Week 2: Infant Development: Growth, Milestones, and Safety

What is the weight growth at 5 months?

• Weight doubles from birth

What is the weight growth at 1 year?

• Weight triples from birth

What is the length growth at 1 year?

• Length increases by 50%

What are some problems that lead to issues with weight gain?

• GI issues

• cystic fibrosis

• latching issues

What rate of head circumference growth is expected in the first 6 months of life?

• Rapid growth

When interpreting a head circumference percentile chart, why is a single measurement insufficient?

• Overall trends matter more than individual data points.

• Important indicator of brain development

What are gross motor skills?

• Involves large muscle groups to perform whole-body movements

• arms, legs, and torso

• whole-body movements

Gross Motor Skills: Early

• Lifting head/chest during tummy time

  • 2-4 months

• Rolling

  • 4 months

• Sitting with support

• 5-6 months

Gross Motor Skills: Later

• Sitting independently

  • 6-8 monthhs

• Crawling

  • 8-10 months

• Pull-to-stand

  • 9-11 months

• Walking with support/independently

  • 12 months

What are fine motor skills?

• The coordination of small muscles

• hands, wrists, and fingers

Fine Motor Skills

• reaching and grasping

  • 3-4 months

• transfer object hand to hand

  • 6 months

• pincer grasp

  • 9-12 months

Name

Pincer Grasp

Moro Reflex

• The baby throws their head back, extends or spreads their arms and legs outward, and opens their hands/fingers

• Triggers: bright light, loud noise, quick change of position

Suck Reflex

• involuntary survival response in newborn babies

• triggers rhythmic sucking movements when the roof of the mouth, lips, or tongue is touched

Asymmetric Tonic Neck

• turning the head causes the arm and leg on that side to stretch out while the opposite limbs bend

Babinski Reflex

• the big toe bends upward (dorsiflexion) and the other toes fan out

• normal in years 1-2

• abnormal in 2 years+

Palmar Reflex

• infant automatically curls their fingers and grips tightly when something touches or strokes their palm

Rooting Reflex

• The infant turns their head toward the touch, opens their mouth wide, and thrusts their tongue slightly toward their bottom lip

• Triggers: touching the corner of a baby’s mouth, cheek, or lips (or smelling breast milk)

Stepping Reflex

• automatic walking or dancing motion that occurs when a newborn is held upright with their feet touching a flat surface

Sensorimotor Development Definition

• Piaget

• Earliest phase of cognitive and motor growth

• Spanning from birth to age two

• Learn about the world entirely through their basic senses and physical movements

Piaget’s Cognitive Development: Sensorimotor Development Stages

1. Reflexes (0-1 month)

2. Primary Circular Reactions (1-4 months)

3. Secondary Circular Reactions (4-8 months)

4. Coordination of Secondary Schemes (8-12 months)

What is the Reflexes (Sensorimotor Development) Stage?

• 0-1 month

• reflexive action that are involuntary and repetitive

  • sucking, grasping

• the first means of interacting with the world

What is the Primary Circular Reactions (Sensorimotor Development) Stage?

• 1-4 months

• repeated actions in the body that are pleasurable or interesting

  • sucking thumb, kicking feet, cooing

• centered on own body

• simple, non-consequential patterns

What is the Secondary Circular Reactions (Sensorimotor Development) Stage?

• 4-8 months

• repeating actions with purpose to cause interesting environmental effects

  • shaking a rattle, banging toys together

• shifting focus from body to objects

What is the Coordination of Secondary Schemes (Sensorimotor Development) Stage?

• 8-12 months

• integrating multiple actions to achieve goals

  • intentional behavior

  • uncovering a toy

• based on object permanence concept

What is object permanence?

• understanding that objects exist even when out of sight

• typical emergence: 8-12 months

What is cause-and-effect learning?

• infants explore cause effect by interacting with toys and the environment

  • pressing a button to hear a sound

  • shaking a rattle

Psychosocial Development: Attachment & Bonding

• secure attachment

• emotional expressions

• stranger anxiety

What is secure attachment?

