Chapter 25 final🙂

Newborns typically regain their birth weight by 7-10 days. At birth, the average length is 19-21 inches (48-53 cm), with an expected growth of about 1 inch (2.5 cm) in the first month and 50% growth in length by the first year. Weight gain averages 5-7 ounces (140-200 grams) per week during the initial months. A full-term newborn's head circumference is approximately 13.5-14.5 inches (34-37 cm), indicating healthy brain development. The anterior fontanelle usually closes between 12-18 months.

The respiratory rate slows from 30-60 breaths per minute at birth to 20-30 by 12 months, and the respiratory system does not fully mature until 7 years of age. A lack of IgA in the upper respiratory tract contributes to infections. The heart size doubles in the first year, and the average pulse rate decreases from 120-140 bpm to about 100 bpm in a 1-year-old. Average newborn blood pressure is 60/40 to 100/50 in a 12-month-old, with peripheral capillaries close to the skin, resulting in a higher risk for heat loss.

Primitive reflexes include:

• Rooting Reflex: When a newborn's cheek is stroked, they turn their head toward the stimulus and open their mouth, aiding in locating food. Disappears by 4 months.

• Sucking Reflex: Caused by touching the roof of the mouth, facilitating feeding. Disappears by 2-3 months.

• Moro (Startle) Reflex: Infants respond to a sudden loss of support or noise by spreading arms and legs, then pulling them in. Disappears by 4-6 months.

• Palmar Grasp Reflex: Newborns grasp an object placed in their palm, supporting their ability to hold onto their caregiver. Disappears by 5-6 months.

• Asymmetric Tonic Neck Reflex: When the head is turned to one side, the arm on that side extends while the opposite arm bends, aiding in hand-eye coordination. Disappears by 5-7 months.

• Babinski Reflex: When the sole of the foot is stroked, the toes fan out and then curl, indicating neurological function. Disappears by 12 months.

Newborns develop natal teeth in the first 28 days of life, possibly associated with other birth anomalies. The first primary teeth erupt by 6-8 months, with primary teeth also called deciduous teeth. An average 12-month-old has four to eight teeth and produces small amounts of saliva by three months.

The ability to conjugate bilirubin and secrete bile is present after two weeks of age. Infrequent stools in infants are normal due to an immature digestive system, as long as they are feeding well and gaining weight. Grunting, straining, or crying during bowel movements is common and usually not a cause for concern unless the stool is hard and dry. Iron can cause stool to appear black or very dark green. Premature babies are at risk for iron deficiency anemia as most iron transfer from mother to fetus occurs in the last trimester.

Development of Gross Motor Skills:

• 1 Month: Lifts and turns head to the side when prone.

• 2 Months: Raises head and chest, improving head control.

• 3 Months: Lifts head to 45 degrees when prone, slight head lag when pulled to sit.

• 4 Months: Lifts head and looks around, rolls from prone to supine, head leads body when pulled to sit.

• 5 Months: Rolls from supine to prone and back again, sits upright when supported.

• 6 Months: Tripod sits.

• 7 Months: Sits alone, some use of hands for support.

• 8 Months: Sits unsupported.

• 9 Months: Crawls, abdomen off the floor.

• 10 Months: Pulls to stand, cruises.

• 12 Months: Sits from standing position, walks independently.

Warning signs are child cannot support at 3 to 4 months of age, child reaches with one hand only, child cannot sit with assistnence by 6 months of age, child does not crawl by 12 months of age, child cannot stand supported by 12 months of age.

In 12 months the infant should be able of feeding himself with a cup and spoon and fingers and assist with dressing.

Hearing a fully developed at birth

Newborn are fully developed in hearing, vision is nearsighted at a distance at 20-38cm (8-15in)

Binoculary vision develops at 6 weeks of age and is well established at 4 months of age. Full color develops by 7 months.

Warning signs are that infant does not respond o loud noise, does not focus on near objects, infant does not make sounds or babble by 4 months of age, infant does not turn to sounds at 4 months of age. ifnant crosses eyes at 6 months.

1-3 months infant makes coos sounds. Infant at 4-5 months makes rasberries sounds and responds to own name.

Squeeling and yelling at 6 months of age. 10 months baby should say mama and dadda without meaning. 12 months are mamma dadda but with meaning also at 12 months sould use 2-3 months old.

