GROWTH AND DEVELOPMENT OF NEWBORN TO INFANCY

INTRODUCTION

Babies are called newborns during their first month of life

Newborn (neonatal) period ;from birth to 2-4 weeks

Infancy;from 2-4 weeks to one year

Although your newborn sleeps a lot, powerful changes are occurring in the five
major areas of development.

PHYSICAL DEVELOPMENT:

Newborn loses some weight shortly after birth. This weight usually is regained
within 10 to 12 days. Most newborns gain about 4 oz (113.4 g) to 8 oz (226.8 g)
per week and grow about 1 in. (2.5 cm) to 1.5 in. (3.8 cm) in the first month.

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 Cognitive development. Cognition is the ability to think, learn, and
remember. Newborn’s brain is developing rapidly. You promote healthy brain
growth every time you interact in a positive way with baby.

 Emotional and social development. Newborns quickly learn to

communicate. They seek interaction with you and express how they feel with
sounds and facial expressions. At first, instinctual behaviors, such as crying
when uncomfortable, are your baby's ways to signal his or her needs. Soon
your newborn starts to subtly communicate and interact with you. For example,
baby's eyes will track your movements, and his or her face will brighten when
you cuddle and talk soothingly. Even at a few days old, your baby may try to
mimic you sticking out your tongue.

 Language development. Newborn is listening to and absorbing the basic

and distinct sounds of language. This process forms the foundation for speech.

Sensory and motor skills development. Newborns have all five senses. Newborn
quickly learns to recognize your face, the sound of your voice, and how you
smell. newborn's sense of touch is especially developed, particularly around the
mouth. Your baby also has a strong sense of smell. After a few days, your
newborn hears fairly well and responds most noticeably to high-pitched and loud
sounds. Baby recognizes and prefers sweet tastes to those that are sour, bitter,
or salty. Vision is developing quickly but is believed to be the weakest of the
senses. Motor skills develop as your baby's muscles and nerves work together.
Movements are mostly controlled by reflexes, such as the rooting reflex, which is
when a newborn's head turns and his or her mouth

Integument

At birth the skin of the neonate is red or dark pink .in the black infant a reddish
black.I t is soft and covered with lanugo and overlaid with vernix CASEOSA

HEAD

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Proportionately large ranging from 34-35cm

EYES

Eye movements are not co ordinated

EARS

The top of the pinna should meet or just cross an imaginary line drawn from the
lateral aspect of the eye to the occiput

Hematologic system

The vascular system and heart are larger in size compared with the adult size

Muscular development

Muscular contour in the healthy infant is smooth and the muscles inspite of their
lack of strength feel hard

NERVOUS SYSTEM

Nervous system is immature

The physical development of the newborn begins at the head, then progresses to
other parts of the body (for example, sucking comes before sitting, which comes
before walking).

Newborn - 2 months

 Can lift and turn the head when lying on his or her back
 Hands are fisted, the arms are flexed
 Neck is unable to support the head when the infant is pulled to a sitting
position
 Primitive reflexes include:
o Babinski reflex -- toes fan outward when sole of foot is stroked
o Moro reflex (startle reflex) -- extends arms then bends and pulls
them in toward body, accompanied by a brief cry, often triggered by
loud sounds or sudden movements
o Palmar hand grasp -- infant closes hand and "grips" your finger
o Placing -- leg extends when sole of foot is stimulated

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 o Plantar grasp -- infant flexes the toes and forefoot
o Rooting and sucking -- turns head in search of nipple when cheek
is touched and begins to suck when nipple touches lips
o Stepping and walking -- takes brisk steps when both feet placed on
a surface, with body supported
o Tonic neck response -- left arm extends when infant gazes to the
left, while right arm and leg flex inward, and vice versa

3 - 4 months

 Enhanced eye-muscle control allows the infant to track objects.

