- Grows and develops skills more rapidly than any other stage
- Progresses in a predictable pattern
Weight and Height
- Increase rapidly
- By 6 months of age, the infant will DOUBLE their birth weight height increase about 6 inches
- By 1 year of age, the infant had TRIPLED their birth weight and has grown 10-12 inches
Head and Skull
- Head Circumference
- At birth average head circumference is 13.7 inches and slightly larger than the chest circumference
- Chest measures about the same as the abdomen at birth
- By 1 year of age, head circumference has grown to ~18 inches
- Chest circumference catches up to head circumference by 5-7 months of age
- Fontanels and Cranial Sutures
- Posterior fontanel is usually closed by 2ND or 3RD months
- Anterior fontanel closes by 12-18 months
- Cranial sutures ossify in later childhood
Skeletal Growth and Maturation
- Skeletal system is completely formed in cartilage at the end of 3 months’ gestation
- Bone ossification and growth occur during remainder of fetal life and throughout childhood
- “Bone age” can be determined by x-ray and will match chronological age – Not done unless necessary to avoid x-ray exposure.
Eruption of Deciduous Teeth (PRIMARY)
- Deciduous teeth begin to erupt between 6-8 months of age
- Signs of teething include:
- Restless or fussy, swollen and inflamed gums
- Does not cause high fever or URI
- Cold teething ring may be soothing
- Nutritional deficiency or prolonged illness in infancy may interfere with calcification of both deciduous and permanent teeth
- Fluoride helps with calcification of teeth
- American Dental Association recommends administration of fluoride to infants and children in areas where fluoride is inadequate or absent in drinking water
- During fetal life:
- ↑ levels of hemoglobin and red blood cells are necessary for normal OXYGENATION
- After birth:
- RESPIRATORY system supplies oxygen
- Hemoglobin decreases in volume
- RBC’s gradually decrease in number until 3 months of age
- Thereafter, count gradually increases until adult levels are reached
- Average BP during first year of life is 85/60 mm HG
- Average apical HR: RECOMMENDED way of taking hr on an infant.
- Asleep = 90 bpm
- Awake = 170 bpm
- Crying = 190 bpm
Body Temperature and Respiratory Rate
- Body temperature follows the average normal range following the postnatal adjustment
- Respirations average 30 breaths/minute
- As infant grows, nerve cells mature, and fine muscles begin to coordinate in an orderly pattern of development
- Average rates of growth and development are useful for COMPARISON
** Table 23-1 Summary of Infant Growth and Development Milestones at the end of the guide**
Gross Motor Development
- Can turn head from side to side when lying prone BIRTH-4 WEEKS
- No longer has Moro reflex 2.5-3 months
- Play’s w/ hands; balances head and body for short periods while sitting 16 WEEKS (4 months)
- Able to sit up; can roll over (roll to abdomen); controls head movements 20 Weeks (5 months)
- Sits alone in highchair; rolls over and back from abdomen 24 WEEEKS (6 months)
- Can lift head up when in supine position 28 WEEKS (7 months)
- Crawls around 32 WEEKS (8 months)
- Stands alone; begins to walk alone; can change self from prone to sitting to standing position 40 WK- 1YR/10-12 months
Fine Motor Development
- Hands flexed BIRTH to 4 weeks
- Hands open 6 weeks
- No longer has grasp reflex 10 to 12 weeks (3 months)
- Grasps objects with 2 hands; eye-hand coordination beginning 16 Weeks (4 months)
- Holds a bottle 24 weeks (6 months)
- Holds a cup; transfers objects from one hand to the other 28 weeks (7 months)
- Palmer grasp lessens and pincer grasp develops 32 WEEKS (8 months)
- PINCER GRASP- USING THUMB AND FINGER
- Stacks blocks; holds crayon to scribble on paper 40 WEEK (1 YR 10-12) months
- Cries when upset BIRTH-4 weeks
- Cooing predominant; babbling sounds 6 WEEKS (1.5 months)
- Laughs aloud 16 WEEKs (4 months)
- Duplicates “ma-ma” and “pa-pa” 28 WEEKS (7 months)
- Words emerge; says “ma-ma” and “da-da” w/ meaning 40 WKS/1 YR/10-12 months
- Some smiling begins BIRTH-4 weeks
- Smiles at significant others 10-12 WKS/2.5-3 months
- Squeals and laughs 16 WEEKS/4 months
- Smiles at self in mirror; Cries when objects are taken away 20 WKS/5 months
- Likes to be picked up; plays “peek-a-boo”; Fear of strangers 24 WKS/6 months
- Imitates simple acts; responds to “no” 28 WEEKS/7 months
- Afraid of strangers 32 WEEKS/8 months
- Does things to attract attention; imitates parents 40 WEEKS-1 YR/10-12 months
