INFANCY

RAZA CRECIA L. MENESES, RN, MAN

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The First Year of Life

Time of rapid growth and development. Growth in the first year is extremely rapid. It occurs in spurts, called saltatory growth.

Infant Weight

At birth: 2.7 4.0 kg

At 6 months: 2X birth weight. At 12 months: 3 X birth weight. At 2 years: 4 X birth weight. At 3 years: 5 X birth weight. At 5 years: 6 X birth weight. At 7 years: 7 X birth weight. At 8 years: 8 X birth weight. At 9 years: 9 X birth weight. At 10 years: 10 X birth weight.
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Weight Gain

(per day)

AGE 0-3 months: 3-6 months: 6-9 months: 9-12 months: 1-3 years: 3-6 years:

WEIGHT GAIN 30 g/day 20 g/day 15 g/day 12 g/day 8 g/day (2.8kg/yr) 6 g/day (2 kg/yr)
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Weight Gain

(per month)

AGE 0-3 months: 3-6 months: 6-9 months: 9-12 months: 1-3 years: 4-6 years:

WEIGHT GAIN 900 g 600 g 450 g 360 g 240 g/month(2.8 kg/yr) 180 g/month (2 kg/yr)
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Formula For Weight

During Infancy WT (Kg) = [ Age (months) +9] /2. During 2-6 Years WT (Kg) = Age (yrs) X 2+ 8. During 7-12 Years WT (Kg) = [Age (yrs) X 7-5] /2.

Length/ Height

Supine length is measured for children of less than 2 years of age After 2 years of age, standing height is taken as a measure of stature.
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Length

At Birth:

At At At At

birth: 48 53 cm one year = 75 cm. two years = 87.5 cm. four years = 100 cm.

Length Gain

AGE 0-3 months: 3-6 months: 6-9 months: 9-12 months: 1-3 years: 3-6 years:

GAIN 3.5 cm/ month 2 cm / month 1.5 cm/ month 1.2 cm/ month 1 cm/month(12 cm/yr) 0.25 cm/month (3 cm/yr)
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Gain In Length

1st year = 25 cm 2nd year = 12 cm 3rd year = 10 cm 4th year = 3 cm At puberty:

Girls = 6-11 cm Boys= 7-12 cm

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Formula for Calculating Height

From 1- 6 Years

Height (cm) = Age (Yrs) X 6 + 77

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Head Circumference

At birth: 35.3 1.2 cm Increases by 6 cm during the first 3 months Further increases by another 6 cm during 3- 12 months.
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Gain in head circumference

During 1st year = 12 cm. During 2nd year = 2 cm. During 3rd year = 1.5 cm. From 3 to 14 years = 2.5 cm

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Changes in head circumference

AGE 0-3 months: 3-6 months: 6-12 months: 1-3 years: 3-6 years: GAIN 2 cm/ month 1 cm / month 0.5 cm/ month 0.25 cm/month 1 cm/year

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VISION

An infants vision is at first, visual acuity 20/100-20/400 Within a week they can focus on objects that are 15-30 cm away Binocularity: fixation of two ocular images into one cerebral picture begins to develop by 6 weeks and established by 4 months
Lack of binocular vision results in strabismus Have visual preference for looking at the human face

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Vision

Stereopsis (three dimensions) begins in the 2nd 3rd month, well developed by age 7 months Depth Perception Incorrect term

What is Stereopsis? Recognizing that an object is three-dimensional, not flat.

With this improved vision they develop hand-eye coordination

Why is the development of hand eye coordination important? Important for skills such as eating, catching, coloring, tying shoes, etc

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Hearing

Birth:

Responds to loud noise by startle or Moro Responds to sound of human voice more readily than to any other sound Turns head to side when sound is made at level of ear Locates sound by turning head to side and then looking up or down Responds to own name

8-12 weeks:

>12 weeks:

24-32 weeks:

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Smell and Taste

The sense of smell does not develop much before birth because baby is surrounded by amniotic fluid until birth
Within 10 days they can distinguish the smell of their mother from another person. The sense of taste develops rapidly. During the 1st year, babies learn about the world through their mouth, putting everything in sight in it. Parents need to make sure the objects are clean, not too small, and without edges.
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Development During the First Year

Teeth Development of the babys teeth usually begin about the 6th week of pregnancy

6-7 Month The 1st baby teeth appear (primary teeth).

