Infants

How to calculate adjusted gestational age

• for 36 wks and less

• 40 wks-gestational age (28 wks)/4=chronological age-ans

• Ex. 6 mo old born at 28 wks

• (40-28)/4=3

• 6 mo-3= 3 mo adjusted gestational age

Wt, length, head Circumference

• Wt

  • newborns lose up to 10% of birth wt in first wk of life

  • Should return to birth wt by DOL 10-14

  • Average wt i=gain is 20-30 g/day

  • Infants double wt by 6 mo and triple by 12 mo

• Length

  • Grow more rapid in 1st 6th mo than second 6th mo

  • Length Inc by 1 inch per month during 1st 6th mo

  • Use board to measure

• HC

  • Inc more rapidly in 1st 6th mo

  • Inc 4 in (10 cm) from birth to 1 year

  • Posterior fontanelle closes 6-8 wks

  • Anterior fontanelle close 12-18 mo

    • Open soft, flat is good

VS

• Newborn (0-28 days):

  • T: 97.7-99.5

  • HR: 110-160

  • RR: 30-60

  • BP 85/40

• Infant (1-12 mo):

  • T: 97.7-99.5

  • HR: 90-160

  • RR: 25-30

  • BP 85/40

Moro reflex

• Birth-4 mo

• Dropping baby head down/”scaring baby” makes their arms and legs go up and fingers will make a C

Sucking/Rooting Reflexes

• Birth-4 mo

• Stroke baby ckeek/edge of mouth…baby will turn head toward side that is touched and start sucking

Asymmetric Tonic Neck

• Birth-3/4 mo

• Turning baby head to one side and that arm and leg extend out and opposite side leg/arm flex inward

Palmar Grasp

• Birth-4 mo

• Put finger in infant hand and they will grasp object

Plantar Grasp

• Birth-8 mo

• Touch baby foot sole and toes curl downward

Stepping

• Birth-4 wks

• Hold baby upright with feet touching flat surface and baby makes stepping movements

Babinski Reflex

• Birth-12 mo

• Stoke bottom of baby foot and toes fan upward and out

Trust Vs Mistrust

• Development of a sense of trust is crucial in 1st year

• Caregivers respond to basic needs of infant; feeding, changing, touching, holding, and talking

• As nervous system matures, infants realize they are a separate being

• They can tolerate small amounts of frustration

• Trust: achieved based on quality of infant/caregiver relationship & care received—-baby learns delayed gratification

• Mistrust: developed when needs aren’t met/not consistently or needs met before baby vocalizes it: baby fails to learn delayed gratification

Sensorimotor stage: Piaget

• Reflexes:

  • birth-1 mo

  • Interacts w/ world through inborn reflexes (rooting reflex)

• Primary Circular Reactions:

  • 1-4 mo

  • Infant repeats pleasurable actions—Ex. thumb sucking

  • They progress from reflexive to repetitive behaviors

• Secondary Circular Reactions:

  • 4-8 mo

  • Infants intentionally repeat actions to trigger a response—Ex. laughing bec others laugh

• Coordination of Secondary Schemes:

  • 8-12 mo

  • Actions intentional to produce a goal-Ex. peek a boo

Gross motor skills

• Head control

  • Head lag as infant, starts improving by 2 mo and none by 4 mo

• 2 mo: moves all extremities, holds head in prone position

• 4 mo: holds head w/o support, pushes on forearms when prone

• 6 mo: rolls from prone to supine, tripod sit, can push up straight in prone

• 9 mo: sits unsupported, can sit down on own

• 12 mo: pulls to stand, walks while holding onto furniture

Fine Motor Skills

• 2 mo: briefly opens hand

• 4 mo: bats at objects, holds toy when put in hand, brings hand to mouth

• 6 mo: reaches for desired item

• 9 mo: pincer grasp, transfers objects from one hand to other

• 12 mo: fine pincer grasp

• *utensils by 1st birthday

Sensory Development

• Sight:

