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
2
Erickson’s Developmental Task
• Trust vs Mistrust– Getting needs met
– Tolerating frustration in small amounts
– Recognizing mother as distinct from others and self
4
TOUCH
• It is the most highly developed sense.
• Mostly at the lips, tongue, ears, and forehead.
• Very comfortable with touch.
6
HEARING
• Ordinary sounds are heard well before 10 days of life.
• Response is either cry, eye movement, cessation of activity or startle reaction
7
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
8
Vision
• Pupils constrict to light
• Bright lights are unpleasant
• Follow objects in line of vision by 6-8 weeks
9
• TASTE– Bitter and sour fluids are resisted while sweet
are accepted.
• SMELL– Only evident in search for nipple as he smells
breast milk.
10
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
11
INFANT REFLEXES• Moro• Tonic Neck• Palmar Grasp• Babinski• Rooting• Sucking• Swallowing• Stepping
12
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
13
Gross Motor DevelopmentRolling Over
15
Supports upper body with arms at 2 months
Rolls over at will at 4 months
Gross Motor DevelopmentSitting Up
16
Sits alone with hands forward for support at 6-7
months
Sits without hands forward at 8 months
Gross Motor DevelopmentAmbulation
17
Walks when led at 10 months
Begins to walk several steps unassisted around 12 months
18
The Development of Locomotion, Prehension, and Perception
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
19
The Development of Locomotion, Prehension, and Perception (cont.)
Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
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
21
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
22
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
23
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.
24
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
25
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
26
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
29
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
33
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
34
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
35
Absolute contraindications to breastfeeding
• Galactosemia• Phenylketonuria• HIV-positive mother• Chemotherapy• Radioactive isotope therapy• Illicit drug use• Active untreated tuberculosis
36
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
37
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
38
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.
39
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!
40
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
41
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
42
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
43
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.
44
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
45
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
46
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