- Infant’s development depends on mutual relationship with give and take between the infant and the environment
- Family Caregivers play most important role
- An infant understands only through the five senses and cannot apply abstract reasoning
- As infant matures, it recognizes parents as primary caregivers and the infant will become fearful when they disappear
- To the infant out of sight = out of existence
- Self-assurance is necessary to confirm that objects and people do not cease to exist when out of sight
- During the first year of life, the infant’s rapid growth creates greater need for nutrients more than any other time of life
- Per Academy of Pediatrics Committee on Nutrition, BREAST-FEEDING is the best method
- First 4 to 6 months of life, use of breast milk or commercial infant formulas exclusively
- May need supplemented vitamins C and D, iron, and fluoride
- Breastfed infants need IRON and vitamin D
- Need for vitamin drops
- Fluoride needed in small amounts for strengthening calcification of teeth and preventing tooth decay
- Recommended for breast-fed and commercial formula-fed babies
Addition of Solid Foods
- At about 4 to 6 months, infant’s milk consumption alone is not enough
- IRON supply becomes low, and supplements of IRON-RICH foods are needed
- Extrusion reflex – thrusting the tongue forward as if to suck, has the effect of pushing solid food out of the infant’s mouth
- Started in small amounts – smooth, thin, lukewarm, and bland
- Offer 1 food at a time, waiting 4-5 before introducing a new solid
- Will help to determine if there is a reaction to a new food
- When teeth start erupting between 4-7 months of age, infant may enjoy teething biscuit for comfort
- 9-10 months chopped food can be substituted for pureed foods
- Breast milk or formula given for first 12 months
- Whole milk introduced between 12 to 13 months
- 7 to 8 months, baby will explore the use of spoon
- Use of fingers to feel texture and feed self, very messy eaters
Weaning the Infant
- 5 to 6 months of age can start using a cup to drink, reluctant to give up bedtime bottle
- Infant must never be permitted to take a bottle of formula, milk, or juice to bed
- Discouraged b/c sugar from formula or juice coats infant’s teeth for long periods and cause erosion of the enamel of deciduous teeth = early childhood caries
- Liquid from milk, formula, or juice can pool in mouth and flow into Eustachian tubes causing otitis media if infant falls asleep with bottle
- Milk need can be met by offering yogurt, custard, cottage cheese if resist drinking from cup
- DO NOT use honey or corn syrup to sweeten milk b/c of danger of botulism; infant’s system is not strong enough to combat
Health Promotion and Maintenance
- Routine checkups, immunizations, family teaching, and education about accident prevention are important aspects of health promotion and maintenance
- Immunizations and frequent well-baby visits help ensure good health
- Reinforcing family teaching and accident prevention help caregivers provide the best care for rapidly growing child
- Well-baby checks at 2 weeks; 2, 4, 6, 9 and 12 months
- Collect data regarding growth and development, nutrition, sleep, caregiver-infant relationship, and any potential problems
- Receive immunizations per CDC recommendations
- Do not need to be postponed if child has a cold
- Should be postponed if child has acute febrile condition or condition causing immunosuppression or receiving corticosteroids, radiation, or antimetabolites
- Side effects of immunizations are minor
- LOW-GRADE fever within first 24-48 hours – treat w/ Acetaminophen
- LOCAL reaction – tenderness, redness, and swelling at injection site – treat w/ cool compresses
- May be fussy and eat less than usual – encourage to drink fluids
- Call healthcare provider with concerns, other reactions, or symptoms don’t disappear in 48 hours
- Caregiver has the RIGHT TO REFUSE immunizations if they have been fully informed about immunizations and possible reactions – maintain non-judgmental viewpoint
- Well-baby visits provide opportunity to ask family about concerns and reinforce teaching
- During well visits:
- Discuss normal GROWTH and DEVELOPMENT MILESTONES
- Discuss any infant sleep and activity concerns
- Encourage caregiver to seek information any other problems, worries, or anxieties
- Provide ample time and opportunity for caregivers to ask questions and gain information
- Reinforce topics concerning care
Bathing the Infant
- Daily bathing is not necessary
