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Chapter 16Chapter 16

The InfantThe Infant

ObjectivesObjectives

• Describe the physical and psychosocial development of infants from age 1 month to 12 months, listing age-specific events and guidance when appropriate.

• Discuss the major aspects of cognitive development in the first year of life.

• Relate the nursing responsibilities in health promotion and illness prevention in infants in the first year of life.

2Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

Objectives Objectives (cont.)(cont.)

• Discuss the nutritional needs of growing infants.• Compare breastfeeding, bottle feeding, and the

various infant formulas available.• Describe how to select and prepare solid foods

for the infant.• List four common concerns of parents about the

feeding of infants.• Discuss the development of feeding skills in the

infant.



• Compare and contrast natural, organic, and processed foods.

• Examine nutritional counseling for the infant.• Identify the approximate age for each of the

following: posterior fontanel has closed, central incisors appear; birthweight has tripled; child can sit steadily alone; child shows fear of strangers.

• Describe normal vital signs for a 1-year-old infant.



• Discuss safety issues in the care of infants.

• Discuss the approach and care of an infant with colic.

• Identify age-appropriate toys and their developmental or therapeutic value.

• Discuss principles of safety during infancy.

• Discuss the development of positive sleep patterns.


MilestonesMilestones

• 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


Average Vital Signs of the InfantAverage Vital Signs of the Infant


Oral StageOral 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

• When infants are able to use their hands more skillfully, they will gradually derive pleasure and comfort from other sources


Motor DevelopmentMotor Development

• Grasp reflex disappears around 3 months of age

• Prehension occurs around 5 to 6 months of age and follows an orderly sequence of development

• Parachute reflex appears around 7 to 9 months as a protective mechanism

• Pincer grasp well-established by 1 year of age

Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 9


The Development of Locomotion, The Development of Locomotion, Prehension, and PerceptionPrehension, and Perception


The Development of Locomotion, The Development of Locomotion, Prehension, and Perception Prehension, and Perception (cont.)(cont.)

Emotional DevelopmentEmotional Development

• Consistency must be established to develop trust, which is vital to the development of a healthy personality

• Infants who are consistently picked up when they cry tend to have fewer crying episodes and less aggressive behavior as toddlers

• Infants will easily accomplish various activities if they are not forced before they reach readiness

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


Need for Constant Care and Need for Constant Care and GuidanceGuidance

• Sensory stimulation is essential for the development of the infant’s thought processes and perceptual abilities

• A crying child should be soothed

• If the infant appears hungry, do not delay the feeding in order to adhere to a specific routine

• An infant can recognize warmth and affection or the lack thereof


Development and CareDevelopment 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


Community-Based Care: Community-Based Care: A Multidisciplinary TeamA Multidisciplinary Team


Health PromotionHealth Promotion

• Nurse’s responsibilities– Guide parents and assist in the acquisition of

necessary skills to ensure the healthy growth and development of their infant

– Provide appropriate community referrals as indicated


Coping with an Irritable or Coping with an Irritable or Lethargic InfantLethargic 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

sucking17Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.

ColicColic

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


Developing Positive Sleep PatternsDeveloping Positive Sleep Patterns

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

• Synchronizing circadian rhythm of infant to family routine is a learned behavior

• 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


Illness Prevention: Parent Illness Prevention: Parent EducationEducation

• Stress importance of periodic health checks

• Ensure infant receives recommended vaccinations at appropriate times

• Provide education and anticipatory guidance for the developmental changes that occur

• Stress importance of changing diaper when it becomes wet or soiled

• Monitor growth of infant by documenting measurements on a growth chart

• Ensure adequate fluid and nutrition are provided


Illness Prevention: Physical Illness Prevention: Physical ExaminationExamination

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

explanations to the parents


ImmunizationsImmunizations

• Stress repeatedly importance of immunizations and timing of administration

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


Nutrition CounselingNutrition 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


Parental Concerns Parental Concerns

• Prior to teaching about infant nutrition, the nurse should assess– Parental knowledge– Infant developmental behavior, readiness– Parent-child interaction– Cultural and ethnic practices


Breastfeeding and Bottle FeedingBreastfeeding 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


Absolute Contraindications to Absolute Contraindications to BreastfeedingBreastfeeding

• Galactosemia

• Phenylketonuria

• HIV-positive mother

• Chemotherapy

• Radioactive isotope therapy

• Illicit drug use

• Active, untreated pulmonary tuberculosis


Prebiotics and ProbioticsPrebiotics and Probiotics

• Prebiotics– Nondigestible food

ingredient– Indirectly stimulates

growth or activity of bifidobacterium (a microorganism)

– Assures balance of bacteria is maintained

• Probiotics– Protective to GI

tract– Used to treat

diarrhea


Safe Bottle FeedingSafe 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


Adding Solid FoodsAdding 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

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


Nursing TipNursing 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


Recommended Fat Intake During Recommended Fat Intake During InfancyInfancy

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

• Easily digestible fats are needed for growth and development, including brain development

• 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


Health PromotionHealth Promotion

• Encourage breastfeeding

• Discourage overfeeding

• Teach recognition of signs of satiety

• Prevent early introduction of solid foods


WeaningWeaning

• 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


Organic and Natural Foods 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


Infant SafetyInfant 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

• 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


Summary of Major Developmental Summary of Major Developmental Changes in the First YearChanges 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


Question for ReviewQuestion for Review

• What is the best way to reduce the incidence of sudden infant death syndrome (SIDS)?


ReviewReview

• Objectives

• Key Terms

• Key Points

• Online Resources

• Review Questions
