Newborn and Infant Growth & Development

Infant Respiratory system

Very small and immature. The trachea and bronchi are very close together. Bronchi and bronchioles are narrow and short. Nasal passages are narrower. Larynx is funnel-shaped. Less alveoli. Chest is barrel shaped. Ribs are flexible.Increased rate of oxygen consumption.

Infant are Obligatory

nose breathers until 4 months of age.

What risks are associated with the anatomy of the infant’s lungs and airway?

increase risk for respiratory infections/obstructions, even little inflammation can cause an obstruction Muscles that aid in respiration Are not developed and strong in the infant

protect the baby’s airway

Protect them from respiratory infections. No smoke around, small cut food, suctioning, place towel behind shoulders

Infant Immune System

An infant’s immune cells are quick and efficient in a broad scope but do not have “memory” to rely on. Fully functional at 6-8 years

Immune protection

Babies acquire some antibodies from breastfeeding and placental transmission from the mother. Good hand-washing and keep away from sick individuals.

viruses/bacteria pose a more serious threat to infants than others

Respiratory syncytial Virus (RSV),E. Coli, Group B streptococcus, Pertussis, Enteroviruses

Infant Cardiovascular system

HR is very fast (110-160) and will slow during the first year of life. Listen to an apical pulse for a full minute. Heart doubles in size at 1 year. BP in all extremities should be similar. Use an appropriate size cuff, Keep infant calm! BP will be about 60/40 when a baby is born.

If Bp is different in arms or legs can indicate

Congenial Heart Defect

Newborn HR

110-160

Newborn RR

30-60

Newborn BP

60/40

Infant HR

90-160

Infant RR

25-60

Infant BP

85/50

Toddler HR

80-140

Preschool HR

70-120

School Age HR

60-110

Adolescent HR

50-100

Toddler RR

25-30

Preschool RR

20-25

School Age RR

20-25

Adolescent RR

16-20

Toddler BP

85-91/37-49

Preschool BP

89-98/37-49

School Age BP

94-106/55-62

Adolescent BP

110-120 / 65-80

Innocent murmur

in an infant two to 3 weeks old, closing of shunts, asymptomatic

Pathologic murmur

poor activity tolerance (weak cry, poor eating, sweating

Infant Hematopoietic system

Fetal hemoglobin has is present until about 6 months of age.

Physiological anemia i

s expected at around 2-3 months of age. AT BIRTH, NEWBORNS HAVE HIGH HEMOGLOBIN (HGB) LEVELS TO SURVIVE THE LOW OXYGEN ENVIRONMENT IN THE WOMB. ONCE BREATHING AIR, THE BABY’S OXYGEN SUPPLY INCREASES, SUPPRESSING ERYTHROPOIETIN PRODUCTION. RED BLOOD CELL PRODUCTION TEMPORARILY HALTS WHILE THE BODY SWITCHES FROM MAKING FETAL HGB TO ADULT HGB. THIS RESULTS IN A NORMAL HARMLESS DIP IN HGB THAT NORMALLY BOTTOMS OUT AT 2-3 MONTHS.

physiologic anemia

Natural transition, 2-3 months, Asymptomatic, no treatment

pathologic anemia Underlying cause

Disease, blood loss, rapid cell destruction (ABO incompatibility) or bone marrow failure

pathologic anemia timing

Anytime, especially within the first month of life

pathologic anemia s/s

Pallor, rapid heart rate, respiratory distress, jaundice, poor feeding

pathologic anemia Hgb levels

Drops lower than 13.5 g/dL in the first month!

pathologic anemia treatment

Blood transfusion, iron or phototherapy

Adult RBC life span is 120 days but

life span of the neonatal RBC is only 60-90 days.

Infant Gastrointestinal system

Digestive processes are very immature. Amylase is limited until 4-6 months of life., Tiny bellies. Babies should only have breast milk or formula for the first 6 months of life. No cows milk at least 6 months of age. Limit cows milk from 6 months to 1 year. Low iron content! Risk for intestinal bleeding or allergies.

Stool at birth

Meconium Stringy, tenacious, and black tarry texture

Stool INGESTION OF COLOSTRUM OR FORMULA Gradual Transition

Few greenish stools to gradual yellow color

EARLY INFANCY Stools of formula fed baby

Lemon yellow color, Soft, more frequent

EARLY INFANCY Stools of breast fed baby

Yellow-orange color, Curdy

Infant Thermoregulation system

Newborns do not regulate their body temperature efficiently. Dress/ bundle/ swaddle appropriately.

Infant Renal system

immature until age 2. Increased and altered drug metabolism. Increased risk for dehydration – Urine is dilute. Monitor intake/output – weigh diapers!! healthy newborns may not have any urine output in the first 24 hours!