 Hand and feet actions begin to come under willed control, but are not fine-
tuned. The infant may begin to use both hands, working together, to
accomplish desired effects. The infant is still unable to coordinate the
grasp, but swipes at objects to bring them closer.
 Increased vision allows the infant to distinguish objects from backgrounds
with minimal contrast (such as a button on a blouse of the same color).
 Infant raises up (upper torso, shoulders, and head) with arms when lying
face down (on his tummy).
 Neck muscles are developed enough to allow the infant to sit, with
support, and keep head up.
 Primitive reflexes have either already disappeared, or are in the process of
doing so.

5 - 6 months

 Able to sit alone, without support, for only moments at first, and then for up
to 30 seconds or more
 Infant begins to grasp blocks or cubes using the ulnar-palmar grasp
technique (pressing the block into palm of hand while flexing or bending
wrist in). Does not yet use thumb opposition.
 Infant rolls from back to stomach. When on tummy, the infant can push up
with arms to raise the shoulders and head above surface and look around
or reach for objects.

6 - 9 months

 Crawling may begin

 Infant can walk while holding an adult's hand
 Infant is able to sit steadily, without support, for long periods of time
 Infant learns to sit down from a standing position
 Infant may pull into and maintain a standing position while holding onto
furniture

9 - 12 months

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  Infant begins to balance while standing alone
 Infant takes steps and begins to walk alone

SENSORY DEVELOPMENT

 Hearing -- begins before birth, and is mature at birth. The infant prefers
frequencies of the human voice.
 Touch, taste, smell -- mature at birth; prefers sweet taste.
 Vision -- the newborn infant can see within a range of 8 - 12 inches. Color
vision develops between 4 - 6 months. By 2 months, can track moving
objects up to 180 degrees, and prefers faces.
 Vestibular (inner ear) senses -- the infant responds to rocking and
changes of position.

LANGUAGE DEVELOPMENT

Crying is a vitally important means of communication. By the third day of life,

mothers can tell their own baby's cry from that of other babies. By the first month
of life, most parents can tell if their baby's cry means hunger, pain, or anger.
Crying also causes a nursing mother's milk to letdown (fill the breast). The
inherent biological response in most humans to an infant's crying ensures the
infant's survival.

The amount of crying in the first 3 months varies in a healthy infant, from 1 - 3
hours a day. Infants who cry more than 3 hours a day are often described as
having colic.Colic in infants is rarely due to a problem with the body.

Excessive crying can be associated with child abuse. Regardless of the cause, it
is a complex problem that deserves a medical evaluation.

0-2 months

 Alert to voices
 Uses range of noises to indicate needs, such as hunger or pain

2-4 months

 Coos

4-6 months

 Makes vowel sounds ("oo," "ah")

6-9 months

 Babbles

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  Blows bubbles ("raspberries")
 Laughs

9-12 months

 Imitates some sounds

 "Mama" and "Dada" are nonspecific (not used specifically for those
parents)
 Responds to simple verbal commands, such as "no"

BEHAVIOR

The behavior of the newborn is characterized by six states of consciousness:

 Active crying
 Active sleep
 Drowsy waking
 Fussing
 Quiet alert
 Quiet sleep

The ability to move smoothly from one state to another is one of the most reliable
signs of nervous system maturity and health. Heart rate, breathing, muscle tone,
and body movements vary with each state.

Many bodily functions are not stable in the first months after birth. This variability
is normal and differs from infant to infant. Stress and stimulation can affect:

 Bowel movements
 Gagging
 Hiccupping
 Skin color
 Temperature control
 Vomiting
 Yawning

Periodic breathing, in which breathing starts and stops again, is normal and is not
a sign of SIDS (sudden infant death syndrome). Some infants will vomit or spit up
after each feeding, but have nothing physically wrong with them. They continue
to gain weight and develop normally.

Other infants grunt and groan distressfully while making a bowel movement but
produce soft, blood-free stools, and their growth and feeding remain good. This is
due to immature abdominal muscles used for pushing and does not require any
intervention.

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Sleep/wake cycles vary and do not stabilize until a baby is 3 months old. These
cycles occur in random intervals of 30 - 50 minutes at birth and gradually
increase as the infant matures. By age 4 months, most infants will have one 5-
hour period of uninterrupted sleep per day.

