Infant GD

Newborns (neonates)

Birth until 1 month.

Infants

1 month to 1 year

• Growth

• Development (sequencial process, attaining different skills)

• Maturation (body systems)

• Development milestones (1st times)

• Anticipatory Guidance (for parents, when to anticipate)

What are the concepts of growth and development?

• Genetics

• Environment

• Culture

• Nutrition

• Health Status

• Family

• Parental attitudes

What are the factors influencing G&D?

1. Cephalocaudal

2. Proximodistal

What are the growth patterns of infants?

Cephalocaudal

Head to toe

• Physical

• GROSS motor skills (bigger muscle groups)

Proximodistal

From center outward

• Physical

• FINE motor skills (hands, fingers)

• Psychosocial (Erikson)

• Cognitive (Piaget)

• Psychosexual (Freud)

• Moral (Kohlberg)

Each measures a DIFFERENT component of development (Birth-12 months)

What are the theories of development?

Trust vs. Mistrust (Birth to 1 year)

What stage of Erikson’s psychosocial development are infants in?

• Needs consistency in having NEEDS met (trust)

• DELAYED GRATIFICATION must be learned (older infant)

• Parent-Infant attachment

What happens during the Trust vs. Mistrust stage for infants?

Sensorimotor (Birth to 2 years)

What stage of Piaget’s psychosocial development are infants in?

• Infants uses SENSORY and MOTOR skills to learn about the world (ex. putting things in mouth)

• EGOCENTRISM

• OBJECT PERMANENECE by 9 MONTHS

• CAUSE and EFFECT

What happens during the sensorimotor stage for infants?

Oral stage (Birth to 1 year)

What stage of Freud psychosocial development are infants in?

• Feeding and sucking (explore environment)

• Biting

What happens during the oral stage for infants?

Premorality or Preconventional (Naivete and Egocentrism) (Birth to 2 years)

• Stage 0

What stage of Kohlberg’s psychosocial development are infants in?

• NO MORALS

• Do what they like

• Dislike what hurts them

What happens during the premorality or preconventional stage for infants?

• DOUBLE birth weight by 4-6 MONTHS

• TRIPLE birth weight by 1 YEAR

What are the weight changes for infant development?

Average newborn length at birth (20 in or 50 cm)

• Length increases 50% by first year

• Grow more in 1st 6 MONTHS (1in/month)

• Slow in next 6 MONTHS (1/2 in/month)

What are the length changes for infant development?

Increases ½ in (1.2 cm) per month

What is the average increase in head circumference for infants?

1. Neurologic

2. Cardiovascular

3. Immunologic

4. Respiratory

5. GI

6. GU

What are the body systems that are affected in G&D of infants?

1. Gross motor skills

2. Fine motor skills

3. Language

What are the skills that are developed in infants?

• Fontanelles and sutures (soft spots, anterior and posterior)

  • Brain growth

• Progressive brain/spinal cord MYELINATION and IMPROVED COORDINATION

• INVOLUNTARY movements to VOLUNTARY

• REFLEXIVE (primative) behavior to PURPOSEFUL movements

What are the developmental changes in the neurological system of an infant?

• FETAL SHUNTS CLOSE, going from fetal to extrauterine circulation

• HEART DOUBLES in size over the 1ST YEAR of life

• HR gradually SLOWS while BP INCREASES

What are the developmental changes in the cardiovascular system of an infant?

• Newborns recieve large amounts of IgG through PLACENTA from mothers (also breast milk)

  • Passive immunity for 3-4 MONTHS

  • Begin to produce immunoglobulins after birth (exposure)

What are the developmental changes in the immunologic system of an infant?

3-4 months

How long is passive immunity for infants?

Infection, maximum protection not reached until early childhood

What are infants at risk for because they do not have their own immunity?

IRREGULAR with periodic pauses

What type of RR pattern does an infant have?

Lungs increase to 3 TIMES THEIR WEIGHT and 6 TIMES THEIR VOLUME at birth in the first year of life

What are the developmental changes in the respiratory system of an infant?

• INFECTION (trachea, bronchi, and bronchioles tiny and collapsible

• EAR INFECTIONS (Eustachian tubes short and horizontal)

What are the risks while the respiratory system is developing?

Obligate nose breather

What type of breathers are infants?

10-20 mL; increases to 200mL at 1 year

• size of a cherry

What is the size of the stomach in an infant?

• ENZYMES MATURING

• Ability to digest and absorb FAT does not reach adult levels until 6-9 MONTHS (no amylase, lipase)

What are the developmental changes in the GI system of an infant?

• KIDNEY mass INCREASES THREEFOLD during first year

• LOW GFR

• DIFFICULTY CONCENTRATING URINE

What are the developmental changes in the GU system of an infant?

F/E imbalances, fluid overload

What are the risks while the GU system is developing?

HEAD LAG, lifts and turns head to side in prone position (on stomach)

What happens at 1-2 MONTHS during the development of an infant’s GROSS motor skills?

Raises head to 90 DEGREES while prone

What happens at 3 MONTHS during the development of an infant’s GROSS motor skills?