• caregiver is responsive to needs

• infants and caregiver forms a trusting bond

• infant feels safe to explore their environment

What is stanger anxiety?

• Occurs at 6-9 months

• Views primary caregiver as their “secure base”

• Strangers are viewed as danger

What are stranger anxiety typical manifestations?

• Clinging to the caregiver when a new person approaches

• “Checking back” with the caregiver to gauge their reaction to the new person

Early Communication

1. cooing (6-8 weeks)

2. babbling (4-6 months)

3. gestures + nonverbal cues (6-12 months)

4. few words (12 months)

Cognitive & Social Milestones: 0-2 Months

• Cognitive Milestones: observes faces and cooing begins

• Social Milestones: eye contact, alert to sound

Cognitive & Social Milestones: 3-4 Months

• Cognitive Milestones: reaches for toys and babb;es

• Social Milestones: copies sounds and shoes happiness

Cognitive & Social Milestones: 5-6 Months

• Cognitive Milestones: explores with hands/mouth, recognizes faces

• Social Milestones: responds to emotions, laughing, stranger anxiety begins

Cognitive & Social Milestones: 7-8 Months

• Cognitive Milestones: object permanence

• Social Milestones: clings to familiar adults, purposeful sounds

Cognitive & Social Milestones: 9-10 Months

• Cognitive Milestones: pincer grasp, watches objects fall

• Social Milestones: waving bye, imitates actions

Cognitive & Social Milestones: 11-12 Months

• Cognitive Milestones: finds hidden objects, cause/effect

• Social Milestones: says simple words, strong attachment

What are the breast feeding recommendations?

• exclusive breastfeeding recommended for ~6 months

  • formula feeding if breastfeeding is not possible or preferred by family

When are solids introduced?

Gradual introduction at ~6 months

What are the signs a baby is ready for solids?

• sits with support

• shows interest

• opens mouth for spoon

What foods should be introduced first?

• iron-rich foods

• cereals, meat, beans

When does self-feeding begin?

encouraged around 8-9 months

What are the safe sleep practices?

• back to sleep for every sleep

• firm sleeping surface, no soft bedding

• room-sharing recommended

  • NOT bed-sharing

  • avoid overheating

How long should newborns sleep?

14-17 hours/day

Typical Sleep Patterns

• night waking is normal

• gradual sleep consolidation (uninterrupted) by 4-6 months

What are general safety guidelines?

1. care seat safety

2. fall prevention

3. choking hazards

4. poison prevention

What is care seat safety?

rear-facing until at least 2 years old

What is fall prevention?

no high surfaces without supervision

What are some choking hazards?

small objects such as grapes and nutes

How to prevent accidental poisoning?

secure medications and household chemicals

Monitoring & Supervision Tips

1. never leave an infant unattended in the bath

2. supervise tummy time and play

3. educate parents on emergency preparedness

What does “Newborn at Risk” mean?

susceptibility to illness or death within the first 28 days

How many weeks are preterm babies?

Before 37 weeks

Why is preterm dangerous?

vital organs like the brain, lungs, and liver do not have time to fully develop

How many weeks are post-term babies?

beyond 42 weeks

Why is post-term dangerous?

• risk of stillbirth (death of fetus)

• meconium aspiration (newborn breaths their meconium)

• macrosomia (large baby)

• placental insufficiency

Small for Gestational Age (SGA) Percentile

• weighing below the 10th percentile

  • for their gestational age and sex

What are the risk of Small for Gestational Age (SGA)?

• wasted muscle tissue, sunken abdomen

  • due to placental insufficiency

  • fetus prioritizes blood flow to vital organs

• lack of subq fat → hypothermia

• polycythemia (concentration of red blood cells in the bloodstream)

  • causes the blood to thicken and flow more sluggish

Large for Gestational Age (LGA) Percentile

• weighing above the 90th percentile

  • for their gestational age and sex

What are the risk of Large for Gestational Age (LGA)?

