infancy

NURS 2510 CLIENT AND CONTEXT 1: HUMAN GROWTH AND DEVELOPMENT

Course Objectives

At the end of the class, students will be able to:

  1. Describe the normal physical development, early motor skills, and perceptual abilities of infants.

  2. Examine sleep and variation in infancy.

  3. Identify newborn reflexes and the purpose they serve.

  4. Explore the basic principles of cognitive development in infancy using Piaget’s theory of cognitive development.

  5. Examine language acquisition in infancy.

  6. Describe the significance of attachment in human development.

  7. Differentiate between various attachment qualities.

Topics and/or Exemplars

  • Sleep

  • Attachment

  • Picture – Stock Photo

Developmental Consideration – Nursing Assessment - Infants

Growth and Physical Development

  • Rapid Growth: Monitor weight, length, and head circumference to ensure infants are meeting growth milestones.

  • Reflexes: Assess primitive reflexes such as:

    • Moro reflex

    • Rooting reflex

    • Grasp reflex

    • Babinski reflex
      These reflexes should be present at birth and disappear at specific developmental stages.

  • Motor Development:

    • Gross Motor Skills: Evaluate head control, rolling, sitting, and crawling based on the infant's age.

    • Fine Motor Skills: Observe grasping and reaching behaviors.

  • Cognitive and Sensory Development:

    • Sensory Abilities: Infants rely heavily on sensory input; assess their ability to:

    • Track objects

    • Respond to sounds

    • Recognize voices, particularly their caregivers.

  • Psychosocial and Emotional Development:

    • Attachment: Observe interactions between the infant and caregiver to assess bonding and attachment.

    • Stranger Anxiety: By about 6-8 months, infants may show fear of strangers; use a calm, gentle approach to reduce stress.

  • Nutrition and Feeding: Assess breastfeeding, bottle-feeding, or the introduction of solid food (typically around 6 months).

  • Immunizations and Health Screening:

    • Vaccination Schedule: Ensure the infant is up-to-date on recommended vaccinations.

    • Hearing and Vision: Early screening for hearing and vision is crucial for development.

    • Developmental Milestones: Use tools, such as the Denver Developmental Screening Test, to evaluate milestones in gross motor, fine motor, language, and social skills.

    • Parental Education and Involvement: Involve parents in the assessment process and provide education on expected developmental milestones, safety, and health promotion.

Positioning During Assessment

  • A parent should be present to understand normal growth and development for the child’s feeling of security.

  • Place the infant on a padded examination table and maintain a warm environment.

  • If the baby can sit without support, the examination can be performed while the baby is in the parent's lap.

  • By age 9 to 12 months, parents must be in full view of the infant as they become aware of their surroundings.

  • Most infants prefer eye contact, so make eye contact with the baby periodically.

  • Smile and keep movements smooth and not jerky.

  • By the age of two, toddlers start developing autonomy and environmental awareness; ensure the toddler is sitting up in the parent’s lap for examination.

  • Greet the child but focus more on the parent to allow the child to see you from a safe distance.

  • Do not offer choices; rather, give firm instruction or offer choices with limited options (Jarvis physical examination and health assessment).

Vital Signs Age Differences

Respirations (breath per minute)

  • Newborn to one month: 30-65

  • One month to one year: 26-60

  • Ages 1-10 years: 14-50

Blood Pressure

  • Age Systolic Range

    • Newborn to 6 months: 45–90

    • Diastolic Range: 30–65

    • 6 months to 2 years: 80–100 / 40–70

    • Children (2–13 years): 80–120 / 40–80

Temperature

  • Normal temperature range: 35.5-37.7°C

  • Infants are sensitive to temperature fluctuations, posing a risk for hypo/hyperthermia.

  • Auxiliary temperature: tends to be one °C lower than oral.

  • Rectal temperature: tends to be one °C higher than oral.

Heart Rate

  • Newborn to 1 month: 100-175 bpm

  • One month to two years: 90-160 bpm

  • Ages 2-6 years: 70-150 bpm

  • Ages 7-11 years: 60-130 bpm

Attachment

  • Definition: The emotional tie to a parent experienced by an infant, from which the child derives security.

  • Attachment Theory:

    • The view that forming an attachment relationship early in life is a fundamental human need.

    • Genetic characteristics of all human beings compel this need.

    • According to Bowlby, by age 5, infants create internal models related to relationships.

  • The majority of parents manage to respond to their infants in ways that foster a close relationship.

  • It is crucial to consider both sides of the relationship equation (the child and the parent).

Attachment Behaviours

  • Stranger anxiety: The distress infants feel when approached by unfamiliar individuals.

  • Separation anxiety: The fear of being separated from primary caregivers.

  • Social referencing: The process by which infants look to caregivers for cues on how to respond to unfamiliar situations.

