Ch_31_Infant and Family/ Trust vs Mistrust

Chapter 31: The Infant and Family

Definition of Infancy

  • Infancy: Time from birth to 12 months of age. Development and physical changes are dramatic. All body systems undergo progressive maturation.

  • Development of skills: Allow infants to explore and cope with the environment around them.

  • Acquiring motor skills: Head to toe center to periphery sequence.

Growth Patterns

  • 1st year of life: Rapid growth, mostly from 1-6 months.

  • Double weight by 6 months.Weekly weight gain is 150g-to 200g until 6 months old.

  • Weight gain slows down 6-12 months.

  • Triple weight by 1 years old.

  • Breastfed: Infants have a harder time in initial 2 month period gaining weight (milk supply, etc). will still meet weight milestones.

  • Height/length: 1 inch a month (1-6 months). Sudden spurts. By one year, birth length has increased by almost 50% in trunk rather than in legs.

  • Head growth: Is rapid in this time frame. Brain is getting bigger. ¾ of an inch in the first 3 months and half of this on 4-6 months

Maturation of Systems

  • Respiratory System: Breathing rates is faster when they are first born and lowers as they get older. HR slows down also.

  • Blood pressure: Systolic BP rises in first 2 months as result of left ventricle pumping blood. Diastolic BP: Decrease during the first 3 months, then gradually rises to numbers at birth.

  • Fetal hemoglobin: Present until 4-5 months of age.

  • Mom’s maternal iron stores: Depleted after 5-6 months. Monitor for changes to ensure they are transitioning to extra uterine circulation.

  • Digestive system: Immature. takes time to develop.

  • Immune system: Immature. Full term infants get a significant amount of IGG for the first 3 months to confer against antigens that they have been exposed to. infants start adapting to own immune system at that point. Immunization happen in infancy to protect them because they lose mother immunity.

  • Regulating body temp: Babies are born we swaddle them almost immediately to get heat and temp regulated

  • At birth: Water weight is 70% and significant extracellular fluid.

  • Renal Structure: Immature, puts infant at risk for dehydration and electrolyte imbalance.

Motor Development

Fine Motor Skills Development:

  • 0-1 month: hands are closed. Refers to use of hands and fingers (grasping) (2-3 months- relex open at 3 months), then it becomes voluntary.

  • Palmar grasp: use whole hand to grasp 3 months

  • Pincer grasp: older- thumb and index finger.

  • Neat pincer grasp: 10 months old.

  • 11 months old: Put objects into containers and dump them out

  • 1 year old: stack a couple blocks into a tower.

Gross Motor Skills:

  • Head control: 3 month old. on their bellies, hold head over plane of bodies.

  • 4 months old: Hold head in front portion their chest like off the table. Bearing weight in forearms.

  • 4-6 months: head control is well established for infants.

  • Rolling over: 5 months old, but newborns may roll accidentally because rounded backs. Belly to back at 5 months and back to belly at 6 months

  • Sleep: Babies should sleep on their back and not tummy due to more at risk of sudden infant death syndrome.

Tummy: prone position. Its good for development. Helps with head control.

Sitting

  • Back isn’t rounded. Back is more straight and the infant has head control.

  • 7 months old: sits alone on hands for support.

  • 8 months old: sit well supported without arms. Turns head side to side and look at surroundings.

  • 10 months old: Prone position on belly and get into sitting position independently.

Locomotion

  • Acquiring ability to bear weight, propel forward on all four extremities. stand upright with support, cruise on furniture. finally walk alone.

  • 4-6 months Ability to use arms with coordinated movement. pushing on arms.

  • 6-7 months bear all weight on leg with assistance. crawling (propelling forward with belly on floor).

  • 9 months: creeping (get up on hands and knees and propelling froward)

  • 10 months: hold on furniture, Pull themselves to standing.

  • 11 months: cruise on furniture with both hands held.

  • 1 years: walk on hand held or independently.

Psychosocial Development

  • Erikson's Theory: Trust vs Mistrust (birth-1 year). The care they receive is important to build trust. Needs continuously met. They are earning trust.

Caregiver does not consistently provide care to infant: affects child’s development, leads to lifelong issues. Hard time moving on effectively to the toddler stage.

Social Development

  • Depends on interaction with caregivers.