• may cause delivery complications

  • birth trauma

• newborn hypoglycemia

• respiratory distress

What does “acquired” mean?

develops over time

What does “congenital” mean?

present at birth

Preterm Infant: System Challenges: Respiratory

• deficiency of surfactant (protective fluid in the lungs that keeps the alveoli open)

  • leads to respiratory distress syndrome (RDS)

• apnea

Preterm Infant: System Challenges: Renal

• inability to concentrate urine

• inability to excrete drugs

Preterm Infant: System Challenges: GI

• small stomach

• weak suck/swallow

• risk for necrotizing enterocolitis

Preterm Infant: System Challenges: Immune

• lacks IgG (crosses placenta in 3rd trimester)

  • vital for long-term immune memory

  • directly neutralizing toxins and targeting viruses and bacteria for destruction

Preterm Infant: System Challenges: Neurologic

• fragile cerebral blood vessels

  • increases the risk for hemorrhage

Preterm Neonate: Oxygenation Nursing Priorities

• maintain SpO2

• caution with retinopathy of prematurity (ROP)

What is Retinopathy of Prematurity (ROP)

• occurs when supplemental O2 is provided to premature babies

• can disrupt the normal growth of retinal blood vessels

• may lead to retinal detachment

• vision loss

Preterm Neonate: Thermoregulation Nursing Priorities

• use radiant warmers or isolettes

Preterm Neonate: Nutrition Nursing Priorities

• TPN or Gavage feedings

• Non-nutritive sucking

  • self-soothing, physiological stabilization, and oral motor development

Preterm Neonate: Cluster Care Nursing Priorities

• always cluster care

• minimize handling to conserve energy

What is consider hypoglycemia in infants?

<40 mg/dL

Which infants are at risk of hypoglycemia?

• Infant of diabetic mother (IDM)

• Small for Gestational Age (SGA)

• Cold-stressed infants

  • to warm up, babies burn vital energy and oxygen reserves → <BG

What are the S&S on infant’s <BG?

• jitteriness

• lethargy

• high-pitched cry

• apnea

Physiologic Jaundice

• occurs AFTER 24 hours of birth

• normal RBC breakdown

• harmless, temporary condition

Pathologic Jaundice

• occurs WITHIN 24 hours of birth

• incompatibility/sepsis

What is the risk of severe jaundice?

• kernicterus

  • encephalopathy

  • rare, severe form of brain damage in newborns

• occurs when there is a high level of bilirubin in the blood

What is phototherapy?

uses specific blue-green light to break down excess bilirubin in a baby's blood

Why is phototherapy used?

• Used to treat newborn jaundice by breaking down excess bilirubin so it can be easily excreted in stool and urine

• Expose maximum skin surface

  • NO onesies

Phototherapy Cautions

• shield eyes and genitals

• monitor for loose stools and dehydration

• check bilirubin levels and temperature fequently

What is Sepsis Neonatorum?

life-threatening bloodstream infection

What are the signs of Sepsis Neonatorum?

• temperature instability (hypothermia)

• lack of “acting right”

• respiratory distress

What is the management for Sepsis Neonatorum?

• labs

• lumbar puncture

• IV antibiotics

What are the signs of infection?

• temperature instability

• poor feeding

• lethargy

• respiratory distress

What are the risks of having a clef lip/palate?

• nutrition risks

• airway risks

What are the risks of having neural tube defects?

• meningomyelocele

  • most serious type of spina bifida

• cover with sterile moist dressing

What is congenital heart disease?

• structural defects of the heart present at birth

• screen with pulse oximetry

How does substance abuse exposure effect infants?

• Neonatal Abstinence Syndrome (NAS)

• newborn baby goes through drug withdrawal after being exposed to addictive substances while in the womb

What are the signs of Neonatal Abstinence Syndrome (NAS)?

• irritability: CNS is overstimulated

• tremors: nervous system is misfiring

• sneezing: nervous system dysfunction

• poor feeding: baby lacks the coordination to successfully suck/swallow

• frantic sucking: misplaced attempt to self-soothe their physical discomfort

What is the nursing care for Neonatal Abstinence Syndrome?

• low-stimulation environment

• swaddling

• small frequent feeds

FINAL THOUGHTS

• infants don’t always look sick

• it’s important to check VS

• pay attention to how they eat