Types of Attachment

  1. Secure attachment: Most common in every country.

  2. Insecure attachment: Can manifest in various ways.

  3. Avoidant attachment: Infants appear indifferent to their caregivers.

  4. Ambivalent attachment: Infants are anxious and clingy.

  5. Disorganized/disoriented attachment: Mixed signals and confusion in the infant's behavior.

Factors Influencing Secure Attachment

  1. Emotional Responsiveness

  2. Tactile Responsiveness

  3. Contingent Responsiveness

  4. Marital Conflict

  5. Mental Health

Characteristics of Securely Attached Children

  • More sociable and positive in behavior towards siblings and friends.

  • Less dependent on teachers and demonstrates less clinginess.

  • Display lower levels of aggression and disruptive behavior.

  • More empathetic and emotionally mature both at school and outside the home.

Large-Scale Loss of Attachment

  • Contemplation of what happens when the loss of attachment occurs on a much broader scale:

    • Example: Children are taken from their families when they cross borders in the USA.

    • Historical context: The Great Food shortage led to orphans being sent to Canada, the USA, and Australia.

    • Emphasis on the necessity for large-scale prevention measures.

Babies - Indigenous Teachings

  • Teachings emphasize joy, love, and happiness.

  • Importance of bonding, learning and nurturing for healthy baby development.

  • Role of family and community in supporting development.

  • Building trust and dependence in infants.

  • Helping to transition new parents.

  • Importance of baby wellness.

A Child Becomes Strong

Wheel of Support for Babies

  • Spirit:

    • Provide opportunities for caregivers to learn new skills for healthy physical development, such as baby massage.

    • Encourage parents to hold and cuddle their baby.

    • Offer support for breastfeeding and connect mothers to support services.

    • Encourage cultural practices like naming ceremonies.

  • Mind:

    • Offer to create a moss bag and cradleboard with parents.

    • Encourage outings for sensory experiences and connecting with different environments.

    • Provide access to parenting programs.

  • Emotions:

    • Demonstrate ways to play, connect, and bond with babies (e.g., singing, finger games, tickling).

    • Check in with mothers regarding their mental health, particularly for signs of postpartum mood disorders.

Decolonizing and Resiliency

  • Importance of prenatal teaching and midwives.

  • Acknowledge ancestral teachings and ceremonial practices, including naming ceremonies and other cultural healing practices (e.g., moss bag, cradleboard).

Health Promotion

  • Immunizations:

    • Vaccines help the immune system recognize and fight bacteria and viruses.

  • Nutrition:

    • Emphasize supporting breastfeeding for health.

  • Common Illnesses in the First Two Years:

    • Risks associated with second-hand smoke and safe sleeping practices.

    • Reference: Healthy Children and Vaccination Schedule — (https://www.gov.mb.ca/health/publichealth/cdc/div/schedules.fr.html#child)

Sleep – States of Consciousness

  • Sleep cycles in infants repeat every 2 hours.

  • By 8 weeks, some infants develop a day/night routine sleeping 2-3 hours at a time.

  • At 6 months, babies typically sleep about 13 hours with more defined sleep routines influenced by cultural beliefs.

  • Different sleep states include:

    • Deep sleep

    • Lighter sleep

    • Wakefulness

    • Fussiness and feeding

    • Drowsiness

Colic

  • Colic usually manifests at 2-3 weeks and resolves around 3-4 months.

  • Important to reassure parents that colic is a normal, self-limiting condition with no long-term effects.

Sudden Infant Death Syndrome (SIDS)

  • Defined as the sudden and unexpected death of an apparently healthy infant under 1 year.

  • Parents and caregivers are encouraged to provide a safe sleep environment which includes:

    1. Placing baby on their back (evidence-based recommendation).

    2. Eliminating soft bedding (quilts, duvets, pillows, soft toys, crib bumpers).

    3. Using only a fitted sheet in the crib.

    4. Avoiding soft surfaces for baby’s sleep.

    5. Keeping the crib or cot near the parent's bed for the first six months.

    6. Avoiding bed-sharing or sleeping with the baby on a sofa, especially if the parents smoke, are more tired than usual, or have consumed substances that promote fatigue.

    7. Maintaining a smoke-free environment during pregnancy and postpartum.

Sexuality

  • Consider various factors influencing sexual well-being, including:

    • Physiological

    • Psychological

    • Environmental

    • Maturational

  • Family attitudes and behaviors contribute significantly to sexual development, particularly during later childhood.

Takeaways

  • Understanding normal and abnormal development patterns.

  • The significance of Indigenous teachings in child development.

  • The importance of attachment in early development.

  • Health promotion practices, particularly concerning SIDS.

  • The role of sexuality in childhood development and its influencing factors.