Breast-fed infants will feed about every 2 hours. Formula-fed infants should be
able to go 3 hours between feedings. During periods of rapid growth, they may
feed more often.

Giving the baby water is not necessary and could be dangerous. An infant who is
drinking enough will produce 6 - 8 wet diapers in a 24-hour period. Teaching the
infant to suck a pacifier or his or her own thumb provides comfort between
feedings.

REFLEXES

. Babies are born with a number of automatic physical responses that help them
negotiate their world.

Reflexes in newborns include the following:

 Root reflex
This reflex occurs when the corner of the baby's mouth is
stroked or touched. The baby will turn his/her head and opens
his/her mouth to follow and "root" in the direction of the
stroking. The root reflex helps the baby find the breast or bottle.
 suck reflex
When the roof of the baby's mouth is touched with the breast or
bottle nipple, the baby will begin to suck. This reflex does not
begin until about the 32nd week of pregnancy and is not fully
developed until about 36 weeks. Premature babies may have a
weak or immature sucking ability, because they are born prior to
the development of this reflex. Babies also have a hand-to-
mouth reflex that accompanies rooting and sucking and may
suck on their fingers or hands.
 Moro reflex
The Moro reflex is often called a startle reflex because it usually
occurs when a baby is startled by a loud sound or movement. In
response to the sound, the baby throws back his/her head,
throws out his/her arms and legs, cries, then pulls his/her arms
and legs back in. Sometimes, a baby's own cries can startle
him/her - initiating this reflex. The Moro reflex lasts until the
baby is about 5 to 6 months old.

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  Tonic neck reflex
When a baby's head is turned to one side, the arm on that side
stretches out and the opposite arm bends up at the elbow. This
is often called the "fencing" position. The tonic neck reflex lasts
until the baby is about 6 to 7 months old.
 Grasp reflex
 With the grasp reflex, stroking the palm of a baby's hand causes
the baby to close his/her fingers in a grasp. The grasp reflex
lasts only a couple of months and is stronger in premature
babies.
 Babinski reflex
With the Babinski reflex, when the sole of the foot is firmly
stroked, the big toe bends back toward the top of the foot and
the other toes fan out. This is a normal reflex until the child is
about 2 years old.
 Step reflex
This reflex is also called the walking or dance reflex because a
baby appears to take steps or dance when held upright with
his/her feet touching a solid surface.
 SUCKING
 Touching the lips with the nippleof the breast or bottle or other
object.shows sucking movements
 DOLLS EYE
 Turn the newborns head slowly.normally to right or left eye donot move
 Palmar grasp
 Object placed in newborns palm .newborn grasp the object by closing fingers
around it
 Plantar grasp
Touching the sole of the foot at the base of the toes .toes grasp around very small
object
Newborn babies not only have unique reflexes, but also have a number of physical
characteristics and behaviors that include the following:
 head sags when lifted up, needs to be supported
 turns head from side to side when lying on his stomach
 eyes are sometimes uncoordinated, may look cross-eyed

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  initially fixes eyes on a face or light then begins to follow a
moving object
 beginning to lift head when lying on stomach
 jerky, erratic movements
 moves hands to mouth

SAFETY

Safety is very important for infants. Base safety on the child's developmental
stage. For example, around age 4 - 6 months, the infant may begin to roll over.
Therefore, take extreme caution while the baby is on the changing table.