Teething often causes pain and swelling and makes for a cranky baby
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Language Acquisition
Cooing: Repetition of vowel sounds by infants

Babbling: Repetition of meaningless language sounds (e.g., babababa)

Single-Word Stage: The child says one word at a time

Telegraphic Speech: Two word sentences that communicate a single idea (e.g., Want yogurt, book table etc)

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Language development
12 weeks cooing, smiles when talked to 16 weeks turns head in response to human voice 20 weeks makes vowels and consonant sounds (ah eee ) 6 months babbling (all sounds) 8 months repeat certain syllables (ma-ma)
http://www.youtube.com/watch?v=wxtLhgzntg8&feature=r elated

12 months understands and says some words

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Psychosocial development

Erik Erikson: First Psychosocial Stage: Trust vs. Mistrust Consistent loving care by a mothering person is essential to build a trust relationship.
Mistrust develops when basic needs are inconsistently met.
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Piagets Cognitive Stages

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Sensorimotor Stage (0-2yrs)

Stage One (birth-1 mo.) Reflexive stage Use of reflexes Stage Two (1 - 4 mos.) Primary circular reactions: child learns about cause and effect as a result of reflexive sensorimotor patterns that are repeated for enjoyment (recognition of causality).

The interesting events are occurring within the body (plays with hands, fingers, feet)

Stage Three (4 - 8 mos.) Secondary circular reactions: The interesting events in this case are located in the external world (Making Interesting Sights Last) Beginning of object permanence: shows separation anxiety Able to imitate selective activity
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Infants imitation of facial expressions

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Sensorimotor Stage, Contd

Stage Four (8 - 12 mos)

Coordination of secondary schemata New Adaptations and Anticipation (voluntary

movement in response to stimuli that can't be seen )

Intentionality occurs in interactions with the environment and the infant is moving towards goal directed behavior: works to get toy that is out of reach Fully developed object permanence
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Stages of Sensorimotor Stage

1.

Modification of reflexes (0-1months)

3. Secondary Circular Reaction (4-8 months)

Strengthens and differentiates reflexes

Focus is on the outside world

2.

Primary Circular 4. Coordination of Reaction (1-4 months) Secondary Schema (8-12 months) Circular pattern of
having a stimulus and responding Focus is on own body

Goal oriented behavior Apply ability to other things

Moral development (Kohlberg)

Level 1: Preconventional morality (0-9y)

Stage 1: the punishment-and-obedience orientation. Children determine the goodness or badness of an action in terms of its consequences.

They avoid punishment and obey unquestioningly those who have the power to determine and enforce the rules They have no concept of the underlying moral order
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Play

Solitary Play:

When a child plays alone even when with other children

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Principles of Motor Development

Gross movements before fine movements

Pattern of development is usually the same, but the rate differs greatly from child to child and from culture to culture.
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2-3 months

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Gross Motor Development

First Month

Turns head to clear nose from bed Keeps hands fisted or slightly open Head lag when pulled from lying to sitting Holds head up while on tummy almost 45 degrees

Second month

Third month

Lift head and chest of the bed Turns head to sounds Reaches for objects with both hands
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Fourth month Rolls from back to side Able to raise head and chest off surface to angle of 90 degrees Fifth month Rolls from abdomen to back May sit if supported When supine, puts feet to mouth Sixth month Transfer toy from one hand to next army crawl on tummy Rolls from back to abdomen
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Seventh month Pushes up on hands and knees Sits w/ little support When held in standing position bounces actively Eighth month Sit without support Creeps Stands leaning against something Ninth month May crawl upstairs
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Tenth month

Stands w/ little support Cruises the room.

