1 INFANCY. 2 The First Year of Life Time of rapid growth and development. Growth in the first year...
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INFANCY
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The First Year of Life
• Time of rapid growth and development.• Growth in the first year is extremely rapid.• It occurs in spurts, called saltatory growth.
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Patterns of Physical Development
• Head to toe– Lift head to see object – Muscle control: pick up – Walk towards
• Near to far: trunk outward– Wave arms– Grab with palm of hand – Pick up with thumb and fingers
• Simple to complex– Eating with fingers – Spoon and fork
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Weight
• Lose some after birth2.7 – 4.0 kg• 20-30 g/day/month 1st 6 months• 15g/day/month in 2nd 6 months
– Birth weight:• Doubled by 6 month• Tripled by 1 yr
– Heredity, feeding habits, and physical activity
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Weight Gain (per month)
AGE WEIGHT GAIN 0-3 months: 900 g 3-6 months: 600 g 6-9 months: 450 g 9-12 months: 360 g 1-3 years: 240 g/month(2.8 kg/yr) 4-6 years: 180 g/month (2 kg/yr)
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Infant Weight
• At birth: 2.7 – 4.0 kg– At 5 months: 2X birth weight.– At 12 months: 3 X birth weight.– At 2 years: 4 X birth weight.– At 3 years: 5 X birth weight.– At 5 years: 6 X birth weight.– At 7 years: 7 X birth weight.– At 8 years: 8 X birth weight.– At 9 years: 9 X birth weight.– At 10 years: 10 X birth weight.
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Weight Gain (per day)
AGE WEIGHT GAIN 0-3 months: 30 g/day 3-6 months: 20 g/day 6-9 months: 15 g/day 9-12 months: 12 g/day 1-3 years: 8 g/day (2.8kg/yr) 3-6 years: 6 g/day (2 kg/yr)
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Formula For Weight
• During InfancyWT (Kg) = [ Age (months) +9] /2.
• During 2-6 YearsWT (Kg) = Age (yrs) X 2+ 8.
• During 7-12 YearsWT (Kg) = [Age (yrs) X 7-5] /2.
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Length/ Height
• Supine length is measured for children of less than two years of age.
• After two years of age, standing height is taken as a measure of stature.
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Height
• Avg newborn =20 inches 48 – 53 cm• Avg 1 year =30 inches 75 cm• Heredity: influences height more than
weight
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Length
• At Birth:– At birth: 48 – 53 cm– At one year = 75 cm.– At two years = 87.5 cm.– At four years = 100 cm.
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Length Gain
AGE GAIN 0-3 months: 3.5 cm/ month 3-6 months: 2 cm / month 6-9 months: 1.5 cm/ month 9-12 months: 1.2 cm/ month 1-3 years: 1 cm/month(12 cm/yr) 3-6 years: 0.25 cm/month (3 cm/yr)
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Gain In Length
• 1st year = 25 cm• 2nd year = 12 cm• 3rd year = 10 cm• 4th year = 3 cm• At puberty:
– Girls = 6-11 cm– Boys= 7-12 cm
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Formula for Calculating Height
From 1- 6 Years
Height (cm) = Age (Yrs) X 6 + 77
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Head Circumference
• At birth: 35.3 ± 1.2 cm.• Increases by 6 cm during the
first 3 months.• Further increases by another
6 cm during 3- 12 months.