Consider the following important safety tips:

 Be aware of potential poisons (household cleaners, cosmetics,

medications, and even some plants) in your home and keep them out of
the infant's reach. Use drawer and cupboard safety latches. Post the
national poison control number -- 1-800-222-1222 -- near the phone.
 Do not allow older infants to crawl or walk around in the kitchen while
adults or older siblings are cooking. Block the kitchen off with a gate or
place the infant in a playpen, highchair, or crib while others cook.
 Do not drink or carry anything hot while holding the infant to avoid burning
the infant -- infants begin waving their arms and grabbing for objects at 3 -
5 months.
 Do not leave an infant alone with siblings or pets. Even older siblings are
seldom prepared to handle the potential emergency situations that may
arise. Pets, even though they may appear to be gentle and loving, may
react unexpectedly to an infant's cries or grabs, or may actually smother
an infant by lying too closely.
 Do not leave an infant unattended on a surface from which the child can
wiggle or roll over and fall off.
 For the first 5 months of life, always place your infant on his or her back to
go to sleep. This position has been shown to reduce the risk of SIDS
(sudden infant death syndrome). Once a baby can roll over by himself, the
maturing nervous system greatly reduces the risk of SIDS.
 Know how to handle a choking emergency in an infant by taking a certified
course through the American Heart Association, the American Red Cross,
or a local hospital.
 Never leave small objects within an infant's reach -- infants explore their
environment by putting everything they can get their hands on into their
mouth.
 Place infant in a proper car seat for every car ride, no matter how short the
distance. Use a car seat that faces backwards until the infant is at least 1
year old AND weighs 20 pounds, or longer if possible. Then you can
safely switch to a forward facing car seat. The safest place for the infant's
car seat is in the middle of the back seat. It is vitally important for the

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 driver to pay attention to driving -- not playing with the infant. If an infant
needs assistance, safely pull the car over to the shoulder and park before
trying to help the infant.
 Use gates on stairways, and block off rooms that are not "child proof" --
remember, infants may learn to crawl or scoot as early as 6 months

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 PHYSICAL GROWTH AND DEVELOPMENT.

Physical Growth and Development

Physical or Motor Sensory
Biologic

1 MONTH
Weight 4.4 ± GROSS MOTOR Startled by sounds
0.8 kg (10 ± 1.5 Lies in flexed position. When prone, pelvis is elevated (Moro reflex)
Ib); gains above Attentive to speech
but knees are not beneath abdomen as they were
680 gm {1.5 Ib) a of others Indefinite
month during after birth (photo 2) Head lags when baby pulled from a stare at
first 6 months, or supine to a sitting surroundings
150 to 210 gm (5 position (photo 3) Fixates on objects
to 7 oz) a week brought in
Head sags forward when baby is held in sitting position
Length May lift head periodically when held over adult's front of eyes.
Approximately Notices faces
53 ± 2.5 cm (21 ± shouider or placed in prone position. Cervical curve
especially and
1 in); increases begins to develop as infant learns to hold head erect bright objects,
about 2.5 cm (I
in) a month (photo 2) Turns head to the side when prone Makes but only if they are
during first 6 crawling movements when prone on flat surface Pushes in the line
months with the feet against a hard surface to move
of vision (photo 4)
Head forward Protective blinking
circumference FINE MOTOR Holds hands in tight fists in response
Increases about
Can grasp an object placed In the hand (palmar grasp to bright light
1.5 cm (0.5 in) a Foilows a bright
reflex) but drops it immediately
month during object to the '
first 6 months Photo 4

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Pulse 130 ± 20 midline of vision if
6 to 8
Respirations
35 ± 10 inches from eyes
Blood pressure
80/50 ± 20/10
Reflexes
Primitive reflexes
govern
movements (see
Table 12-4). Has
well-developed
sucking, rooting,
swallowing, and
extrusion (tongue
thrust) reflexes,
Moro reflex
(startle reflex),
and asymmetric
tonic neck reflex
(head turned to
one side, one arm
extended on the
same side, the
other arm flexed
to shoulder)
(photo /). Dance
and doll's eye
reflexes fading
Physiologic
immaturity
Breathes through
nose
2 MONTHS
Posterior fontanel GROSS MOTOR Turns head to side
dosed at 6 to 8 Less fixed prone position: arms flexed, hips flat, legs when a sound
weeks of age occurs at ear level
extended, head in midposition or side (photo 5) No
When on back,
head droop when suspended in prone position
follows a dangling
(photo 6 Less head lag when pulled from a supine to a object or a moving
sitting light beyond the
position (photo 7) Lifts head almost 45 degrees above a midline of vision
flat surface when Beginning

