Care of Newborn and Infant

Care of the Newborn and Infant: Growth and Assessment

Growth and Development: Developmental Patterns of Newborns and Infants

  • Infant Stage of Growth and Development:

    • From newborn through 12 months of age.

  • Cephalocaudal Pattern:

    • Skills are attained from head to toe.

  • Proximodistal Pattern:

    • Skills are attained from the trunk outward to extremities.

  • Motor Skill Development:

    • Gross motor skills are gained before fine motor skills.

Health Assessment: Newborns and Infants

  • Timing of Appointments:

    • Conduct health assessments at:

    • Newborn

    • 1 month

    • 2 months

    • 4 months

    • 6 months

    • 9 months

    • 12 months

  • Involvement of Caregivers:

    • Assess infants on the caregiver's lap.

    • Explain all procedures to caregivers during the assessment.

  • Assessment Techniques:

    • Auscultate first while the infant is quiet or sleeping.

    • Perform the most invasive procedures last to minimize distress.

    • Use age-appropriate techniques to assess for hip dysplasia.

Health Assessment: Physical Variants in Newborns and Infants

  • Fontanelles: (It should feel soft and spongy)

    • Posterior Fontanelle:

    • Smaller, closes between 2 and 3 months.

    • Anterior Fontanelle:

    • Larger, closes between 9 and 18 months.

  • Common Physical Variants:

    • Strabismus:

    • Common until 6 months of age. Do not have muscle control over their eye movements, which may result in misalignment of the eyes. Regular pediatric check-ups should monitor this condition, as most infants naturally outgrow strabismus by the age of 6 months.

    • Ear Inspection:

    • Pull back and down on the pinna of the ear to inspect.

    • Chest Shape:

    • Normally appears barrel-chested (1:1 anteroposterior to transverse diameter).

    • Breathing Patterns:

    • Diaphragmatic breathing with irregular respiratory patterns and occasional pauses. Until 5 years old, they have weak intercostal muscle

    • Acrocyanosis:

    • May be present in newborns, characterized by blue discoloration of the extremities.

    • Heart Rate:

    • Often irregular, and S3 may be audible.

    • Asymptomatic murmurs are frequently present and considered normal.

  • Other Physical Development Indicators:

    • Incomplete bone ossification.

    • Benign metatarsus adductus is normal.

    • Passive immunity lasts until 3 to 6 months of age.

    • High levels of fetal hemoglobin (HgbF) present at birth, leading to physiological anemia later.

    • Skin variants include salmon patches and Mongolian spots.

Health Assessment: Reflexes

  • Myelination:

    • Spinal cord myelination occurs from newborn to 24 months.

  • Primitive Reflexes:

    • Includes:

    • Sucking reflex: This reflex allows the infant to feed effectively, enabling them to latch onto the breast or bottle and draw milk.

    • Rooting reflex: This reflex involves the infant turning their head toward a stimulus, such as a cheek being stroked, which assists in locating the breast or bottle for feeding.

    • Babinski reflex: This reflex is characterized by the infant's toes spreading outward when the sole of the foot is stroked, which is an important indicator of neurological development.

    • Moro (startle) reflex: This reflex occurs when an infant feels a sudden loss of support, causing them to extend their arms and legs and then retract them, showcasing their involuntary response to potential danger.

    • Stepping reflex: This reflex manifests when an infant is held upright with their feet touching a flat surface, prompting them to make stepping motions as if walking, which is a crucial aspect of early motor development and coordination.

    • Palmar grasp

    • Plantar grasp

    • Tonic neck (fencer) reflex: This reflex occurs when an infant's head is turned to one side, causing the arm and leg on that side to extend while the opposite arm and leg flex, simulating a fencer's pose, which plays a role in developing head and neck control.

    • These reflexes are innate and typically disappear during the first year of life.

    • The Babinski reflex can last until 12 to 24 months.

  • Protective Reflexes:

    • Develop after primitive reflexes disappear.

    • Assess these during evaluations of toddlers and older children.

Health Assessment: Stool

  • Meconium:

    • The newborn’s first stool; thick and green in color.

  • Breastfed Stool Characteristics:

    • Thinner consistency; typically seeded and yellow.

  • Formula-Fed Stool Characteristics:

    • Pastier consistency and darker in color.

  • Normal Bowel Movement Patterns:

    • It's normal for infants to have one stool every other day, or up to 10 stools daily.

