Infancy

PRESENTED BY:
ROCHELL ANNE D. L IM, RN, MN
Objectives:
At the end of this session, students will be able to:
1. Describe normal infant growth and development and associated parental concerns;
2. Assess an infant for normal growth and development milestones.
3. Formulate nursing diagnoses related to infant growth and development and associated
parental concerns.
4. Identify expected outcomes to promote optimal infant growth and developmental needs as
well as manage seamless transitions across differing healthcare settings.
5. Implement nursing care related to normal growth and development of an infant, such as
encouraging eye–hand coordination.
6. Evaluate expected outcomes for achievement and effectiveness of care.
Nursing Process
ASSESSMENT
• Nursing assessment of an infant begins with an INTERVIEW with the PRIMARY CAREGIVER.
• Important areas to discuss include nutrition, elimination, growth patterns, and development.
• An infant’s height, weight, and head circumference are important indicators of growth.
• The physical assessment of an infant must be done quickly yet thoroughly.
• A parent is present to make the infant feel comfortable.
• Using a calm, unhurried approach.
Growth and Development of an Infant
PHYSICAL GROWTH
WEIGHT
Most infants double their birth weight by 4 to 6 months and triple it by
1 year.
 During the first 6 months, infants typically average a weight gain of 2
lb per month.
 During the second 6 months, weight gain is approximately 1 lb per
month.
 The average 1-year-old boy weighs 10 kg (22 lb); the average girl
weighs 9.5 kg (21 lb).
An infant’s weight, however, is relevant only when plotted on a
standard growth chart and compared to that child’s own growth curve.
PHYSICAL GROWTH
HEIGHT
 An infant increases in height during the first year by 50%, or
grows from the average birth length of 20 in. to about 30 in.
(50.8 to 76.2 cm).
 Height, like weight, is best assessed if it is plotted on a standard
growth chart.
 During the second half of the first year, it becomes more
apparent as lengthening of the legs occurs.
At the end of the first year, the child’s legs may still appear
disproportionately short, however, and perhaps bowed.
PHYSICAL GROWTH
HEAD CIRCUMFERENCE
 By the end of the first year, the brain already reaches two
thirds of its adult size.
 Some infants’ heads appear asymmetric until the second
half of the first year, especially if they are always placed on
their back to sleep (which they should be), causing the skull
bones to flatten in the back.
PHYSICAL GROWTH
BODY PROPORTION
 The circumference of the chest is generally less than that of the
head at birth by about 2 cm.
 The abdomen remains protuberant until the child has been
walking well for some time, generally well into the toddler
period.
 Cervical, thoracic, and lumbar vertebral curves develop as
infants hold up their head, sit, and walk.
Lengthening of the lower extremities during the last 6 months
of infancy readies the child for walking and often is the final
growth that changes the appearance from “baby like” to
“toddler like.”
PHYSICAL GROWTH
BODY SYSTEMS
 In the cardiovascular system, heart rate slows from 110 to
160 beats/min to 100 to 120 beats/min by the end of the
first year.
 Infants are prone to develop a physiologic anemia at 2 to
3 months of age.
 The respiratory rate of an infant slows from 30 to 60
breaths/min to 20 to 30 breaths/min by the end of the
first year.
 At birth, the gastrointestinal tract is immature in its
ability to digest food and mechanically move it along.
PHYSICAL GROWTH
BODY SYSTEMS
 The liver of an infant remains immature, possibly causing an
inadequate conjugation of drugs (if a drug should be necessary
for treatment of illness) and the inefficient formation of
carbohydrate, protein, and vitamins for storage.
The kidneys remain immature and not as efficient at eliminating
body wastes as in an adult.
 An infant’s immune system becomes functional by at least 2
months of age.
 The ability to adjust to cold is mature by age 6 months.
PHYSICAL GROWTH
TEETH
 The first baby tooth (typically
a central incisor) usually
erupts at age 6 months,
followed by a new one
monthly
 Fluoride supplementation
should be administered at 6
months of age (AAP, 2017).
MOTOR DEVELOPMENT
GROSS MOTOR DEVELOPMENT
Four positions:
A. ventral suspension,
B. prone,
C. sitting, and
D. standing
GROSS MOTOR DEVELOPMENT
A. Ventral Suspension Position
refers to an infant’s appearance when
held in midair on a horizontal plane and
supported by a hand under the abdomen.
One-month-old infants lift their head
momentarily and then drop it again.
