Health Promotion of the Infant - Study Guide

Unit Learning Outcomes

• Identify the major biologic, psychosocial, cognitive, and social developments occurring during the first year of life.
• Discuss strategies for parents to cope with concerns related to normal growth and development during infancy.
• Discuss optimal health recommendations during infancy, specifically covering nutrition, sleeping and activity, and dental health.
• Develop a teaching plan for parents regarding injury prevention for the infant.

Biologic Development during Infancy

• General Growth Patterns: Characteristics of development follow a head-to-toe (cephalocaudal) and center-to-periphery (proximodistal) direction.
• Weight Gain:
  • The infant doubles their birth weight by $6$ months.
  • The infant triples their birth weight by $1$ year.
• Height/Length Increases:
  • During the first $6$ months, an infant grows approximately $1\,in$ per month.
  • The average height at $6$ months is $25.5\,in$.
  • Growth slows significantly during the second half of the first year ($6-12$ months).
  • By $1$ year of age, the infant is $1.5$ times their birth length, with an average of $29\,in$.
• Head Circumference:
  • Increases by approximately $0.6\,inches$ during the first $6$ months.
  • Increases by approximately $0.2\,inches$ between $6-12$ months.
  • The typical measurement at $6-12$ months is $17-18\,in$.
• Chest Circumference:
  • The chest circumference and head circumference become approximately equal by $1$ year of age.

Biological System Development

• Respiratory System: The respiratory rate slows and stabilizes over time; infants exhibit periodic breathing patterns.
• Cardiovascular System: Characterized by sinus arrhythmia (heart rate fluctuates with breathing).
• Hematopoietic Changes: Infants may experience physiologic anemia as maternal iron stores are depleted and red blood cell production adjusts.
• Digestive Processes:
  • Enzymes present include Amylase, Lipase, Trypsin, and Rennin.
  • The infant relies on the suck, swallow, and breathe reflex for successful feeding.
• Immunologic System:
  • Infants receive maternal immunity via breastmilk.
  • Infants are highly susceptible to infection.
  • Vernix caseosa provides a protective skin barrier at birth.
• Thermoregulation: Infants gradually develop the ability to shiver and increase their adipose tissue (fat) to help maintain body temperature.
• Renal Function: Kidneys are immature during infancy, resulting in the need to void frequently.
• Sensory Development:
  • Auditory acuity reaches an adult level shortly after birth.
  • Visual acuity improves gradually.
  • Binocularity and depth perception develop during the first year.

Fine Motor Development Milestones

• 1 - 2 Months: Palmar grasp reflex is present.
• 2 - 3 Months: Purposeful grasping of objects begins.
• 4 Months: The startle reflex (Moro reflex) disappears.
• 7 Months: The infant can transfer an object between hands.
• 8 Months: The plantar grasp reflex begins to lessen.
• 8 - 10 Months: Crude pincer grasp is developed (using the whole hand to pick up objects).
• 11 Months: Neat pincer grasp is developed; the infant can remove objects from a container.
• 12 Months: The infant may try to build a tower of two blocks but will typically fail to do so.

Gross Motor Development Milestones

• 0 - 2 Months: Head lag is present when pulling the infant to a sitting position.
• 1 Month: When in a prone position, the infant momentarily lifts the head.
• 4 Months:
  • The infant achieves head control.
  • When prone, the infant lifts the head and chest $90\,degrees$ and bears weight on the forearms.
• 5 Months: The infant can roll over from the abdomen to the back.
• 6 Months: When prone, the infant lifts the head, chest, and upper abdomen, bearing weight on the hands. This position helps facilitate turning from the abdomen to the back.
• 7 Months: The parachute reflex (a protective response) develops.
• Locomotion Stages:
  • Coordination of arms increases at $4$ months.
  • Crawling (pulling body along floor) occurs at $6-7$ months.
  • Creeping (moving on hands and knees) occurs at $9$ months.
  • Walking with assistance (cruising) occurs at $11$ months.
  • Walking alone may occur by $12$ months.

Development of Sitting

• 1 Month: The back is completely rounded; the infant has no ability to sit upright.
• 2 Months: The infant exhibits more control; the back is still rounded, but they can try to pull up with some head control.
• 4 Months: The back is rounded only in the lumbar area; the infant can sit erect with good head control.
• 7 Months: The infant can sit alone but must lean on their hands for support. This is also when transferring objects between hands occurs.
• 8 Months: The infant can sit without any support.
• 10 Months: The infant can move independently from a prone position into a sitting position.