    • Focus should be on the consistency rather than the quantity of stools.

    • Grunting is not a sign of constipation.

    • They are still developing their digestive systems, and variations in bowel movements can be expected during this early stage.

Health Assessment: Pain Assessment of Newborns and Infants

  • Pain Observation:

    • Assess pain by observing behaviors and the ability to be consoled.

    • Involve caregivers in the pain assessment process.

  • FLACC Scale:

    • Stands for: Face, Legs, Activity, Cry, Consolability.

    • Each domain scores from 0 to 2.

    • Total score ranges from 0 to 10; higher scores indicate more pain.

  • Neonatal Infant Pain Scale (NIPS):

    • Assess facial expression, cry, breathing pattern, arm movement, leg movement, and state of arousal.

    • Score each domain from 0 to 1, except for the cry which is scored from 0 to 2.

    • Maximum score is 7; a higher score indicates more pain.

Physical Growth: Newborns and Infants

  • Length Growth:

    • Grow 1.5 to 2.5 cm per month during the first 6 months.

    • Grow 1 cm per month from 6 to 12 months.

  • Weight Growth:

    • Infants may lose up to 10% of body weight in the first week of life but typically regain it by the end of the second week.

    • Gain approximately 20 to 30 g per day during the first 1 to 3 months.

    • Weight doubles by 4 to 6 months and triples by 12 months.

    • 2.2kg = 1 pound "Therefore, it is important for caregivers to monitor weight closely during this period to ensure healthy growth and development."

  • Head Circumference:

    • Increases rapidly during the first 6 months, then growth slows until 12 months.

  • Documentation:

    • All physical growth data points should be documented on growth charts to assess trends and averages.

Developmental Theories in Infancy

Theorist

Domain

Stage

Implications

Erikson

Psychosocial

Trust vs. mistrust

Infants learn to rely on caregivers; their basic needs are met.

Piaget

Cognitive

Sensorimotor

Infants learn about the world around them through sensations.

Freud

Psychosexual

Oral motor

The infant is focused on oral sensations for pleasure, such as sucking and feeding.

Movement and Physical Development

  • Age and Milestones:

    • 1 Month:

    • Holds chin up when lying on stomach; opens hands slightly at rest.

    • 2 Months:

    • Holds head up when on stomach; moves both arms and both legs.

    • 4 Months:

    • Holds head steady without support; holds toy when placed in hand; brings hands to mouth; pushes up to elbows when on stomach; swings at hanging toy using whole arm.

    • 6 Months:

    • Rolls from stomach to back; pushes up with straight arms when on stomach; sits in a tripod position.

    • 9 Months:

    • Gets self into sitting position; transfers objects from hand to hand; uses full hands to “rake” food into mouth; sits without support.

    • 12 Months:

    • Pulls to stand; walks while holding onto furniture; drinks from a cup without a lid when held by an adult; uses thumb and forefinger (pincer grasp) to pick up food.

Communication and Language Development: Newborns and Infants

  • Developmental Timeline:

    • Crying:

    • The primary mode of communication. Different pitches indicate different needs.

    • Cooing:

    • Begins at 2 months of age.

    • Babbling:

    • Begins at 6 months of age.

    • Imitation:

    • Begins at 9 months of age. Infants start to copy sounds.

    • First Words:

    • By 12 months, infants can say a few words and use simple gestures. Important to read to child during early stages

Sensory Development: Newborns and Infants

  • Vision:

    • At birth, infants have 20/400 vision; no color vision until 7 months.

  • Hearing:

    • Infants display a preference for high-pitched voices.

  • Taste:

    • Prefer sweet tastes over sour tastes.

  • Touch:

    • Infants prefer soft, gentle touch.

Social and Emotional Development: Temperament of Newborns and Infants

  • It is important to recognize that temperament can vary widely among infants, influencing how they respond to their environment and interact socially.

  • Is a way of responding to the environment

  • Tailor parenting strategies around temperament to mitigate negative responses

  • Temperament Types:

    • Easy Temperament:

    • Establishes routines quickly; generally happy and adaptable.

    • Difficult Temperament:

    • Requires higher levels of activity; fussiness and crying are common.

    • Slow to Warm Up Temperament:

    • Moderate fussiness; initial negative reactions but adapts over time.