Two-month-old infants hold their head in
the same plane as the rest of their body, a
major advance in muscle control.
By 3 months, infants lift and maintain
their head well above the plane of the rest
of the body in ventral suspension.
A. Ventral Suspension Position
Landau reflex
 is a new reflex that develops at 3 months.
When held in ventral suspension, the
infant’s head, legs, and spine extend. When
the head is depressed, the hips, knees, and
elbows flex. This reflex continues to be
present in most infants during the second 6
months of life, but then it becomes
increasingly difficult to demonstrate.
 It is an important reflex to assess because
a child with motor weakness, cerebral palsy,
or other neuromuscular defects will not be
able to demonstrate the reflex.
A. Ventral Suspension Position
Parachute reaction
 At 6 to 9 months, this means that
when infants are suddenly lowered
toward an examining table, the arms
extend as if to protect themselves
from falling.
 Children with cerebral palsy do not
demonstrate this response because
they flex their extremities too tightly.
GROSS MOTOR DEVELOPMENT
B. Prone Position
 When lying on their stomach, newborns can turn their
head to move it out of a position where breathing is
impaired, but they cannot hold their head raised for an
extended time.
 By 1 month of age, they lift their head and turn it easily to
the side. They still tend to keep their knees tucked under
their abdomen, however, as they did as a newborn.
 Two-month-old infants can raise their head and maintain
the position, but they cannot raise their chest high enough
to look around yet. Their head is still held facing downward.
GROSS MOTOR DEVELOPMENT
B. Prone Position
 A 3-month-old child lifts the head and shoulders well off the table and looks
around when prone. The pelvis is flat on the table, no longer elevated. Some
children can turn from a prone to a side-lying position at this age.
 Four-month-old infants lift their chests off the bed and look around actively,
turning their head from side to side. They are able to turn from front to back.
Five-month-old infants are able to rest weight on their forearms when prone.
They can turn completely over, front to back and back to front.
GROSS MOTOR DEVELOPMENT
B. Prone Position
By 6 months, infants can raise their
chests and the upper part of their
abdomens off the table.
By 9 months, a child can creep from
the prone position. Creeping means
the child has the abdomen off the
floor and moves one hand and one leg
and then the other hand and leg, using
the knees on the floor to locomote
GROSS MOTOR DEVELOPMENT
C. Sitting Position
When placed on his or her back and
then pulled to a sitting position, a
newborn has extreme head lag; this
lag is present until about 1 month.
In a sitting position, the back appears
rounded and an infant demonstrates
only momentary head control.
GROSS MOTOR DEVELOPMENT
C. Sitting Position
 By 2 months, infants can hold their
head fairly steady when sitting up,
although their head does tend to bob
forward and will still show head lag
when pulled to a sitting position.
A 4-month-old child reaches an
important milestone by no longer
demonstrating head lag when pulled
to a sitting position
GROSS MOTOR
DEVELOPMENT
C. Sitting Position
 A 5-month-old infant can be seen to
straighten his or her back when held or
propped in a sitting position.
By 6 months, infants can sit momentarily
without support. They anticipate being
picked up and reach up with their hands
from this position.
A 7-month-old child can sit alone but only
when the hands are held forward for
balance.
GROSS MOTOR
DEVELOPMENT
C. Sitting Position
 An 8-month-old child can sit
securely without any additional
support.
At 9 months, infants sit so steadily
that they can lean forward and
regain their balance. They may still
lose their balance if they lean
sideways, which is a skill not
achieved for another month.
GROSS MOTOR DEVELOPMENT
D. Standing Position
A newborn stepping reflex can still be demonstrated at 1 month of age. In a standing position,
the infant’s knees and hips flex rather than support more than momentary weight.
At 3 months, infants try to support part of their weight on their feet.
At 4 months, infants are able to support their weight on their legs. They are successful at doing
this because the stepping reflex has faded.
By 5 months, the tonic neck reflex should be extinguished, and the Moro reflex should be
fading.
By 6 months, infants nearly support their full weight when in a standing position.
A 7-month-old child bounces with enjoyment in a standing position.
Nine-month-olds can stand holding onto a coffee table if they are placed in that position.
GROSS MOTOR
DEVELOPMENT
D. Standing Position
Ten-month-olds can pull themselves to a
standing position by holding onto the side of a
playpen or a low table, but they cannot let
themselves down again as yet
At around 11 months, an infant learns to
“cruise” or move about the crib or room by
holding onto objects such as the crib rails,
chairs, walls, and low tables.
