5 - infancy

5 – infancy

As a nurse – important to know that unparalleled growth in the first year, any problems become critical

Knowledge of infant develop help nurses educate parents

Physiological development

Brain and NS develop a lot during first 2 years

-              Brain and medulla (regulate vital functions) mostly developed at birth

-              Least developed = cortex (perception, movement, thinking, lamguage)

1.        Synaptogenesis

Creating of synapses

2.        Synaptic pruning

Removal of extra neurons/unused pathways/synaptic connections, make brain more efficient, happens throughout life

3.        Neuroplasticity

Ability to recognize neural structure, adapt, change and function in response to experiences

4.        Myelinization

Myelin coating on axons, insulate them and improve conductivity of nerves. Happen rapidly in infancy and childhood

Growth and physical development

Rapid growth

-              Rapid physical growth in first year

-              Monitor waist, length, head circumference to check growth milestones

Reflexes

-              Assess primitive reflexes: moro, rooting, grasp, Babinski

-              Should be present at birth and disappear at specific developmental stages

-              Delay, absence, decrease strength or persistence of reflex can indicate problem in neurological development

1.        Adaptive reflex – help newborn survive, some go into adulthood. Ex. Withdrawl painful stimuli + constriction of pupil to light

a.        Rooting – stroke baby cheek and turn toward touch

b.        Sucking on thumb

2.        Primitive reflex – controlled by primitive part of brain, disappear within first years of life. Should be gone by 6 months

a.        Startlem/moro – when startled, throw arm out, open hand, pull arm back

b.        Babinski – stroke sole of foot, fans outward, big toe move up

Indicate CNS disorder in adults

Body systems

Cephalocaudal pattern – growth from head downward

Proximodistal pattern – from centre of body outward

Bones

-              Change in size, number. Ossify, harden throughout body until puberty

Muscles

-              All muscle fibres present at birth, continue to grow. Allow for motor skills, walking, running

Lungs and heart

-              Improvement and efficenty in lungs, strength in heart muscle for stamina

Motor development

Gross motor skills - locomotor

-              Head control, rolling, sitting, crawling based on age

1 month – stepping

4-6 months – roll over, sit w/ support, move on hand/knees

7-9 m – sit w no support, crawl

10-12 m – pull themselves up, walk, grasp furniture

13-19 m – walk backward, sideway, run

19-24 m – walk up/down stairs

Non locomotor skills

1 m – lift head, follow object

2-3 – lift head on stomach

4-6 m – hold head erect sitting

10-12 – squat

13-18 – roll ball, clap

19-24 – jump with 2 feet

Fine motor skills

-              Grasping and reaching behaviours

1 m – hold object in hand

2-3 m – swipe at objects

4-6 m – reach and grasp object

7-6 m – transfer object from hands

10-12 – show hand prefrence, gasp spoon but poor aim

13-18 – stack block, objects into container

19-24 – feed self

Cognitive and sensory development

Sensory abilities

-              Infants rely on sensory input (ex. Mouth)

-              Assess ability to track objects, respond to sound, recognize voices especially with caregivers

Vision

-              40 worse than adults. See close up objects, tracking improves. Colour vision similar to adults

Auditory

-              As good as adult, locate direction of sound at birth

Perceptual

-              Via visual and auditory experience. Focus on edge to recognize pattern, voice. Match sound to visual at 6 months. Processed with intermodal perception, transfer information across senses, recognize toy by touch when seeing it.

Touch and motion

-              Best developed sense. Responsive to social touch. Important for development, sensitive on mouth, hand, face, feet

Smell and taste

-              Differentiate between 5 flavours

Piaget says sensorimotor stage happens in the first 2 years

Cognitive – long way from maturity but lots of progress

Language acquisition

-              First sounds around 1-2 months

-              Coo and laugh signal pleasure, has variation

Coo – vowel sounds  ex. Ooo , uuuu

Babbling – repeating vowel sounds ex. Babbabba

Prelinguistic communication – before words, w sounds, facial expression. Ex. Shake head, frown

Holophrases -  one word  ex. Up

Naming explosion – learn new word rapidly

Telegraphic speech – short sentences – pick me up

2-3 months – cooing sound alone, smile and cooed when talked to

4-5 month – vowel and consonant sound w/ cooing

6 m – phonemes of all languages

8-9 months – phonemes, ryhtym, intonation of language, 20-30 words

12 month – expressive language, single words

12-18 m – word gesture combination with variation

18-20 month – 2 word sentences, vocab 100-200 words

Usually late speech catches up. Those who don’t catch up have receptive language problem or other cognitive.