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 lying prone (photo 8) Holds head erect in midposition binocular fixation
Holds head erect when held upright (photo 9) Turns and convergence to
from side to back objects nearby
FINE MOTOR Eyes follow
moving person
Hands may be open
nearby
Holds a rattle briefly when placed in the hand
3 MONTHS
Weight 5.7 ± GROSS MOTOR Symmetric posture of head and body Turns head and
0.8 kg (12.3 ± 2 (photo 10) looks in same
Ib) Very slight head lag when pulled from supine to sitting direction to locate
Length 60 ± 2 position Sits, back rounded, knees flexed when sound When on
cm (23.5 ± 1 in) supported in sitting position (photo / /) Raises chest, back, turns eyes to
a
Pulse 130 ± 20 usually supported on forearms, when in
dangling object or
Respirations 35 prone position (photo 12) Holds head erect and steady
a moving
± 10 FINE MOTOR
light to marginal
Blood pressure Hands open or closed loosely (photo / /)Holds hands in
field of vision
80/50 ± 20/10 front of face and stares at them (photo13) Holds object
(180 degrees)
Reflexes put in hand with active grasp (photo 14} Carries hand
Binocular
or object to mouth at will (photo 15) Reaches for bright
Grasping coordination
(palmar) reflex objects but misses them (vertical
absent
and horizontal
Landau reflex vision) when an
appears: an infant
object is moved
suspended in a
from right to
horizontal prone
position with the left and up and
head flexed down in front
against the chest of face Regards toy
reflexly draws dangied in midline
the legs up
against the of chest promptly
abdomen Loses interest in
objects that are
suddenly removed
from the
perceptual field
Blinks at objects
that threaten
the eyes Beginning
ability to

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 coordinate
various sensory
stimuli
4 MONTHS
Drools between 3 GROSS MOTOR Follows moving
and 4 months of objects well with
Symmetric body postures predominate
age, indicating eyes. Even the
increased Sits with adequate support Enjoys being propped up
most difficult
production of (photo 16)
saliva. Unable to types of eye
swallow it, movements are
therefore, it runs present
from mouth
Fairly good
Reflexes binocular vision
Tonic neck, Looks briefly for
Moro, sucking, Holds head erect and steady when placed in sitting toy that
and rooting position (photo 16) Lifts head and shoulders at a 90 disappears
(when awake) degree angle when on Accommodation
reflexes absent;
abdomen and looks around (photo 17)Attempts to roll begins to
extrusion reflex
or actually rolls over from front to back Sustains small develop. Can
fading (3 to 4
portion of own weight when .held in accommodate
months)
standing position (photo 18) Activates arms at sight of to nearby objects
proffered toy Can focus on small
FINE MOTOR objects.
Holds hand predominately open (photo 19) Brings Stares at rattle
hands together in midline. Plays with fingers placed in hand
(photo 20)Grasps object held near hand. Cannot pick it and takes It to the
up when mouth Recognizes
familiar objects,
Drop Grasps objects with both hands (photo 21) such
Attempts to reach objects with hands but overshoots
as feeding bottle
The Objects are carried to mouth Thumb apposition in and toys Beginning
grasping occurs between third and fourth months hand-eye
Fingers and clutches clothing
coordination
Comforts self by
sucking thumb
or pacifier
5 MONTHS
Weight At least GROSS MOTOR Localizes sounds
twice the birth