NO HEAD LAG, plays with feet, ROLLS PRONE TO SUPINE

What happens at 4-5 MONTHS during the development of an infant’s GROSS motor skills?

TRIPOD SITS, rolls from SUPINE TO PRONE (PSSP)

What happens at 6 MONTHS during the development of an infant’s GROSS motor skills?

• CRAWLING (with ab off floor)

• PULLS UP and starts CRUISING (holding onto stuff)

What happens at 9 MONTHS during the development of an infant’s GROSS motor skills?

Starts WALKING

What happens at 12 MONTHS during the development of an infant’s GROSS motor skills?

FISTS MOSTLY CLENCHED, then OPEN

What happens at 1-2 MONTHS during the development of an infant’s FINE motor skills?

HOLDS OBJECTS in hands

What happens at 3 MONTHS during the development of an infant’s FINE motor skills?

• REACH and GRASP

• Hits at OBJECTS but MISSES

What happens at 4-5 MONTHS during the development of an infant’s FINE motor skills?

• TRANSFERS objects from ONE HAND to ANOTHER

• PICKS UP objects with whole hand

• RAKING GRASP (picking up things like a rake)

What happens at 6-7 MONTHS during the development of an infant’s FINE motor skills?

• PINCHER GRASP

• Wave BYE BYE

• CLAP hands

What happens at 9 MONTHS during the development of an infant’s FINE motor skills?

• RELEASE on DEMAND

• Feeds self

What happens at 12 MONTHS during the development of an infant’s FINE motor skills?

• Prefer faces, high-contrast colors

• 20/100; 20/150 at birth

• Eye coordination (different direction is normal)

What is an infant’s vision like?

• Intact and acute as an adult at birth

• Hearing screening at birth

What is an infant’s hearing like?

Stranger/separation anxiety (understand themselves as different from everyone else)

What psychosocial issue might an infant develop at 6-9 MONTHS?

Crying

What type of communication does an infant use?

• Reflexive to voluntary smile

• COOing

What language development happens at 3 MONTHS in infants?

• SQUEAL and BABBLE (gagaga, mamama, bababa)

• Understands simple commands

What language development happens at 6-9 MONTHS in infants?

2 OR 3 RECOGNIZABLE WORDS (ex. mama, dada, bye bye)

What language development happens at 12 MONTHS in infants?

• Immunizations

• Assessment of growth

• Assessment of development

• Prevention of disease

• Acnticipatory guidance

What are the nursing interventions to help the promotion of healthy growth and development of an infant or toddler?

20 HOURS total per day

How long do newborns sleep up to?

• Sleeping patterns vary widely

• Anticipatory guidance for parents

• SAFE SLEEPING PRACTICES (can cause SIDS)

What is the education for rest and sleep for infants for parents?

• NO CO SLEEPING (no with parent, suffocate baby)

• Hard, firm mattress

• No soft or loose bedding

• Nothing else in bed (toys, blankets, etc.)

• Place infants ON BACK (supine) to sleep

What are the safe sleeping practices?

SIDS

Sudden, unexpected infant death

• Suffocation (maybe from sleep) and undetermined reasons

• Alone

• Back

• Crib

What are the ABC’s of safe sleep for babies?

• <6 MONTHS: “Breast is best”, Formula feeding

• 6-12 MONTHS: weaning to cup (sippy)

• Start SOLID foods at 6 MONTHS

• 8-9 MONTHS: finger foods

Continue breast or formula

What does feeding and nutrition look like in infants?

Allergies

Why should you give the infant ONE NEW FOOD every 3-5 DAYS?

• Honey (botulism)

• Fruit juice

• Popcorn

• Carrot chunks

• Hot dog

• Grapes

• Cows milk

What are the foods to avoid in infants?

• Erupt between 5-9 MONTHS

• 6-8 TEETH by 12 MONTHS

When do teeth come in for infants?

• Fluoride supplementation, if needed

• WIPE TEETH WITH WASHCLOTH

• After 6 MONTHS use RICE GRAIN sized amount of TOOTHPASTE

• Bottle mouth caries (Nighttime bottles, juice)

What does dental care look like in infants?

Solitary play

Infants play by themselves, even with other babies

• Healthy

• Provide toys appropriate for their level of fine or gross motor skills

• Reaching for toys they are interested in promotes GROSS motor skills

• Older infants build FINE motor skills with stacking things

How do infants maximize development through play?

Safety! Nothing too small

What should be the concern when infants are playing with toys?

• Patterns of crying

• Colic (crys for hours everyday, grows out of it eventually)

• Teething

What are some common developmental concerns that are normal?

• Infant seats facing REAR of car, secured tightly in the center of the back seat

• NEVER LEAVE UNATTENDED

How do you promote safety of infants in the CAR?

• BABYPROOF the home (ex. baby gates)

• Safe baby furnishings

• Preventing falls

• Burn prevention

• Preventing asphyxiation

• Preventing lead exposure (paint in house)

How do you promote safety of infants in the HOME?

• NEVER leave baby unattended in bath (can drown, no buckets of water)

• If family has a pool, LOCK fence or screen enclosure, doors locked

• Water safety

• Burn prevention

How do you promote safety of infants in the WATER?