - 2yr
WHO
Growth chart used 2-20yr
CDC
Infant Nutrition: Birth - 6mo
Human milk (preferred)
Human Milk
Most desired, complete diet for up to 6mo
Provides immunity to the infant (during last 3 months of pregnancy antibodies are provided to baby via passive immunity through the placenta– lasting a few weeks to months, longer if baby is breastfed)
Easily digested
>6mo can have significant health impact on children as they grow into adulthood
AAP&Nutrition recommends
Exclusively breastfeeding for 6mo
Continue for 1yr or longer as complementary foods are introduced
Prevents disease into adulthood
All infants should receive..
Vit D supplement of 400U/day beginning at hospital discharge
After 4 mo exclusively breastfed should receive
Iron supplement of 1mg/kg/day until iron containing foods can be introduced
Formula: Milk based
Preferred in full-term infant
Prepared with Cow milk with added veg oils, vitamines, minerals and iron
Formula: Soy based
For infants that are lactose intolerant and allergic to milk based formulas or casein protein in cow’s milk, or for those parents who wish for a vegetarian diet.
Made with soy protein and added veg oils and corn syrup and or sucrose
Special formula for Low birth weight infants
Low sodium formula
Predigested protein formula (for those who cannot break down casein or whey)
Feedings number/day
In general will decreased from 6 at 1 month to 4-5 at 6 months
Total amount of formula ingested/day
32oz
Amount of food infant should receive/day
Based on weight, age and if they are taking solid foods
Rule of thumb: infants under 6mo who haven’t started solid foods should be taking 2-2.5 oz/lb/day
Babies eat 3-4oz every 3-4 hr
Introducing solid foods
Start at about 6mo (before that, the digestive tract isnt fully developed and cannot digest solid foods)
Signs of readiness for Solid foods
Can sit in high chair and hold their head up
Can open their mouth when food comes their way
Can move food from a spoon into their throat and swallow appropriately
Introduce 1st (solid food)
Iron fortified cereal (rice, barley, oatmeal, and high protein cereals)
Rice cereal is usually first
Rice cereal
Easily digestible and low allergenic potential
DO NOT put in a bottle! Needs to be spoon fed
Honey and infants
Avoid for first 12mo due to botulism
Common sequence of introducing foods
Strained fruits, followed by veggies, then meats
Introducing new foods
Feed small amount 1tsp-few tbsp in 4-7 day intervals
only introduce one food at a time to identify allergies
Amount of solid food increased
Quantity of milk decreased to less than 1L/day to prevent overfeeding
Gross motor: 1mo
Marked head lag
Can turn head from side to side when prone
(must hold/support baby head)
Gross motor: 3mo
Can hold head up with slight head lag
Gross motor: 4mo
Head lag is almost gone
Can roll from their back to their side
Important to put baby on their back to sleep (need to be aware of them rolling to side and belly to prevent SIDS)
🚩posteriorr fontanel not closed
Gross motor: 5mo
Can roll from belly to back
Gross motor: 6mo
Can sit in high chair (good head control) and roll from back to belly
🚩 any head lag at this age needs a neurologic evaluation
Gross motor: 7mo
Can sit leaning forward on hands and bears weight on legs
Gross motor: 9mo
Creeps on hand and knees and pulls themselves to standing position
Gross motor: 10mo
Change from prone to sitting
Important IV consideration when standing, creeping, crawling
dont put IV in feet because we dont want to limit their movement
Gross motor: 11mo
Can cruise while holding furniture
Gross motor: 12-14mo
Can stand alone and walks with one hand held
Most have taken at least one independent step by 14 mo
Infant who doesnt pull to stand by 11-12 mo
🚩Needs to be evaluated for possible developmental dysplasia of the hip
Fine motor includes
Using hands and fingers to grasp objects
Grasping occurs between
2-3mo as a reflex and gradually becomes voluntary
Palmer grasp is replaced with Pincer grasp
Fine motor: 3mo
Will hold a rattle if placed in their hand, will not reach for it
Fine motor: 4 mo
plays with hands and can carry objects to mouth
❌ remove all small objects (anything that can fit down a toilet paper roll can be choked on)
Fine motor: 5mo
able to voluntary grasp objects
Fine motor: 6mo
Hold bottle, grasp their feet and pull to mouth and feed themselves a cracker
Fine motor: 7mo