Eleventh month

Stands alone

Twelfth month Walks

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Fine Motor Behavior

At 4 month: brings hands together and shake rattle At 6 month: palmer grasp

At 7 month: pass object from hand to another

At 8 month: advanced eyehand coordination At 10 month: pincer grasp At 12 month: holds cup or spoon
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Hematologic System
Hgb A production largely replaces Hgb F by 4 months (physiologic anemia due to fetal RBCs destruction)
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Respiratory System
RR slows 3060

Upper respiratory infections tend to be more severe due to

small lumen of respiratory tract inefficient mucus production.

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Immune System

Become functioning at 2 months.

Produce both IgG & IgM antibodies by the 1st year.

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Emotional

At 6 weeks: social smile At 4 months: recognize his primary caregiver. At 7-8 months: stranger anxiety, continue until 12 months.
At 8 months: separation anxiety, continue until preschool period.
Both are related to infants ability to discriminate between familiar and nonfamiliar people

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Dentition

First tooth erupt 5-7 months Has 6-8 deciduous teeth by the 1st year of age. The sequence of eruption is:

At At At At

6 7 8 9

months: months: months: months:

lower central incisors. lower lateral incisors. upper central incisors. upper lateral incisors.

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GI System

Can digest protein at birth

Amylase deficiency until 3rd month of age (cannot digest complex CHO) Lipase deficiency during entire 1st year Infant needs frequent feedings Extrusion reflex exists until 3-4 months

Introduction of solid food 4-6 months.

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Energy Requirement
Age < 6 months Energy requirement Wt (kg) x 108/ day

6mo-1 year

Wt (kg) x 98/ day

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Water requirements = amount foods + fluids

Age 3 days 10 days 3 mo 6 mo 9 mo

Amount 80-100 ml/kg/day 125-150 ml/kg/day 140-160 ml/kg/day 130/155 ml/kg/day 125-145 ml/kg/day

With BF and formula: none additionally needed in first 4 to 6 months

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Infant Nutrition

Birth through 4-6 months

Breast milk
OR

Iron-Fortified infant
formula
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Breast- Versus Bottle-Feeding

Debate focused on whether breast-feeding is better for the infant than bottle-feeding American Pediatric Association strongly endorses breastfeeding throughout the first year of life Benefits

Appropriate weight gain Fewer allergies Fewer illnesses Reduced childhood cancer and reduced incidence of breast cancer in mothers and their female offspring Lower incidence of SIDS Stronger attachment bond
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Infant Nutrition
4 through 7 months

Breast milk
OR

Iron-Fortified infant formula Iron-Fortified infant cereal Vegetables Fruit

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Infant Nutrition

8 through 11 months

Same as 4 through 7 months

PLUS

Meat Egg yolks

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Infant Nutrition

11 months

Finger foods Cup

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Tips for Introduction of Solid Foods

Start slowly Only 1 new food every 4-5 days Hold baby during feeding First food: Iron-Fortified infant
rice cereal
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Tips for Introduction of Solid Foods

Use single-ingredient foods Read food labels Avoid desserts Avoid foods that can choke
infants
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Feeding Problems

Colic (<3months): gas production, and bloating

Cause? Not always known: formula fed! (high in carbohydrate) Overfeeding : swallowing too much air. Breastfeeding?

Foods in the mothers diet Cows milk, or other items

Spitting up

Normal occurrence: after meals, mouthful of milk. Unless projectile vomiting: Organic problem: pyloric sphincter closure
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Common Health Concerns

Teething: gum sore, tender can lead to decreased intake and cry. Thumb sucking: does not deform the jaw as long as it stops by school-age. Diaper dermatitis: prolong contact with urine or feces. Constipation: increased with formula fed. Sleep problems: as a result of colic or other health problems.
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