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weight. Mean age Sits with slight support made below
for doubling birth Balances head well when sitting the ear (photo 26)
weight is 3.8 Looks after a
months Physical Holds back straight when pulled to a sitting position
dropped object
growth slowing (photo 22) Pushes whole chest off .a flat surface when
Inspects objects
down Can prone Rolls from back to front (photo 23} Sustains
visually for a
breathe through more of own weight when held in standing position
mouth when nose Pulls feet up to mouth when supine (photo 24) lengthening period
is obstructed of time Can fixate
FINE MOTOR
on objects more
Uses thumb in partial apposition to fingers more than'
skillfully (photo 25) Tries to obtain objects beyond
reach (photo 25) Grasps objects independently of direct 3 feet away Visual
acuity, 20/200
stimulation of the palm of the hand
Grasps objects with whole hand, either right or left
Holds one object while looking at another (photo 25)
6 MONTHS
Weight 7.4 ± 1 GROSS MOTOR Localizes sounds
kg (16.5 ± 2.5 Sits alone briefly if placed in a favorable leaning made above
Ib); gains about position the ear (photo 32)
340 gm (0.75 \b)
on hard surface. Holds arms out Back is straight when Retrieves a
a month, or 90 to dropped object that
1 50 gm (3 to 5 sitting in high chair (photo 28) Pulls to a sitting position
oz) a week during Springs up and down when sitting Lifts chest and upper can be seen and
second 6 months abdomen when prone, putting the reached Enjoys
more complex
Length 65.5 ± 3 weight on the arms and hands (photo 29) Turns visual
cm (26 ± 1 in); completely over, with rest periods during the
gains about 1.25 turn. Infant must be protected from falling Sustains stimuli Moves in
cm (0.5 in) a most all of own weight when held in standing order to see an
month during object
second 6 months position (photo. 30) Hitches—moves backward when in
a sitting position by
Head
circumference using the arms and hands
43 cm (17 in). FINE MOTOR
Increases about.
0.5 cm (0.25 in)
per month during
second 6 months
Pulse 120 ± 20
Respirations 31
±9
Biood pressure
90/60 ± 28/10

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Teething Two
lower central
incisors erupt (6
± 2 months)
Begins to bite
and chew

Grasps with simultaneous flexion of fingers: begins to

use fingers to feed self a cracker (photo 28) Retains
transient hold on two objects, one in each hand
(photo 31)
Drops one object when another is offered Begins to
transfer object from one hand to the other Manipulates
small objects Begins to bang objects that are held
(rattles, spoon.
toy) Holds own bottle but may prefer for ii to be held
7 MONTHS
Reflexes GROSS MOTOR Head turns in a
curving arch to
Sucking and Sits alone on hard surface, leaning forward on hands
rooting reflexes localize sounds
(photo 34)
disappear at 7 to Depth perception
8 months when Lifts head as if trying to sit up when supine Control of beginning to
asleep trunk is more advanced Rolls more easily" from back to
abdomen Sustains all of weight on feet when held in develop
Parachute reflex standing Fixates on very
appears between small objects and .
7 to 9 months. An position.
details
infant suspended Bounces actively when held in standing position Discrimination
in a horizontal
FINE MOTOR between simple
prone position
and lowered Holds 2 toys at once (photo 35) geometric forms
suddenly will begins to.
extend the hands Approaches a toy and grasps it with one hand
develop Has
forward to (unidextrous) Transfers a toy from one hand to the preferences in taste
provide other, usually for
protection from

16
falling. This successfully foods
reflex continues Imitates simple acts of others Bangs objects that are
indefinitely held Uses a raking motion to try to obtain small objects
(photo 33)
(photo 36) Holds cup
Teething
Upper central
incisors erupt
(7.5 ± 2 months)
Lower lateral
incisors erupt (7
± 2 months)
Ultimate color of
iris is established

8 MONTHS
Beginning of a GROSS MOTOR Sits alone steadily Pulls self into Recognizes
pattern in bowel standing position with help (photo 38) Hand-eye familiar words and
and bladder coordination is perfected so that random reaching and sounds
elimination grasping no longer occur
FINE MOTOR
Holds 2 objects while looking at a third
Persistently reaches for objects beyond range of grasp
(photo 39)
Releases objects from hands voluntarily Complete
thumb apposition Pincer grasp beginning to develop,
using the fingers
against the lower portion of the thumb (photo 39) Eats
finger foods, such as crackers, that can be held in
one hand Drinks from cup with assistance (7 to 9
months) (photo
40)
9 MONTHS