At 12 months, the child can stand alone at
least momentarily.
FINE MOTOR DEVELOPMENT
One-month-old infants still have a strong
grasp reflex so they hold their hands in
fists so tightly that it is difficult to extend
their fingers.
A 2-month-old infant will hold an object
for a few minutes before dropping it. The
hands are held open, not closed in fists.
By 3 months, infants reach for attractive
objects in front of them.
When they reach 4 months, infants bring
their hands together and pull at their
clothes. They will shake a rattle placed in
their hand.
FINE MOTOR DEVELOPMENT
Thumb opposition (ability to bring the thumb and fingers together) begins, but the motion is a
scooping or raking one, not a picking-up one, and is not very accurate.
Five-month-old children can accept objects that are handed to them by grasping with the
whole hand. They can reach and pick up objects without the object being offered and often play
with their toes as objects.
By 6 months, grasping has advanced to a point where a child can hold objects in both hands.
FINE MOTOR DEVELOPMENT
Seven-month-old infants can transfer toys
from one hand to the other. They hold a first
object when a second one is offered.
By 8 months, random reaching and
ineffective grasping disappear as a result of
advanced eye–hand coordination.
A major milestone at 10 months is the ability
to bring the thumb and first finger together in
a pincer grasp (This enables children to pick up
small objects such as crumbs or pieces of
cereal from a high chair tray). They use one
finger to point to objects. They offer toys to
people but then cannot release them.
FINE MOTOR DEVELOPMENT
At 12 months, infants can hold a crayon well enough to draw a semi-straight line.
They enjoy putting objects such as small blocks in containers and taking them out again.
They can hold a cup and spoon to feed themselves fairly well (if they have been allowed to
practice) and can take off socks and push their hands into sleeves (again, if they have been
allowed to practice).
They can offer toys and release them.
DEVELOPMENTAL
MILESTONES
DEVELOPMENTAL
MILESTONES
DEVELOPMENTAL
MILESTONES
DEVELOPMENTAL
MILESTONES
LANGUAGE DEVELOPMENT
Infants begin to make small, cooing (dovelike) sounds by the end of the
first month.
By 2 months, they can differentiate their cry.
In response to a nodding, smiling face, or a friendly tone of voice, a 3-
month-old infant will squeal with pleasure or laugh out loud
By 4 months, infants are very talkative, cooing, babbling, and gurgling
when spoken to. They definitely laugh out loud.
By 5 months, an infant says some simple vowel sounds (e.g., “goo-goo,”
“gah-gah”).
LANGUAGE DEVELOPMENT
At 6 months, infants learn the art of imitating. They may imitate a
parent’s cough, for example, or say “Oh!” as a way of attracting attention.
The amount of talking infants do increases still more at 7 months. They
can imitate vowel sounds well (e.g., “oh-oh,” “ah-ah,” “oo-oo”).
By 9 months, an infant usually speaks a first word: “da-da” or “baba.”
By 10 months, an infant masters another word such as “bye-bye” or
“no.”
By 12 months, infants can generally say two words in addition to “ma-
ma” and “da-da,” and they use those two words with meaning
PLAY
1-month-olds can fix their eyes on an object, they are interested in watching a mobile over
their crib or playpen.
Two-month-old infants will hold light, small rattles for a short period of time but then drop
them.
Three-month-old infants can handle small blocks or small rattles.
Four-month-olds need a playpen or a sheet spread on the floor so they have an opportunity to
exercise their new skill of rolling over.
Five-month-old infants are ready for a variety of objects to handle, such as plastic rings, blocks,
squeeze toys, clothespins, rattles, and plastic keys.
A 6-month-old child can sit steadily enough to be ready for bathtub toys such as rubber ducks
or plastic boats if carefully supervised
PLAY
7-month-old infants can transfer toys, they are interested in items such as blocks, rattles, or
plastic keys that are small enough to be transferred easily.
Eight-month-old infants are sensitive to differences in texture.
The 9-month-old infant needs the experience of creeping. This means time out of a crib or
playpen so there is room to maneuver
By 10 months, infants are ready for peek-a-boo and will spend a long time playing the game
with their hands or with a cloth over their head that they can easily reach and remove.
By 11 months, children have learned to cruise or walk by holding on to low tables.
Twelve-month-old infants enjoy putting things in and taking things out of containers
DEVELOPMENT OF SENSES
Vision
One-month-old infants are able to regard an
object in the midline of their vision (something
directly in front of themselves) as soon as it is
brought in as close as about 18 in. (46 cm).