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Gain in head circumference
• During 1st year = 12 cm.• During 2nd year = 2 cm.• During 3rd year = 1.5 cm.• From 3 to 14 years = 2.5 cm
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Changes in head circumference
AGE GAIN 0-3 months: 2 cm/ month 3-6 months: 1 cm / month 6-12 months: 0.5 cm/ month 1-3 years: 0.25 cm/month 3-6 years: 1 cm/year
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Proportion
• Large: head and abdomen• Short/small: arms and legs• Head grows rapidly b/c brain development• Soft spots allow head to grow and close
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Soft Spots
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1st Year Physical Developments
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Sight: Improves Rapidly
• Blurry at first, within week can focus on object 7-10 inches away 15-30 cm away
• 1 month, focus on objects 3 feet away By 3 ½ months, vision almost as good as an adult• Prefer patterns with high contrast and faces
– alternating stripes, bull’s eyes– Prefer color red
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Depth Perception
2nd month: recognize that object is three-dimensional, not flat
Binocularity: fixation of two ocular images into one cerebral picture begins to develop by 6 weeks and established by 4 months
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Hand-Eye Coordination
• Develop hand-eye coordination: – Move hands and fingers in relation to what is
seen• 3-4 months: reach for what they see
– Essential for:• Eating • Catching a ball • Coloring • Tying shoes
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Hearing
• develops before birth• At birth, can tell general direction sound is
coming from• Prefer human voice
– soothing voice calms– loud voice alarms
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Smell and Taste
• Within 10 days can tell mom’s smell• Can distinguish taste by 2 weeks old
– show preference for sweet taste• Learn about world by using mouth
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Voice
• Cry becomes softer as lungs mature• Physical growth of throat muscles, tongue,
lips, teeth, and vocal cords• Tongue and mouth interior change making
speech development possible
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Teeth
• Begin to develop in 6th week of pregnancy– Primary teeth begin to appear between 6-7 months of age– Complete set by 20 months (1 year, 8 months)
• Teething can be painful process– Can refuse food or drool a lot, increased desire for liquid,
coughing, and fever• how to help minor teething pain:
– teething biscuits or rubber teething rings– rub ice cube on gums to ease pain temporarily– teething medication
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Motor Skills
• Abilities that depend on use and control of muscles
• Mastering motor skills requires intellectual, social, emotional, and physical development– Control head by 1 month– 2-3 months can lift their chest– By 9 months crawling- adds opportunity for
learning
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The Developing Brain
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Rules to Build a Brain By
• Keep it simple and natural– Rich environment- lots of loving interaction and
talking• Match experiences to the child’s mental
capacities– Learn by physical experiences
• Practice makes perfect– Repetition
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Rules to Build a Brain By continued
• Make sure the child is actively involved– Learn by doing
• Provide variety, but avoid overloading– Give range of experiences, avoid being
overwhelmed• Avoid pushing the child
– Learn better if emotionally involved
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Language Acquisition
Cooing: Repetition of vowel sounds
by infants Babbling: Repetition of
meaningless language sounds
(e.g., babababa) Single-Word Stage: The child says
one word at a time Telegraphic Speech: Two word
sentences that communicate a
single idea (e.g., Want yogurt)
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Language development
12 weeks cooing, smiles when talked to
16 weeks turns head in response to human voice
20 weeks makes vowels and consonant sounds
6 months babbling (all sounds)8 months repeat certain syllables
(ma-ma)12 months understands and says
some words
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Psychosocial development
• Erik Erikson: First Psychosocial Stage: Trust vs. Mistrust
• Consistent loving care by a mothering person is essential to build a trust relationship.
• Mistrust develops when basic needs are inconsistently met.
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Piaget’s Cognitive Stages
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Sensorimotor Stage (0-2)
• Stage One (birth-1 mo.)• Use of reflexes
• Stage Two (1 - 4 mos.)• Primary circular reactions: Actions that are at first random and
activate a reflex are attempted again to try and induce the experience again (recognition of causality). The interesting events are occurring within the body (plays with hands, fingers, feet).
• Stage Three (4 - 8 mos.)• Secondary circular reactions: The interesting events in this case
are located in the external world (Making Interesting Sights Last)• Beginning of object permanence: shows separation anxiety • Able to imitate selective activity
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37Infants’ imitation of facial expressions
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Sensorimotor Stage, Cont’d
• Stage Four (8 - 12 mos.)• Coordination of secondary
schemata • New Adaptations and
Anticipation• Intentionality occurs in
interactions with the environment and the infant is moving towards goal directed behavior: works to get toy that is out of reach
• Fully developed object permanence
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Moral development (Kohlberg)
• Level 1: Preconventional morality (0-9y)• Stage 1: the punishment-and-obedience orientation.