- An infant in a tub should always be held securely
- Regular shampooing is important to prevent seborrheic dermatitis (cradle cap)
- Scented or talcum powder should not be used after bath
- Tends to cake in skin creases causing irritation
- May cause respiratory problems when inhaled
- Can cause allergic reactions
- Excessively dry skin may benefit from application of lanolin or A+D ointment
- After bath, fingernails inspected and cut if long. Cut straight across
Caring for the Diaper Area
- Soiled diapers should be changed FREQUENTLY to prevent diaper rash
- Caregiver should check 2-4 hours while infant awake to see if diaper is soiled
- Cleanse diaper area with water and mild soap or commercial diaper wipes
Dressing the Infant
- Dress the infant with the same amount of clothing the adult finds comfortable
- Dressing for outdoors in cold weather, a head covering is important b/c infants lose large amount of heat through their heads
- In hot, sunny weather, the infant should not spend much time in direct sun b/c infant’s skin is tender and burns easily
- Infants do not need hard-soled shoes
- Shoes with stiff soles hamper the development of the foot
- Shoes should be durable and flexible and ample room in the toe
- Most infant sleep 10-12 hours each night
- Take 3 naps per day
- Infants should not have pillows in the bed d/t risk of SUFFOCATION
- Consistent bedtime routine is helpful in establishing healthy sleeping patterns and prevention of sleep problems
- Place infant in crib while awake and letting fall asleep in the crib creates good sleeping habits
- Using the crib for sleeping only and not for play activities, associates the crib with sleep
- Teething begins in second half of the first year
- Can begin practicing good dental hygiene
- Rub the gums and newly erupting teeth w/ clean, damp cloth
- Soft bristled toothbrush can be used when several teeth present
- Gentle cleansing w/plain water is adequate
- Toothpaste is not recommended b/c infant will swallow too much of it
***See Family Teaching Tips – Infant Safety, pg. 522***
- Provide information and anticipatory guidance about:
- Motor Vehicle
- Remind caregivers that the infant is developing rapidly and safety precautions should stay one step ahead of infant’s developmental abilities
- Caregivers should teach older children in family to be watchful for possible dangers to infant, and they must be alert to potential dangers the older sibling may introduce
- Unsafe toys
- Rough play
- Jealous or harmful behavior
Be one step ahead of child’s development and prepared for the next stage.
- Always hold bottle when feeding, neverprop bottle.
- Crib and playpen bars should be spaced no more than 2 3⁄8 in apart.
- Check toys for loose or sharp parts or small buttons.
- Keep small articles (such as buttons, marbles, safety pins, lint, balloons) off the floor and out of infant’s reach.
- Store products such as baby powder out of child’s reach.
- Keep plastic bags out of child’s reach.
- Do not use pillows in a crib.
- Avoid giving child foods such as hot dogs, grapes, nuts, candy, and popcorn.
- Remove bibs at nap and bedtimes.
- Do not tie pacifier on a string around the child’s neck.
- Never leave child unattended on a high surface such as a highchair, bed, couch, or countertop.
- Place gates at the tops and bottoms of stairways.
- Raise crib rails and be sure they are securely locked.
- Place infant in an approved infant car carrier in the back seat when in a car. Follow the manufacturer’s instructions regarding the age and size of the infant regarding placement of the carrier (rear- or front-facing).
- Never leave child unattended in a car.
- Never leave child alone in the bathtub, or near any water, including toilets, buckets, or swimming pools.
- Fence and use locked gates around swimming pools.
- Cover unused plugs with plastic covers.
- Keep electrical cords out of sight.
- Remove tablecloths or dresser scarves that child might grasp and pull.
- Pad sharp corners of low furniture or remove them from child’s living area.
- Turn household hot water to a safe temperature—120°F (48.8°C).
- Check toys for nontoxic material.
- Move all toxic substances (cleaning fluids, detergents, insecticides) out of reach and keep them in locked areas.
- Remove any houseplants that may be poisonous.
- Protect child from inhaling lead paint dust (from remodeling) or chewing on surfaces painted with lead paint.
- Place medicines in locked cupboards; remind family and friends (especially those with grown children or no children) to do the same.