Health Promotion: Social Determinants of Health

  • Risk Factors:

    • Tobacco exposure, food and housing insecurity, parental substance abuse.

  • Protective Factors:

    • Support networks, positive family relationships, adequate childcare.

  • Infant Behavior:

    • Influenced by caregiver-infant relationships and daily routines.

  • Safety Considerations:

    • Importance of a safe home environment and parental knowledge related to infant care.

Health Promotion: Sleep and Play in Newborns and Infants

  • Sleep Recommendations:

    • Room sharing with parents in their own bed until 6 months of age.

    • SIDS (Sudden Infant Death Syndrome) prevention techniques: always place infants on their backs to sleep.

    • Newborns typically sleep about 16 hours per day.

  • Play Activities:

    • Infants engage primarily in solitary play.

    • Recommended playtime activities include reading, singing, and engaging with age-appropriate toys.

    • Toys for Younger Infants:

    • Includes items that can be kicked or batted, unbreakable mirrors, and toys with contrasting patterns.

    • Toys for Older Infants:

    • Toys that make noise or light up, soft dolls, teething toys, board books, and large blocks.

Health Promotion: Immunizations

  • Purpose of Immunizations:

    • Protect against communicable diseases.

  • Types of Vaccines:

    • Live attenuated

    • Inactivated

    • Toxoid

    • Conjugate

  • Barriers to Vaccination:

    • Lack of transportation, financial concerns, safety concerns.

Health Promotion: Nutrition for Newborns and Infants

  • Feeding Choices:

    • Breastfeeding or formula feeding.

  • Hunger Cues:

    • Rooting and sucking, crying, and moving hands to mouth indicate hunger.

  • Introduction of Solid Foods:

    • Typically starts at 6 months of age, following the disappearance of the tongue extrusion reflex and the ability to sit in a high chair with good head control.

    • Start with iron-fortified cereal, then gradually introduce other pureed foods to prevent allergies.

    • Wait between 3 days when introducing new foods to monitor for any signs of allergic reactions or intolerances, ensuring a safe and gradual transition to a diverse diet.

    • Cannot give cow’s milk until 12 months of age because it can cause GI bleed and impaired nutrient absorption; instead, continue breastfeeding or formula feeding until then to provide essential nutrition.

Health Problems: Common Developmental Concerns

  • Oral Health:

    • First tooth typically appears between 4 to 7 months.

    • Teething Symptoms:

    • Fussiness, increased salivation, low-grade fevers, difficulty sleeping.

    • Recommendations for teething include:

    • Use of frozen teething rings and topical analgesics with caution.

    • Clean gums with a soft washcloth or infant toothbrush until teeth erupt.

    • Avoid refined sugars and propping bottles during feeding.

  • Colic:

    • Characterized as a self-limiting condition of increased fussiness and inconsolable crying, peaking at 6 weeks and typically resolving by 3 to 6 months.

    • No treatment is needed, but caregivers require emotional support; encourage them to lay the infant in the crib if frustrated.

  • Brief Resolved Unexplained Events (BRUE):

    • Symptoms include:

    • Cyanosis or pallor,

    • Irregular, slowed, or absent breathing,

    • Hypertonia or hypotonia,

    • Altered level of responsiveness.

    • Episodes can last less than 60 seconds and need further evaluation by a healthcare provider. High-risk factors include being less than 2 months old, a history of prematurity, or more than one BRUE episode.

  • Diaper Dermatitis:

    • Any skin breakdown in the diaper region, characterized by erythema and excoriation, while skin folds remain unaffected.

    • Treatment includes leaving diapers off to allow the skin to dry, frequent diaper changing and using commercial barriers.

    • Seek healthcare provider advice if there are signs of odor, fever, or purulent drainage.

  • Seborrhea (Cradle Cap):

    • Characterized by scales and erythema, usually only on the scalp, and is not painful or itchy.

    • Resolves by 12 months of age. Remove scales gently using a soft brush. Hydrocortisone cream may be used if it extends beyond the scalp.

  • Fever in Infants:

    • Defined as a temperature over 100.4°F (38°C), indicating illness or infection.

    • Administer antipyretics only if the infant is symptomatic and irritable.

    • Common symptoms accompanying fever include tachypnea, irritability, and tachycardia.

    • Avoid placing infants in cool baths, as this can be uncomfortable; monitor for signs of poor perfusion, hyperventilation, or hypoventilation.