– Children determine the goodness or badness of an action in terms of its consequences.
– They avoid punishment and obey unquestioningly those who have the power to determine and enforce the rules
– They have no concept of the underlying moral order
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Play
• Solitary Play: When a
child plays alone even
when with other
children
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Principles of Motor Development
• Gross movements before fine movements• Pattern of development is usually the same,
but the rate differs greatly from child to child and from culture to culture.
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2-3 months
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• First Month– Turns head to clear nose from bed– Keeps hands fisted or slightly open– Head lag when pulled from lying to sitting
• Second month– Holds head up while on tummy almost 45 degrees
• Third month– Lift head and chest of the bed– Turns head to sounds– Reaches for objects with both hands
Gross Motor Development
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• Fourth month– Rolls from back to side– Able to raise head and chest off surface to angle
of 90 degrees
• Fifth month– Rolls from abdomen to back– May sit if supported– When supine, puts feet to mouth
• Sixth month– Transfer toy from one hand to next– army crawl on tummy– Rolls from back to abdomen
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• Seventh month– Pushes up on hands and knees– Sits w/ little support– When held in standing position
bounces actively• Eighth month
– Sit without support– Creeps– Stands leaning against something
• Ninth month– May crawl upstairs
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• Tenth month– Stands w/ little support– Cruises the room.
• Eleventh month– Stands alone
• Twelfth month– Walks
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• At 4 month: brings hands together and shake rattle.
• At 6 month: palmer grasp.• At 7 month: pass object from hand to another.• At 8 month: advanced eye-hand coordination.• At 10 month: pincer grasp.• at 12 month: holds cup or spoon
Fine Motor Behavior
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Hematologic System
Hgb A production
largely replaces Hgb F
by 4 months
(physiologic anemia
due to fetal RBCs
destruction)
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Respiratory System
• RR slows.• Upper respiratory infections tend to be more
severe due to small lumen of respiratory tract and inefficient mucus production.
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• Become functioning at 2 months.
• Produce both IgG & IgM antibodies by the first year.
Immune System
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Emotional
• At 6 weeks: social smile.• At 4 months: recognize his primary
caregiver.• At 7-8 months: stranger anxiety,
continue until 12 months.• At 8 months: separation anxiety,
continue until preschool period.• Both are related to infant’s ability to
discriminate between familiar and nonfamiliar people
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Dentation
• First tooth erupt 5-7 months• Has 6-8 deciduous teeth by the first year of
age.• The sequence of eruption is:
– At 6 months: lower central incisors.– At 7 months: lower lateral incisors.– At 8 months: upper central incisors.– At 9 months: upper lateral incisors.
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GI System
• Can digest protein at birth.• Amylase deficiency until 3rd month of age
( cannot digest complex CHO)• Lipase deficiency during entire 1st year.• Infant needs frequent feedings.• Extrusion reflex exists until 3-4 months.• Introduction of solid food 4-6 months.
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Handling and Feeding Infants
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Gentle Handling of an Infant
• Never shake a baby• Shaken baby syndrome- when someone severely
shakes the baby usually to make them stop crying– Damages the brain– Learning problems– Mental retardation– Blindness– Deafness– death
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Gentle Handling of an Infant continued
• Safe ways to handle a stressful situation with crying:– Put baby down in a safe place and calm down– Ask a friend or relative to care for the baby– Take deep breaths– Talk out your problems
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Energy Requirement
Age Energy requirement< 6 months Wt (kg) x 108/ day6mo-1 year Wt (kg) x 98/ day
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Water requirements = amt in foods + fluids
Age Amount• 3 days 80-100 ml/kg/day• 10 days 125-150 ml/kg/day• 3 mo 140-160 ml/kg/day• 6 mo 130/155 ml/kg/day• 9 mo 125-145 ml/kg/day• With BF and formula: none additionally needed in
first 4 to 6 months
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Feeding Methods
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Infant Nutrition
Birth through 4-6 months
Breast milk
OR
Iron-Fortified infant formula
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Breast- Versus Bottle-Feeding
• Debate focused on whether breast-feeding is better for the infant than bottle-feeding
• American Pediatric Association strongly endorses breast-feeding throughout the first year of life
• Benefits– Appropriate weight gain– Fewer allergies– Fewer illnesses– Reduced childhood cancer and reduced incidence of breast cancer in
mothers and their female offspring– Lower incidence of SIDS– Stronger attachment bond
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Breastfeeding Basicshttp://video.about.com/breastfeeding/Breastfeeding.htm
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Why Breastfeed?