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Reflexes Plantar CROSS MOTOR Head turns directly
grasp absent Raises to a sitting position alone with good to source of sound
Teething coordination Increased depth
perception
Upper lateral Sits steadily for longer period of time
incisors erupt (9 Recovers balance when leaning forward^ but not Recognizes by
looking or
± 2 months) sideways
moving toward
Crawls instead of hitching. Crawling may be done as familiar object
early as the 4th month; the average age is 8 to 9
months. When crawling the infant is prone; the when named Able
abdomen touches the floor; the head and shoulders are to follow objects
supported by the elbows. The body is pulled along by through
the movement of the arms while the leg movements transition from one
may resemble swimming or kicking motions (photo 42) place to
Creeping. This is a more advanced type of locomotion another
than crawling. The trunk is carried above the floor, but
parallel to it. The infant uses both hands and knees in
moving forward. Not all infants follow this pattern of
hitching, crawling, and creeping. Different infants use
various means of locomotion and may even skip a
stage, especially if they are ill or cannot practice
moving about
Beginning to pull self to standing position alone while
holding on to furniture (photo 43)
FINE MOTOR
Bangs two objects together
Pokes objectives with ringers
Uses thumb and index finger in early pincer grasp
Has preference for the use of one dominant hand
Holds own bottle with good hand-mouth coordination.
Puts nipple in and withdraws it from mouth at will
Drinks from cup with some spilling (9-12 months)
(photo 44) Attempts to use a spoon but spills contents
(photo 45)
10 MONTHS
Macula is well GROSS MOTOR Marked interest in
developed so that very small objects
Moves from prone to sitting position
fine visual Searches for a. lost
discriminations May sit by falling down from standing position
toy with greater
can be made Sits steadily for indefinite period of time. Does not

18
 want persistence
to lie down unless sleepy Creeps well (photo 46) Pulls
to standing position well, holding to the crib rail or
other support Cruises well (walks sideways while
holding on to a
supporting object with both hands) (photo 47) Makes
stepping movements forward when two hands
are held (photo 48)
FINE MOTOR
Picks small objects up with index finger and thumb'
(pincer grasp)
Releases an object after holding It Brings the hands
together
11 MONTHS
GROSS MOTOR Tilts head
backward to see
Stands erect with minimal support and lifts one foot to
upward
take a step (photo 50)
Cruises: walks holding on to furniture
FINE MOTOR
Explores toys and other objects more carefully
Removes covers from boxes (photo 5/) Takes toy out of
box or cup Puts toy inside box or cup but may not let go
yet Beginning to hold a crayon and make a mark on
paper (photo 52)
12 MONTHS
Weight 10 ± 1.5 GROSS MOTOR Listens for
kg (22 ± 3 recurring sounds
Stands alone for variable length of time (photo 53)
pounds); has Full binocular
tripled birth Sits down from standing position alone vision well
weight Walks in few steps with help or alone (hands held at established
Length 74.5 ± 3 shoulder height for balance (photo 54} Improves Amblyopia may
cm (29 ± 1.5 competence in motor skills through practice develop with lack
inches); length FINE MOTOR of binocularity
has increased by -
Good pincer grasp Follows fast-
almost 50 per moving object with
cent from birth Picks up small bits of food and transfers them to mouth. eyes
Head Enjoys eating with fingers (photo 55) Attempts to put a Discriminates
circumference small pellet into a narrow-necked bottle but does not simple geometric

19
46 cm (18 succeed Releases one or more objects inside another forms: squares,
inches); head object or container Attempts to put one block on top of circles
circumference another but does not succeed (photo 56) Visual acuity:
has increased by Turns pages in a book but usually not one at a time 20/100 to 20/50
one third since Drinks from & cup and eats from a spoon but still
birth requires some help (photo 57) Holds crayon adaptively
Brain weight has to make a stroke or a mark on
increased rapidly a piece of paper
since birth,
resulting in
significant
developmental
achievements
Head and chest
are equal in
circumference
Anterior fontanel
closes between
12 and 18 months
Pulse 115 ± 20
Respirations 30
± 10
Blood pressure
96/66 ± 30/24
Reflexes
Babinski reflex
disappears
Landau reflex
disappears
between 12 to 24
months
Teething Has 6
to 8 deciduous
teeth
Lumbar curve
and the
compensating
dorsal curve
develop as
walking
continues