  • Newborns nearsighted: objects 8-15 in from face

  • Eyes wander & occasionally cross but by 6 mo should disappear

• Hearing

  • Fully developed at birth

  • Hearing screen performed before discharge

• Smell & Taste

  • Develops rapidly; can identify moms boob milk by day 7

  • Newborns prefer a sweeter taste

• Touch

  • Preemies respond to therapeutic touch

  • Holding, stroking, rocking, or cuddling calms baby when upset

  • Can tell caregiver mood by how they touch them

Language Development

• 2 mo

  • Cries and makes other vocalizations

• 4 mo

  • Coos and vocalize response to voices

  • turns head to familiar voices/sounds

• 6 mo

  • Squeals and yells

  • Sticks tongue out and blows

• 9 mo

  • Mama and dada w/o meaning

  • Responds to simple commands

• 12 mo

  • Attaches meaning to mama and dada

  • Uses 2-3 recognizable words w/ meaning

Social & Emotional Development

• Socialization

  • By 2 mo babies are ready to socialize

  • First real smile at 2 mo

  • 6-8 mo infants enjoy interactive games

  • Warning signs: not smiling by 3 mo, refuse to cuddle, no interest in peek a boo by 8 mo

• Stranger Anxiety

  • Developed around 9 mo

  • Infant becomes clingy and whiny when approached by strangers

  • Indicates the infant is recognizing self as separate from others

• Separation Anxiety

  • Begins in last few months of infancy

  • Infant becomes distressed when parents leave

  • They will eventually calm down and become engaged w/ current caregiver

  • Once older they will have the ability/memory to know parents are coming back

• Temperament

  • Infants are slow to warm up to others and should be approached slowly and calmly

  • Infants that are quiet may be easily overwhelmed

Promoting Healthy Growth and Development

• Play

  • Infants practice gross and fine motor skills and language through play

  • Play is natural way for infants to learn

  • Older infants are geared towards motor and language skill development

  • Infants engage in solitary play—they don’t share with others

• Safety:

  • Rear facing until 2 y/o

  • Never In-front of an airbag and middle seat preferred

  • don’t leave them unattended in car

  • they can suffocate from heat in summer if left in car

  • Cribs: firm mattress, well fit sheet, side rails up, empty of all objects

  • Never leave unattended on elevated surface and restrain in swings and bouncy seats

  • No infant walkers

  • Safety gates on stairs, electrical outlets covered, cabinets and drawers should be latched, meds and cleaning supplies out of reach

  • Age appropriate toys and keep free of choking hazards

  • Never leave unattended in water

  • Keep toilet lid down

  • Gate around pool

• Nutrition

  • Recommend for all infants

  • 20 kcal/ounce

  • Breastfeed infants need supplemental Vit D 400 IU/day

  • Only use fortified iron formulas

  • Ed on storage of formula: store in fridge up to 48 hrs

  • Semi up right position

  • Burp 2-3 times per feed

  • 6-10 feeds per 24 hrs

  • Solid foods introduced at 6 mo—cereal 1 st

  • Veggies before fruits

  • Introduce new foods 3-5 days apart

  • Avoid: cows milk, honey, excessive fruit juice, choking foods (popcorn, grapes, raw carrots, hot dogs)

• Teeth and Gums

  • Clean gums w/ damp washcloth after feedings

  • After teeth eruption, can continue to use damp cloth or soft toothbrush

  • toothpaste not necessary

  • No bottles in bed (causes tooth decay)

Colic

• Inconsolable crying that last 3+ hrs per day with no physical cause

• Can begin as early as 2 wks and last up to 3 mo old

• Ed parents that normal crying inc at 6 wks and diminishes by 12 wks

• Parents should ensure basic needs are met, then attempt soothing techniques

Spitting Up

• Regurgitation of small amounts of stomach contents

• Feed smaller amounts more frequently

• Burp 2-3 times per feeding

• Keep baby up right for 30 mins post feed

• Avoid bouncing or excessive activity immediately after feeding

• Reassure parents that if the infant is wetting 6-8 diapers per day and gaining wt the spit up is normal

• If infant vomits 1/3 or more of feedings, chokes when vomiting or experiences forceful emesis the PCP should be notified

Thumb Sucking & Pacificers

• Self activity

• Pacifier has been linked to inc Otitis media

• Dont try to break habit during stressful time for infant

• Attempt to wean when baby approaches 1 yr (when need for sucking naturally decreases) should be weaned by 2-3 yrs old

Teething

• Signs

  • Drool

  • Biting hard objects

  • Irritable

  • Refusal to eat

  • Not sleeping well

• Treatment

  • Chew on cold teething ring

  • Rub an ice cube wrapped in a cloth on gumline

  • OTC topical anesthetics

  • Tylenol/ibuprofen (6th mo)

  • *teething s/s shouldn’t last more than a few days