• Healthy• Free• Bonding• Natural• Builds immune system• Mom burns more calories and loses weight
quicker
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How long should you breastfeed?
• Recommend 1st 6 months• First milk- colostrum
– High in fat, protein, antibodies
• 20 minutes on each breast• Feed on demand• 5-6 wet diapers• 3-4 dirty diapers• http://video.about.com/breastfeeding/Breast-Feedin
g-Positions.htm
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Nutrition
• Avoid gassy foods:– Broccoli, green leafy vegetables, spicy foods
• Mom’s diet becomes baby’s diet
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Video Clips and Pictures
• http://www.ameda.com/breastpumping/videos/popup_video.aspx?id=LatchOnEnglish
• http://www.breastfeeding.com/helpme/helpme_video_4_bf_positions.html
• http://www.breastfeeding.com/helpme/helpme_videos/18_how_baby_sounds_bfing.html
• http://similac.com/feeding-nutrition/diaper-decoder
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How to Feed with a Bottle
• Hold baby is semi-upright position• Support neck and head with the head held
above the stomach• Hold the bottle at an angle
– Prevents swallowing air• Never prop a bottle
– Choking hazard, tooth decay, digestive problems
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Burping a Baby
• Burping helps expel air the baby swallowed• You should burp a baby once during feeding
and once after
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4 through 7 months
Breast milk
OR
Iron-Fortified infant formula
Iron-Fortified infant cereal
Vegetables
Fruit
Infant Nutrition
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Types of Formula
• Powder, concentrate, ready to feed (RTF)
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8 through 11 months
Same as 4 through 7 months
PLUS
Meat
Egg yolks
Infant Nutrition
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11 months
Finger foods
Cup
Infant Nutrition
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Tips for Introduction of Solid Foods
Start slowly
Only 1 new food every 4-5 days
Hold baby during feeding
First food: Iron-Fortified infant rice cereal
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Tips for Introduction of Solid Foods
Use single-ingredient foods
Read food labels
Avoid desserts
Avoid foods that can choke infants
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Introducing New Foods
• Introduce solids around 4-6 months• Cereal first
– Mix with breast milk or formula to make it runny– Feed with a spoon, never in a bottle
• Vegetables, then fruits– 1 new food at a time for at least 3 days– Feed with a spoon, never in a bottle
• Never feed straight from the jar• 8-10 months, start using fingers; eventually move to
spoons
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What Infants Need to Stay Healthy
• Enough calories to provide rapid growth• Protein, iron, vitamins B, C, and D• Food that is easy to digest• Adequate amounts of liquid
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Feeding Problems
• Colic (<3months): gas production, and bloating– Cause? Not always known: formula fed! (high in carbohydrate) – Overfeeding : swallowing too much air.– Breastfeeding?
• Foods in the mother’s diet• Cow’s milk, or other items
• Spitting up– Normal occurrence: after meals, mouthful of milk.– Unless projectile vomiting: Organic problem: pyloric sphincter
closure
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Sleep
• Newborns sleep 12-20 hours a day– By 1 year has 2-3 sleep periods including naps
• Preparation for sleep:– Change diaper and clothes, wash face/hands– Rock to calm the baby– Put the baby in the bed on it’s back– Follow the same routine to provide comfort each
time
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Common Health Concerns
• Teething: gum sore, tender can lead to decreased intake and cry.
• Thumb sucking: does not deform the jaw as long as it stops by school-age.
• Diaper dermatitis: prolong contact with urine or feces.• Constipation: increased with formula fed.• Sleep problems: as a result of colic or other health
problems.