Cognitive Development (Piaget)

• Sensorimotor Phase: Lasts from birth to $24$ months.
  • Reflex Stage (birth – 1 month): Primary use of reflexes.
  • Primary Circular Reactions (1 – 4 months): Repeated actions centered on the body.
  • Secondary Circular Reactions (4 – 8 months): Repetition of actions to trigger a response outside the body. This involves imitation, play, and affect.
  • Coordination of Secondary Schema (8 – 12 months): Intellectual reasoning begins.
• Three Main Cognitive Events:
  • Separation: Learning they are separate from others.
  • Object Permanence: Understanding objects exist when out of sight.
  • Mental Representation: Thinking about objects or people when they are not present.

Psychosocial Development (Erikson)

• Core Conflict: Trust vs. Mistrust.
• Key Relationship: The primary relationship is with the caregiver (parent).
• Foundations of Trust: Trust is built through the reliable provision of food, warmth, and shelter.
• Frustration Management: Development involves learning delayed gratification. Too much or too little frustration can impact development. Successfully building trust gives the infant the confidence to explore their surroundings.
• Narcissism: Total concern for self; the infant moves from crying for needs to reaching for them.
• Grasping: Evolves from an initial reflex to a purposeful action.

Body Image and Social Development

• Development of Body Image: As object permanence develops, the infant realizes they are a unique individual. There is an increased interest in their own image and a realization that their body is useful.
• Social Milestones:
  • Attachment to caregivers.
  • Reactive Attachment Disorder (RAD): A risk if attachment is not formed.
  • Separation anxiety and stranger anxiety emerge.
  • Play is identified as a major socializing agent.

Language Development

• Birth: Crying is the first form of verbal communication.
• 6 Weeks: Vocalizations begin.
• 3 - 4 Months: The infant will coo, gurgle, and laugh aloud.
• 8 Months: The infant begins to imitate sounds and adds consonants to vocalizations.
• 9 - 10 Months: The infant can comprehend the word "No" and follow simple commands.
• 10 - 11 Months: The infant ascribes actual meaning to a word.
• 1 Year: The infant typically says three to five words with specific meaning.

Temperament and Coping

• Temperament: Influences the interaction between the child and parents and can be affected by the environment and family dynamics.
• Revised Infant Temperament Questionnaire: Used to assist in determining temperament; designed for infants younger than $4$ months. It helps guide child-rearing practices.
• Parental Concerns: These include separation/stranger fear, child-care arrangements, limit setting/discipline, thumb sucking, pacifier use, and teething.
• The Period of "PURPLE" Crying:
  • P: Peak of crying (crying may increase each month, peaking at $2$ months then decreasing).
  • U: Unexpected (crying can come and go without reason).
  • R: Resists soothing (baby may not stop crying no matter what is tried).
  • P: Pain-like face (baby may look like they are in pain even when they are not).
  • L: Long lasting (crying can last as much as $5\,hours$ a day or more).
  • E: Evening (baby may cry more in the late afternoon and evening).
• Interventions: Note that "Parenting time-outs" are recommended for coping. Play should be interpersonal to facilitate development.

Nutrition and Health Recommendations

• Primary Nutrition: Breast milk is the first choice for the first $6$ months.
• Fluids: No additional fluids are needed in the first $4$ months.
• Safety Warning: No honey should be given in the first year of life (risk of botulism).
• Solid Foods: Introduced after $6$ months of age.
• Finger Foods: Introduced around $9$ months.
• Weaning: Transitioning from breast or bottle to a cup occurs after $1$ year.
• Supplements: Fluoride supplements may be necessary depending on water supply.

Sleep, Activity, and Dental Health

• Sleep Patterns:
  • Infants usually establish a nocturnal pattern of $9-11\,hours$ by $3-4$ months.
  • Total daily sleep needs decrease from birth to $5\,months$ and then again from $6\,months$ to $1\,year$.
• Safe Sleep (The ABCs):
  • A (Alone): Place baby alone in the crib.
  • B (Back): Place baby on their back to sleep (Back to Sleep campaign).
  • C (Crib): Use a firm, flat mattress with a fitted sheet; keep the crib empty.
• Dental Health:
  • Cleaning begins as soon as primary teeth erupt.
  • The first dental visit should be at $6$ months (when teeth erupt).
  • Water is preferred over toothpaste until after $2$ years of age.

Injury Prevention (SAFE PAD)

• Common Risks: Aspiration of foreign objects, suffocation, motor vehicle injuries, falls, poisoning, burns, and drowning.
• SAFE PAD Guide:
  • S: Suffocation and Sleep position.
  • A: Asphyxia and Animal bites.
  • F: Falls.
  • E: Electrical burns and other Burns.
  • P: Poisoning and Ingestions.
  • A: Automobile safety.
  • D: Drowning.