Two-month-old infants focus well (from about age
6 weeks) and so are able to follow moving objects
with the eyes (although still not past the midline)
Three-month-old infants can follow an object
across their midline
Four-month-old infants are able to recognize
familiar objects, such as a frequently seen bottle,
rattle, or toy animal.
DEVELOPMENT OF SENSES
Vision
By 6 months, infants are capable of organized depth perception.
Seven-month-olds pat their own image in a mirror.
By 10 months, an infant looks under a towel or around a corner for a
concealed object (the beginning of object permanence, or an awareness
that an object out of sight still exists).
DEVELOPMENT OF SENSES
Hearing
By 1 month, this reaction is even more marked.
Hearing awareness becomes so acute by 2 months of age that infants will
stop an activity at the sound of spoken words.
Many 3-month-old infants turn their head to attempt to locate a sound.
At 4 months of age, when infants hear a distinctive sound, they turn and
look in that direction.
DEVELOPMENT OF SENSES
Hearing
By 5 months of age, infants demonstrate they can localize sounds
downward and to the side, by turning their head and looking down.
Six-month-olds have progressed to being able to locate sounds made
above them
By 10 months, infants can recognize their name and listen acutely when
spoken to.
By 12 months, infants can easily locate sounds in any direction and
turn toward them.
DEVELOPMENT OF SENSES
Touch
Infants need to be touched so they can experience skin-to-skin contact.
Clothes should feel comfortable and soft rather than rough;
diapers should be dry rather than wet
Teach parents to handle infants with assurance yet gentleness.
DEVELOPMENT OF SENSES
Taste
Infants demonstrate they have an acute sense of taste by turning away
from or spitting out a taste they do not enjoy.
When infants are introduced to solid food at about 6 months, urge
parents to make mealtime a time for fostering trust as well as supplying
nutrition by being certain feedings are done at an infant’s pace and the
amount offered fits the child’s needs and not the parent’s idea of how
much should be eaten.
DEVELOPMENT OF SENSES
Taste
Infants demonstrate they have an acute sense of taste by turning away
from or spitting out a taste they do not enjoy.
When infants are introduced to solid food at about 6 months, urge
parents to make mealtime a time for fostering trust as well as supplying
nutrition by being certain feedings are done at an infant’s pace and the
amount offered fits the child’s needs and not the parent’s idea of how
much should be eaten.
DEVELOPMENT OF SENSES
Smell
Infants can smell accurately within 1 or 2 hours after birth.
They respond to an irritating smell by turning their head away from
it.
They appear to enjoy pleasant odors and learn early in life to
identify the familiar smell of breast milk
EMOTIONAL DEVELOPMENT
One month-old infants show they can
differentiate between faces and other objects by
studying a face or the picture of a face longer
than other objects.
By 3 months, infants demonstrate increased
social awareness by readily smiling at the sight of
a parent’s face.
By 4 months, when a person who has been
playing with and entertaining an infant leaves, the
infant is likely to cry or show that the interaction
was enjoyable.
By 5 months, infants may show displeasure
when an object is taken away from them
EMOTIONAL DEVELOPMENT
By 6 months, infants are increasingly aware of the difference between people
who regularly care for them and strangers.
Seven-month-old infants begin to show obvious fear of strangers.
Fear of strangers reaches its height during the eighth month, so much so that
this phenomenon is often termed eighth-month anxiety, or stranger anxiety
(Levine, 2011).
Nine-month-old infants are very aware of changes in tone of voice.
By 12 months, most children have overcome their fear of strangers and are
alert and responsive again when approached.
COGNITIVE DEVELOPMENT
In the first month of life, an infant mainly uses
simple reflex activity.
By the third month of life, a child enters a
cognitive stage identified by Piaget (1952) as
primary circular reaction. During this time, the
infant explores objects by grasping them with the
hands or by mouthing them.
At about 6 months of age, infants pass into a
stage Piaget (1952) called secondary circular
reaction. Now when infants reach for a mobile
above the crib, hit it, and watch it move, they
realize it was their hand that initiated the motion,
and so they hit it again.
COGNITIVE DEVELOPMENT
By 10 months, infants discover object permanence. Infants are ready for
peek-a-boo once they have gained this concept.
As infants reach 1 year of age, they are capable of reproducing new
events (they deliberately hit a mobile once, it moves, and they hit it
again).