Attachment

  • Evident during infancy. mostly during second half (6months). Caregivers are attached to infant even before they are born.

  • 12 weeks of care (3 months): they start to care but they normally don’t care during the first month. They cry, smile more to caregiver.

  • 6 months old: Distinct preference for primary caregiver. Follow individuals around. Cry when they leave, enjoy playing with them more. Feel more secure in their arms. Start protesting when they are being put for a nap. Upset when caregiver leaves room.

  • Separation anxiety: 4-8 months old — develop object permanence: Know that caregivers are absent they don’t like it.

  • 11-12 months old: Start anticipating caregivers are going to leave.

  • After one month showing attachment to caregiver: Many infants begin attaching to other members of the family.

Language Development

  • Infant first means of communication: crying

  • 1st month old: Crying is mostly physiologic (hungry, need diaper changed)

  • 12 weeks old: Crying decreases, cry for other reasons.

  • Vocalizations: Heard during crying, Become syllables and words mama, dada.

  • Vocalization: 5-6 weeks by making small throat sounds.

  • 2 months old: Single vowel sounds.

  • 3-4 months old: cooing, consonants.

  • 6 months old: imitate sounds.

  • 9-10 months old: Understand words NO, obey simple commands. shake head no.

  • 12 months- 1 year: Say 3-5 words understand as many 100 words.

  • Language development is based on: Repetition. Reading to baby is important to them too.

Importance of Play

  • Play is vital for development, shifting from self-focused to engagement with external stimuli.

  • Birth to 3 months: worried about basic needs.

  • 3-6 months: Show interest in external stimuli. Touch.

  • 1 month old: Quieting attitude

  • 2 months: Social smile

  • 3 months: Squealing

  • 4 months: Laugh aloud, show preference to certain stuffy, excited when they see it. Look at mirrors and recognize images. Smile at themselves and touch.

  • 6-12 months: More sensory motor skills (peekaboo).

  • 6-8 months old: Stranger danger scenario, Don’t want to play with others that aren’t primary caregivers.

  • 12 months: They start saying words like mama, dada, mommy, daddy

Nutrition

  • Start prenatally

  • 6 months of life: Human milk (breast milk)

  • American Academy of Pediatric: Recommends supplementation of Vitamin D ( 400 international units, daily). prevents iron deficiency anemia and rickets. Recommend it unit they are receiving at least 1 liter of vitamin D Fortified Formula or containing solid foods.

  • Breastfed: Recommend Vit D supplement unit they are in a solid food.

  • Second 6 months: Selection and preparation of solid foods.

  • Breastfed babies: 4 months old when mothers fetal iron stores are depleted. Recommended IRON supplement of 1 mg/kg/day. Unit they get enough iron in their diet from solids.

  • Feeding: Depends on successful growing, wet diapers, underlying conditions. Do not need a schedule if they are crying, content when they are being fed. etc.

  • Breastfeed babies: Fed more, they don’t stay full as long.

  • Baby is older: Digestive and gastric system (stomach grows). Hold more volume and stretch time between feeds. Therefore as they get older, amount of feeding decreases.

  • Cultural: Some cultures give honey to pediatric patients. Educating cultures that honey should be avoided in infants due to Botulism.

  • Second six months of life: Human milk or formula is the primary source of nutrition, also transition period, start getting solid foods introduced. Milk intake can slightly go down, but they are not taking solids for calories, not primary. Developmentally specific to infant. Swallowing skill must be present.

  • Recommendation for first solid: Iron fortified cereal (high source of iron content). Others introduce a vegetable first but know infants can have allergies. Wait 4-7 days to introduce next solid to account for allergic reactions.

Sleep and Activity

  • Birth to 2 months old: Sleeps 15-20 hours a day.

  • 6-12 month old: Decreases to 9-17 hours

  • Sleeping through night: 3-4 months of age. Not the case for everybody.

  • Breastfed babies: wake up more often to eat.

  • Older babies: more awake hours during the daytime hours.

  • Nocturnal pattern of sleep- 8 hours a day: 12 months of age.

  • Babies: Do not need encouragement to be mobile, they are naturally active. Swingers etc can restrict movement, they normally don’t need them.

Immunizations

  • Infancy (birth to 12 months) includes numerous vaccinations to protect against diseases; CDC changes schedule.