CHAPTER 16

The Infant

MILESTONES

Describes general patterns of achievement at various stages Often referred to as norms Nurse must understand normal range for milestone

achievement Establishment of sleep-wake cycle Social smile Drinking from cup Separation anxiety

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AVERAGE VITAL SIGNS OF THE INFANT

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ERICKSON’S DEVELOPMENTAL TASK

Trust vs Mistrust Getting needs met

Tolerating frustration in small amounts

Recognizing mother as distinct from others and self

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SEN

SES

TOUCH

HEARING

VISION

TASTE

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TOUCH

It is the most highly developed sense.

Mostly at the lips, tongue, ears, and forehead.

Very comfortable with touch.

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HEARING

Ordinary sounds are heard well before 10 days of life.

Response is either cry, eye movement, cessation of activity or startle reaction

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HEARING

BAER done at birth Ability to hear correlates with ability to

enunciate words Ask for history of otitis media or aids Referral for fluid in ears Repeat hearing test Speech therapy

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VISION

Pupils dilate to light

Bright lights are unpleasant

Follow objects in line of vision

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TASTE

Bitter and sour fluids are resisted while sweet are accepted.

SMELL Only evidence in search for nipple as he smells

breast milk.

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ORAL STAGE

• Sucking brings comfort and relief from tension

• Important to hold infant during feedings

• Allow sufficient time for infant to suck

• Infants on IV fluid/nutrition need additional attention and a pacifier to ensure the need for sucking is satisfied

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MOTOR DEVELOPMENT

Grasp reflex disappears around 3 months of age Touch palm of hand of infant and flexion occurs.

Prehension occurs around 5 to 6 months of age Grasp objects between fingers and opposing thumb Can hold drinking cup

Parachute reflex appears around 7 to 9 months as a protective arm mechanism When infant is suddenly thrusted downward when prone

Pincer grasp well-established by 1 year of age Coordination of index finger and thumb

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FINE MOTOR DEVELOPMENTIN INFANCY

6-month-old

12-month-old

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REFLEXES

Swallowing

Gagging

Sucking

Grasp

Tonic Neck

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THE DEVELOPMENT OF LOCOMOTION, PREHENSION, AND PERCEPTION

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THE DEVELOPMENT OF LOCOMOTION, PREHENSION, AND PERCEPTION (CONT.)

Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

SOCIAL DEVELOPMENT

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SITTING UP

Age 2 months Age 6 months 19

AMBULATION

13 month old

Nine to 12-months20

SPEECH MILESTONES

1-2 months – coos

2-6 months- laughs and squeals

8-9 months – babbles, mamma and dada as sounds

10-12 months – mamma/dada specific

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EMOTIONAL DEVELOPMENT Consistency must be established to develop

trust, which is vital to the development of a healthy personality.

Pick up when crying

When infant shows readiness to learn a task, parents should provide encouragement

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EMOTIONAL DEVELOPMENT

Emotions are instable- changes from crying to laughter.

His affection for love from his family is apparent.

10 months – begins to express anger, sadness, pleasure, jealousy, and affection.

12 months- above emotions are distinguishable. 23

NEED FOR CONSTANT CARE AND GUIDANCE

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A crying baby needs to be soothed

Each time the parents attend to the baby needs, will help the baby at later months to develop trust when not met immediately.

You will never spoil a child by holding them too much

The newborn expresses his emotion through cry, for hunger, pain or discomfort.

DEVELOPMENT AND CARE

Important to note that no two infants are the same

Physical patterns cannot be separated from social patterns

Abrupt changes do not take place with each new month of life

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COPING WITH AN IRRITABLE OR LETHARGIC INFANT

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Whether irritable or lethargic, many of the same interventions can be used

An irritable baby cries and may be difficult to soothe

A lethargic baby may “shut down” and sleep in order to avoid an excessively stimulating (loud or noisy) environment

Shield infant’s eyes from bright light

Sit quietly with infant; don’t talk or sing

Eliminate as much noise as possible

Talk in a soft voice Swaddle snugly Change infant’s position

slowly Provide nonnutritive

sucking

COLIC

Periods of unexplained irritability and crying in an otherwise healthy and well-fed infant

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Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

DEVELOPING POSITIVE SLEEP PATTERNS

Newborns sleep in 4-hour intervals By 4 to 6 months, can be up to 8 hours

Position infants on their backs on a firm mattress Infants rely on parent to soothe them back to sleep if

awakened during the night Assist infant to learn self-soothing behaviors – placing pacifier

in crib

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Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

