Prenatal to Infant Period Notes

Prenatal Period

  • Period from fertilization to birth.
  • Stages include morula, blastocyst, embryo, and fetus.

Apgar Scoring

  • Assessment of newborn functioning at 1 minute and 5 minutes after birth.
  • Assesses 5 essential categories:
    • Heart rate
    • Respiratory rate
    • Muscle tone
    • Reflex irritability (response to catheter in nostril)
    • Response to slap to sole of foot

Physical Characteristics of the Newborn: Head and Skull

  • Sutures: Bands of cartilage separating skull bones.
  • Fontanels: Soft spots in the baby’s head.
  • Molding: Change in newborn’s skull shape as the head passes through the narrow birth canal.

Skull Features

  • Frontal bone
  • Parietal bone
  • Occipital bone
  • Temporal bone
  • Squamous suture
  • Lambdoid suture
  • Coronal suture
  • Sagittal suture

Fontanelles

  • Frontal fontanelle
  • Sphenoidal fontanelle
  • Mastoid fontanelle
  • Occipital fontanelle

Physical Characteristics of the Newborn: Length and Weight

  • Length:
    • Average: 20 inches from head to heel
    • Normal range: 19-21 inches
    • Growth rate: Approximately 1 inch per month for the first year
  • Weight:
    • Average: 7.5 pounds
    • Normal range: 5.5-10 pounds
    • Weight loss: Newborns typically lose 5% to 10% of their birth weight in the first few days of life.

Physical Characteristics of the Newborn: Genitals

  • Breasts: Neonates of both sexes may have swollen breasts, which will disappear over time.
  • Scrotum: Should be palpated for the presence of testicles.
    • Testicles usually descend from the abdominal cavity into the scrotal sac during the seventh month of fetal life.
    • If the testicles have not descended, monitor for descent over the next few months.
  • Urine:
    • Urine is normally present in the bladder at birth.
    • The newborn should void within 24 hours after birth.

Physical Characteristics of the Newborn: Face

  • Eyes:
    • Tears appear at approximately 4 weeks of age.
    • Eye color is typically slate gray or dark blue until 3-6 months of age.
  • Cleft palate: Incomplete formation and non-union of the hard palate.
  • Teeth:
    • Deciduous teeth (primary or “baby” teeth) erupt around 7 months of age.
    • Replaced by permanent teeth by 7 years of age.

Newborn Reflexes

  • Moro reflex
  • Tonic neck reflex
  • Rooting reflex
  • Sucking reflex
  • Palmar grasp reflex
  • Babinski reflex

Motor Development

  • Gross Motor Skills: Movements of the large muscles of the arms and legs.
  • Fine Motor Skills: Movements of the hands and fingers.

Psychosocial Development

  • Attachment:
    • Natural instinct to form a primary attachment between the infant and the mother.
    • Provides security and allows children to explore their environment.
    • Predicts the ability of children to form future attachments.
    • Failure to form attachment may lead to long-term emotional difficulties.
  • Engrossment: Process of bonding.
  • Temperament:
    • Infants are born with a biologically determined temperament that affects their moods and responses to stimulation.
    • Willingness to interact with others.
  • Personality:
    • Arises over time and is shaped by temperament and affected by the environment.

Parental Guidance

  • First 6 months: Use distraction techniques.
  • Age-appropriate toys.
  • 6-12 months: Memory and cognition increase, allowing for more direct guidance.
  • Infants can understand the tone of repeated verbal cues and can be told “no.”

Cognitive Development

  • Learning occurs through observation and sensory perception.
  • Infancy is the stage of sensorimotor development.
  • By 8 months, infants begin to plan and coordinate actions.

Communication

  • Crying:
    • Cry fretfully with fingers in their mouth indicates hunger.
    • Cry fretfully, draw legs up in a flexed position, and pass flatus usually indicates colic.
    • High-pitched, shrill cry usually indicates injury to the central nervous system.
  • Pleasure and smiles: Response to familiar voices.
  • Cooing.
  • Babbling.

Nutrition

  • Breastfeeding or iron-enriched formula is recommended.
  • Weaning occurs around 8-9 months.
  • Introduction of solid foods begins at 5-6 months.
  • Introduce foods several days apart to detect food allergies.

Rest and Sleep

  • The faster the rate of growth, the more sleep is required.
  • Sleep patterns may be interrupted by discomfort or hunger.
  • Infants may sleep as much as 20 hours per day.
  • Infants should sleep in a crib.
  • No blankets should be used in the crib.
  • Infants should be laid on their back to prevent SIDS (Sudden Infant Death Syndrome).