Can transfer objects from one hand to another, use one hand for grasping and hold a cube in each hand simultaneously
Fine motor: 8-9 mo
Uses crude (not fully developed) pincer grasp, bangs blocks, explores movable parts
Fine motor: 10mo
Can pick up a raisin and other finger foods
Can deliberately let go of objects and will offer it to someone
Fine motor: 11-12mo
Places objects into a container and removes them
2 mo Developmentally
Social smile in response to various stimuli
Follows midline
Vocalizes along with using facial and body expressions, distinct from crying
When prone, lifts head to 45 degree – tummy time is important
2mo Physically: Skin
Infant acne may continue to 3mo, cradle cap, eczema is common
2mo Physically: Head
Posterior fontanel should be closed
2mo Physically: Eyes
Unequal movement
2mo Physically: Neck
holds head 45 degree when prone, if on back turn head from side to side to prevent plagiocephaly or bald spot
2mo Neurologically: Grasping reflex
Present when infant immediately closes fingers when and object placed in hand
Gone by 3-4 mo
2mo Neurologically: Stepping reflex
Present when you hold the infant upright and touch foot to flat surface, they begin stepping
Gone by 2-4 mo
2mo Neurologically: Sucking reflex
Present when the infants soft palate, lip, mouth cheek or chin is stimulated or stroked, will automatically begin sucking
Gone by 4-6mo
2mo Neurologically: Rooting reflex
Present when the infants cheek is stroked, the baby will turn head in the direction of the stimulus, mouth open ready to suckle
Gone by 4mo
4mo Developmentally
Sit with support Rolls from back to side Has almost no head lag when pulled to sit Grasp objects with both hands Regards hands. hands together Laughs Bears weight on legs when held up
4mo Physically/ Neurologically
Drooling begins
Moro and rooting reflexes are gone
Sucking, palmar grasp, plantar grasp and fading
Makes consonant sounds (like K or N)
Laughs out loud and show many expressions
Begins to show memory
Separation/Individuation begins, know that they are separate individual than their mother
6mo Developmentally and Physically
Feeds self with fingers Works for toys Reaches for objects Turns to rattle Imitates speech sounds Speaks single syllabus (like Ma, Da) Teething my begin with eruption of 2 lower central incisors between 6-10 mo
Quick guide to teeth coming in
Take child’s age in months and minus 6 equals how many teeth they should have
6-8 mo
They begin to fear strangers. Stranger anxiety is prominent during this time
Talk softly and meet the child at eye level
Maintain safe distance
Avoid sudden intrusive gestures
Start with least invasive to most
Try to keep on moms lap, do assessment on mom first then baby
9mo Developmentally and Physically
Creeps on hands and knees Sits for prolonged time Pulls self to standing position Stands holding furniture Responds to simple verbal commands Understands "n-no" Eruption of upper incisors begins between 8-12mo
For pain with teething
Massage gums, give them ibuprofen or tylenol
Dont give hard, cold items to put in mouth- they damage the gums and cause bleeding
12-14mo Developmentally and Physically
Birth weight triples Says 3-5 words besides "MaMa, DaDa" Plays repetitive games Waves bye-bye Indicates wants without crying Bangs 2 cubes together Recognizes objects by name Stands alone for few seconds May be walking on their own Has 6-8 deciduous teeth
Common health consideration
Vaccine preventable diseases
Diaper rash
Eczema (have higher risk for development of asthma)
Teething
RSV (between November and April, Premature baby: talk about Synagis)
Jaundice
SIDS (dont lay baby on belly, prone only)
Abuse
FTT (failure to thrive)
Colic (remind parents to take slow deep breaths and a time out and tell them that this will get better with time)
Apnea of Prematurity (home monitor and protect from SIDS because these children are at greater risk for SIDS)
Flu
Safety Considerations for infant: Risk for
Suffocation (positioning is important) Aspiration Falls Bodily damage from sharp objects Poisoning from ingestion (store hazardous items in high places) Motor vehicle accident (proper car seat)
Car Seat recommendations
Children need to be in a rear facing seat until 2yr or until they reach the max height and weight for the seat
Once rear facing seat is outgrown: then use forward facing seat
Once forward facing seat is outgrown: then need to use a belt positioning booster seat until they have reached 4ft 9in and are between 8-12 yr