IMMUNIZATIONS

Stress repeatedly importance of immunizations and timing of administration

Delays can lead to increased risk of serious illness or even death

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ILLNESS PREVENTION: PHYSICAL EXAMINATION

Physical examination in the clinic setting at least five times in the first year Hearing and vision Screening tests administered as required Growth grids and developmental screening Immunizations Nutritional counseling Provide appropriate education and/or explanations to

the parents

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BREASTFEEDING AND BOTTLE FEEDING

Human milk is best for infants younger than 6 months

Formulas that are cow’s milk based and iron-fortified are recommended by the AAP

Whole cow’s milk not given until after 1 year of age

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SAFE BOTTLE FEEDING

Check expiration date on container Follow instructions on how to mix, store, and give

formula to infant Always use clean containers to mix/store formula Do not heat bottle in microwave Do not save formula that is left from a feeding; can

lead to diarrhea

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ABSOLUTE CONTRAINDICATIONS TO BREASTFEEDING

Galactosemia Phenylketonuria HIV-positive mother Chemotherapy Radioactive isotope therapy Illicit drug use Active untreated tuberculosis

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NUTRITION COUNSELING

Solid food can slowly be added beginning around 6 months of age The tongue extrusion reflex has completely disappeared GI tract is mature enough to digest food

Between 4 and 6 months, sucking is more mature, and munching or an up-and-down chewing/chomping motion ensues

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ADDING SOLID FOODS

Do not introduce new food if infant is ill, as adverse effects such as allergic reactions may not be appropriately identified

Rice cereal is recommended as first food

Do not mix cereal or baby food with formula

Introduce one food at a time in small amounts

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NURSING TIP

Do not introduce new food if infant is ill, as adverse effects such as allergic reaction may not be appropriately identified

Introduce one food at a time in small amounts and continue for several days before introducing new food

Delay introduction of foods known to cause allergic responses, such as orange juice, fish, nuts, strawberries, chocolate and egg whites

Do not start with mixed veggies Do not feed from jar

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NURSING TIP

New solid foods should be introduced before the milk feeding to encourage the infant to try the new experience

As solid food intake increases, the amount of formula or milk should decrease to avoid overfeeding

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RECOMMENDED FAT INTAKE DURING INFANCY

Infants require almost three times more calories per kilogram of weight than adults

By age 6 months, the digestive tract has the ability to digest fats present in food

A well-balanced diet provides appropriate fat and cholesterol intake

A low-fat diet should not be given to infants under 2 years of age

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WEANING

Signs of readiness include Infant eagerly looks forward to new tastes and textures

found on the spoon May not want to be held close during feedings May start to “bite” the nipple as teeth erupt Imitates parents/siblings

Should be gradual, start with daytime then progress to nighttime

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ORGANIC AND NATURAL FOODS

Do not contain any additives Strict guidelines/regulations on soil, fertilizers,

herbicides/pesticides If animal, no drugs or hormones are used prior to

processing

Nutritive value has not been shown by evidence-based research to be superior to nonorganic foods

Stress importance of reading food labels

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INFANT SAFETY

Car safety Rear-facing for infants younger than 1 year or 22 lb

Fall prevention Never leave an infant unattended on a flat surface Crib rails should be raised and securely locked Protect from stairways and pools Keep car seat on floor.

Toy safety Should be appropriate for stage of development No small or removable parts that can be easily

swallowed A child’s response to a toy may indicate readiness to

learn new skills

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SUMMARY OF MAJOR DEVELOPMENTAL CHANGES IN THE FIRST YEAR

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Weight doubles by 6 months of age and triples by 1 year of age

Head and chest circumference are equal by 1 year of age

Maternal iron stores decrease by age 6 months

Depth perception begins to develop at age 9 months

Infants older than 4 months can voluntarily roll over

By age 1 year, infants can take some independent steps

Primitive reflexes are replaced by voluntary movements

Tooth eruption begins at age 6 months, when “biting” activities begin

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• Birth to One year– Mobiles– Safety mirrors– Rattles– Stacking toys– Simple pop ups picture books– Musical toys– Squeeze toys– Infant swing– Teething toys

RED FLAG IN INFANT DEVELOPMENT

Unable to sit alone by 9 months.

Unable to transfer objects from hand to hand by 1 year.

Abnormal pincer grip or grasp by age 15 months.

Unable to walk alone by 18 months

Failure to speak recognizable words by 2 years.

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