Psychological and emotional development

Attachment

-              Observe interactions between infant and caregiver, assess bonding and attachment

Develop temperament and how they approach the world, personality and characteristics stem from infancy. Unique traits and behaviours

-              Early months, smile, laugh with peers

-              9-12 months, accept toys and play social games

Erikson stage of trust vs mistrust in first 2 years – learn who to rely on

Self concept

Interal model of attachment and temperament develop, also model of self

Subjective existential self

I exist – awareness that they are separate person in environment. Fully aware around 8-12 months

Objective categorical self

-              I am object in the world. Categorised by categories (gender) or quality (shy) around 2 and a half years. Can label themselves

Emotional self

-              I have emotions. Identify change of emotions in faces at 2-3 months. Use caregiver to guide emotions.

Stranger anxiety

-              6-8 months, begin to fear strangers

-              Use calm gentle approaches + parents in assessment

Nutrition and feeding

-              Assess breast feeding, bottle feeding, or solid food introduction at 6 months

-              How they eat, weigh, breastfeeding concerns

Immunization and health screening

Vaccination schedule

-              Ensure up to date

Hearing and vision

-              Early screening important for development

Developmental milestones

-              Using tools like Denver screening test to evaluate milestones

Parent education and involvement

-              Involve them in assessment, and give education

Vital signs

Temperature

Sensitive to temperature fluctuations keep at 35.5 – 37.7 C

Risk for hypo or hyperthermia

Cant use oral on infant

-              auxillary temp 1 lower than oral

-              rectal one c higher than oral

heart rate

newborn – 1 month = 100-175

1m to 2 years – 90-160

2 -6 – 70-150

7-11 – 60 – 130

Slows down as age

Respirations

Newborn to 1 month – 30-65

1 month – 1year – 26-60

1-10 years – 14-50

Blood pressure

Newborn to 6 month 45-90/30/65

-              low because of smaller bodies

6 mo to 2 years 80-100/40-70

2-13 years 80-120/40-80

Attachment behaviours (around 6 months)

-              stranger anxiety – pull away from strangers

-              separation anxiety – being taken from caregivers

-              social referencing – look to parents to see how they respond

type of attachment

-              secure attachment – most common

-              insecure attchemnt

o   avoidant attachment – avoid caregiver, independent

o   ambivalent attachment – clingy, upset when caregiver leaves, hard to calm down

o   disorganised attachment – confusing, approach caregiver but back away

influence on secure attachment

1.        emotional responsiveness

parents willing to form bond with child

2.        tactile responsiveness

having pleasant contact when talking

3.        contingent responsiveness

verbal, nonverbal, parent responding to needs correctly

4.        marital conflict

shapes attachment when not seeing positive interaction with parents

5.        mental health

secure attachment

-              more social positively towards sibling and friends

-              less clingy and dependant on teacher or parents

-              less aggressive and disruptive at school

-              empathetic and emotionally mature in school / out of home

loss of attachment on broad scale

-              colonization

-              taken from families in countries

decolonizing and resiliency – indegnous

prenatal teaching + baby wellness – build trust

ancestral teaching + ceremony practices

-              naming or walking out ceremony

-              moss bag, baby swing, cradle board

health promotion

-              education on immunizations

-              support breastfeeding

-              proper nutrition education

-              illness in first years

-              second hand smoke

-              safe sleep

sleep

cycle of wakefulness/fussy -> feed -> drowsy -> deep sleep -> light sleep

repeating cycle every 2 hours

8 weeks, develop day/night routine, sleep up to 2-3 hours

6 months – sleep 13 hours with schedule

-              cultural beliefs play a role in parent response to sleep patterns

-              central sleep apnea (brain stop breathing signal) or obsttuctive sleep apnea (airway blocked)

SIDS sudden infant death syndrome

Sudden death of infant under 1 year due to unsafe sleep

Safe sleep environment

-              sleep on back

-              no quilt, duvet, pillow, toy, crib bumpers

-              no soft surface

-              in a crib or cot near parents bed first 6 months

-              no bed sharing especially if parents; smoke, more tired, alcohol or other fatigue substance

-              smoke free environment during pregnancy and post birth

colic

-              consistent crying for 3+ hours a day, unsoothable

-              appear at 2-3 weeks, disapper around 3-4 months

-              reassure parents its normal, no long term effects