Object permanance develops at 8 months of age.

More warnings signs of infants are infants do not make sounds at 4 months of age. infant does not laugh or squel by 6 months of age. infant does not babble by 8 months of age. Infant does not use single words at 12 months of age.

Fine MOTOR SKILLS:

1 month fist mostly clenched and involuntary hand movements.

3 months holds hand in front of face and hands open

4 months bats at objects

5 months grasps rattle

6 months releases object in hand to take another

7 months transfer object from one hand to another

8 months gross pincher grasp

10 months fine pincer grasp and puts objects into containers.

11 months offers objects to other and releases them.

12 months feeds self with cup and spoon and makes simple mark on paper and pokes with index finger.

at eight months infant develops stranger anxiety.

More warning signs are child does not smile at people at 3 months of age. or refuse to cuddle or enjoy people. The child shows no interest in peekaboo at 8 months of age.

appropriate

Appropriate toys for a newborn- 1 month is mobile with contrasting coolors or patterns, unbreakable mirror. soft music via tape or music box, soft brightly colored toys.

appropriate toys for a 1-4 months old is bright mobile, unbreakable mirror, rattles, singing by parent or caregiver, varied music, high contrast colors.

4-7 months appropriates are fabric or board books, different types of music and easy to hold toys like fancy rattles, floating or squirting bath toys, soft dolls or animals.

8-12 months plastic cups and bowls and buckets. unbreakable mirror and large building blocks, stacking toys, and busy boxes wirth buttons and knobs that make things happen, balls and dolls and board books with large pictures, toy telephone, push and pull toys.

AAP does not recommend the use of walkers.

Avoid stuffed animals with eyes or buttons, avoid feeding popcorn, nuts, carrot slices, grapes, and hot dog pieces.

Drop of progesterone drop after delivery of placenta which stimulate anterior putitary gland to produce prolactin.

Colostrum is produced for the first 2-4 days of birth. by day 10 mature breast milk is produced.

sore nipples teaching: expose nipples to air between feedings, use aloe vera or vitamin E to help heal sore nipples, may also use medical grade lanolin or preservative free lanolin.

Apply warm compresses or encourage mother to take warm shower.

Poor sucking teaching: Feed on cue, not on schedule, encourage sleepy infant by stroking feet, undressing, and rubbing head.

AAP recommends 10-12mg of iron for commercial formulas.

Never give cows milk and fruit juice to infant diet.

introduce foods every 3-5 days after 6 months. Don’t add anything seasoning or sugar to this. can also introduce peanut to infant at 6 months.

Avoid egg yolks and meat until 10 months of age.

Avoid honey in infancy, avoid excessive fruit juice.

Cup should be introduced at 6-8 months,

No spill cup is not recommended because of risk for dental carries.

Fruit juice not introduced until 6 months of age, 2-4 oz per day.

by 3 months of age at 7-8 hours without waking up.

Baby should sleep on firm mattress without pillows or comforters.

SIDS is associated with prone side lying position.

Newborn fed every 1 ½ - 3 hours around the clock.

Rice cereal to infant bottle is not proven for discouraging night waking and not recommended.

before teeth eruption parents should clean a child’s gums after feeding with damp washcloth and continue with soft cloth after eruption.

No high sugar drinks to bed.

start weaning from bottle at age 12-15 months.

Receive first dental check up at 1 year of age

Discipline refers to molding of a child’s behavior through instruction, practice, and consistency.

Colic is inconsolable crying that lasts 3 hours of longer per day which are no physical cause, which typical resolve at 3 months of age.

Educate parents that normal crying increases by 6 weeks and diminishes by 12 weeks.

Teach parents that feeding smaller amounts and more frequent basis may help decrease spitting up episodes.

Always burp 2-3 episodes per feeding. Keep baby upright 30 minutes after feeding and do not lay them.

If infant is wetting at least six diapers per 24 hours and gaining weight then spitting up is normal.

If infant is vomiting more then one third of feedings, or chokes when feedings, or experiences forceful emesis then notify PCP.

Sucking is normal until it goes beyond school age period.

Application of cold to gum can soothe infant. and Orajel to treat pain but avoid applying to lips. Occasional acetaminophen or ibuprofen can be given.