Infant Minimum acceptable urine output

1-2 mL/Kg/hour, At least 6 wet diapers in 24 hours

Neurologic system

Critical brain growth and myelinization of the spinal cord. By six months of age, an infant’s brain weighs half on an adult brain. Neck muscles are weak and underdeveloped. Infant reflexes are KEY indicators for healthy neurologic development

By six months of age, an infant’s brain weighs

half on an adult brain

The posterior fontanel closes at

2-3 months of age and anterior fontanel closes at about 12-18 mouths.

Setting the Family up for a smooth transition home

Newborn Exam, Hearing Test, Accurate Vital Signs

CCHD screening

Screening is done when a baby is at least 24 hours old. Helps detect critical congenital heart defects by checking a pre-ductal and post-ductal SpO2.

Newborn screening tests PKU

Rare metabolic disorder where the infant lacks enzymes needed to break down phenylalanine (amino acid). Requires dietary changes – highly specific, low protein plan designed to prevent the amino acid phenylalanine from building up in the body. phenylalanine is NEUROTOXIC in these infants

Newborn screening tests

CCHD, PKU, Congenital hypothyroidism Cystic fibrosis Maple syrup urine, and many other metabolic and genetic diseases!!

Infant education

Breastfeeding. (Lactation consult) Follow up with the pediatrician. Well-child visits. Tummy Time! SAFETY (Car seat, crib, sleep) Feeding. (Every 2-3 hours or on-demand.) Hygeine

Infant education Weight loss/ weight gain.

Infant’s may lose weight (diuresis) during the first week after birth but should regain their weight by days 10-14.

infant sensory skills Touch

First sense a baby develops! Provide comfort touch– Kangaroo care

infant sensory skills Smell

Babies can smell mom’s breastmilk at about 2 weeks old.

infant sensory skills Taste

Prefers sweet tastes. Rice/iron ceral, then veggies, then fruits

infant sensory skills Hearing

Should be intact at birth.test to be done before baby leaves the hospital.

infant sensory skills Vision

Babies are near sighted at birth. Red reflex should be present. Provide bright colored toys, books…NO SCREENS!

Infant by 3 months should

turn head to the sound of a rattle and follow rattle with eyes

Growth & Development

Development should happen cephalocaudal & proximodistal.

Cephalocaudal

Head to Toe progression (develops head control before he can stand.)

Proximodistal

Progresses from the core of the body outward(infant learns to sit unsupported before he can use a Pincer grasp)

Length at birth is

20 inches.

First year, they should grow approximately

10 inches.

5 inches

In the second year, they should grow

3 years to puberty they should grow approximately

2.5 inches per year.

Head Circumference Birth to 3 months (13-14 inches) –

increases 2 cm each month

Head Circumference 4-6 months –

increases 1 cm each month

Head Circumference 6-12 months

increases 0.5cm each month

6-10 months

Teething should begin by

By 12 months

6-8 teeth should be present.

Weight should double by

5-6 months, and triple by 1 year.

Growth charts

By the WHO and the CDC Assessed at each visit. , Notify the physician if growth is greater than 95% (overweight) or less than 5% (failure to thrive).

Adjusted age for premature infants

Infant’s chronological age - # of weeks the infant was premature = Adjusted age

Newborns will lose up to 10% of their birth weight in

first 3-4 days of life.

Moro Reflex

With sudden extension of the head the arms abduct and move upwards when infant is startled.

Birth to 6 months.

Moro Reflex Timing

Stepping reflex

Elicited by holding an infant upright with his feet touching a flat surface.

Birth to 4 weeks

Stepping reflex Timing

Asymmetric tonic neck reflex

Fencing, lying on their back and the head is turned to one side.

Birth to 4 months.

Asymmetric tonic neck reflex Timing

Rooting

turning head and opening mouth when cheek is stroked, aids in their finding and latching on to the nipple to feed.

Birth to 4 months.

Rooting Timing

Babinski

Stroke the lateral plantar foot from heel to toes, then across the metatarsal pads to the great toe. Present - toes fan out. Absent- Toes curl downward with no fanning.

Birth to one year.

Babinski timing

Parachute Reflex

Suspend the baby prone and slowly lower his head toward the surface. His arms and legs will extend in a protective fashion

Appears around 8 months and should never disappear.

Parachute Reflex

Neuro screening tools may be used

Denver II Developmental Screening Test, Prescreening Developmental Questionnaire (PDQ II), Ages and Stages Questionnaire (ASQ), Infant Toddler Checklist for Language and Communication, Infant Development Inventory

Tummy Time

2-3 times per day as soon infant is home from hospital! Gradually increase time as the baby tolerates.

General Language, Social, & Emotional Milestones of infants

Crying is the first form of communication. Can turn head to the sound of a rattle by 3 months.

4 months

Purposeful (social) smile by

5-6 months

Learns to babble and babbles continuously at

Stranger danger develops by

6 months.

7 to 9 months explores

cause and effect (ex. throwing things off the crib)

At 12 months

Points to objects when named. Says 2-5 words.

Up to 2 months Motor

Head lag Holds head up while prone, Moves bilateral extremities Grasp reflex strong to fading

Up to 2 months Cognitive (Piaget)

Observes Movement Gazes at an object