Chapter 16The 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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SENSES

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 constrict to light

• Bright lights are unpleasant

• Follow objects in line of vision by 6-8 weeks

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• TASTE– Bitter and sour fluids are resisted while sweet

are accepted.

• SMELL– Only evident 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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INFANT REFLEXES• Moro• Tonic Neck• Palmar Grasp• Babinski• Rooting• Sucking• Swallowing• Stepping

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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 thrust 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

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Gross Motor DevelopmentRolling Over

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Supports upper body with arms at 2 months

Rolls over at will at 4 months

Gross Motor DevelopmentSitting Up

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Sits alone with hands forward for support at 6-7

months

Sits without hands forward at 8 months

Gross Motor DevelopmentAmbulation

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Walks when led at 10 months

Begins to walk several steps unassisted around 12 months

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The Development of Locomotion, Prehension, and Perception

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

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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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SPEECH MILESTONES• 1-2 months - cooing

• 2-6 months - laughs and squeals

• 8-9 months - babbles, mama and dada as sounds

• 10-12 months – Mama/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 and comfort when crying

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

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Emotional Development In infancy, emotions are unstable- change from crying to

laughter quickly

Affection for love from family is apparent in early life

10 months - begin to express anger, sadness, pleasure, jealousy, and affection

12 months - above emotions are distinguishable

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Need for Constant Care and Guidance

• A crying baby needs to be soothed

• Each time the parents attend to the baby needs, the baby learns to develop trust in caregivers even when needs are not met immediately later in life

• You will never spoil a child by holding them too much

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

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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

• 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

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Colic

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

27Elsevier 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

28Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Immunizations

• Nurses must stress importance of immunizations and timing of administration

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

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VaccinationsMyths

• Vaccines cause Autism

• Waiting to vaccinate or following modified schedule is better for infants

Facts• This argument was based

on a now DEBUNKED study!

• It is most important to vaccinate at young age when immune system is still not fully developed!

30Sources: who.int/, cdc.gov, publichealth.org

VaccinationsMyths

• Not immunizing will only affect my child.

• Immunizations contain high levels of Mercury which will harm my child.

• There are very few deaths from vaccine-preventable illnesses.

Facts• Many children rely on “Herd

Immunity”!• Almost all routine childhood

vaccinations are now Mercury-free. Mercury is also found in drinking water, formula, and breastmilk!

• Globally, 1.5 million children die each year from vaccine-preventable diseases!

31Sources: who.int/, cdc.gov, publichealth.org

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 in bottle!

• 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

• Research has shown that early introduction of foods known to cause allergic responses, such as wheat, eggs, nuts, and seafood may reduce the risk of developing food allergies. However, some families may choose to omit or delay introduction if there are family allergies.

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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

• Do not start with mixed foods.

• Honey should NEVER be given to infants younger than one year!

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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• Car seat should be placed in center back seat.• No car seats in front seat!!!• Sleeping in car seat may increase risk for SIDS.

• 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.

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Infant Safety• 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• Appropriate toys for infants include: Mobiles, safety

mirrors, rattles, stacking toys, simple pop-up picture books, musical toys, squeeze toys, infant swings, and teething toys

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Summary of Major Developmental Changes in the First Year

• 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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RED FLAGS 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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