20
Physiologic
stability achieved
and maintained
during first year

AVERAGE ACHIEVEMENT LEVELS OF INFANTS—1 MONTH TO 1 YEAR

Psychosoclal, Intellectual, Moral Language, Speech Play Stimulation
Psychosexual, Development Development (Visual,
Spiritual Development Auditory,
Tactile, and
Kinetic)
1 MONTH
PSYCHOSOCIAL INTELLECTUAL RECEPTIVE LANGUAGE Hold, touch, and
Sensorimotor Stage (0 Responds to human voices rock infant
Beginning
gently
development of sense to 2 years) EXPRESSIVE
Negative Substage I (birth to 1 LANGUAGE Talk and sing
of trust
counterpart: mistrust month): Infant uses Opens and closes mouth as softly to infant at
close range
reflexes to begin to adult speaks
Totally egocentric
make associations Encourage
Complete dependence between an act and a Utters small throaty sounds mutual eye
on caregivers, usually sequential response; Utters sounds of comfort contact
mother Bonding cannot distinguish self when feeding
Provide pacifier
progresses Shows from environment Cry patterns developing. for sucking
regard for human face.
Substage II: Primary Cries when hungry or pleasure
Activity diminishes Circular Reaction (1 uncomfortable Begins to
Place cradle gym
when a to 4 months); Begins coo or crib mobile
human face can be to repeat actions of within infant's
seen Establishes eye own body voluntarily reach
contact Smiles briefly (hand-to-mouth
Place large bright
Quiets, cuddles, and movement permits
sucking) pictures on crib
molds
or wall
when held Perceives MORAL
Repeat noises
self and parents as Preconventional made by infant
one Morality Stage 0 (0 to
2 years) The good is Coo to Infant
PSYCHOSEXUAL what I like and want! Respond to
Oral Stage (0 to 1 crying signals
year) Oral-dependent
Have ticking
or oral-passive: need
clock, wind
for sucking pleasure
chimes, radio,
SPIRITUAL television, or

21
Undlfferentlated (0 to music box
1 year) nearby
Feelings of trust, Provide soft,
warmth, and security cuddly toys and
form the foundation - clutch toys too
for the later large to
development of
swallow
faith
Use soothing
lotion when
massaging
infant's body
Swaddle to
soothe infant
Place infant
when awake
where household
activities are in
progress
Take infant for
rides In carriage
or car
Provide regular
periods of
affectionate play
when infant is
alert and
responsive
2 MONTHS
PSYCHOSOCIAL INTELLECTUAL RECEPTIVE LANGUAGE Same as at 1
Sense of Trust Sensorimotor Stage Alert expression when month
Substage II: listening Offer a rattle",
Distinguishes
"mother" or primary Primary Circular Direct definite regard pull from supine
caregiver from others Reaction (1 to 4 Soothed by caregiver's, to sitting position
and is more responsive months) mother's, voice Hold or dangle
to that person toy in front of
MORAL EXPRESSIVE
infant to
Eye-to-eye contact, en LANGUAGE
Preconventional encourage eye
face orientation, Morality Stage 0 (0 to Cry patterns develop movement
smiling, and 2 years)
vocalization are the Crying becomes Change patterns
evidences of differentiated, varying with of objects from

22
attachment between the reason for crying, e.g., bright and shiny
infant and parents, hunger, sleepiness, or pain. to dull and dark
especially the mother Pitch and intensity vary for further
Smiles back in Responds vocally to stimulation
response to another's caregiver's voice: "ah," "eh," Place in vertical
smile. This is the "uh" infant seat so that
beginning of social environment can
Coos
behavior. The true be viewed from a
social smile may not different angle
appear until the 3rd Outings in
month carriage or car if
Has learned that not done earlier
crying brings attention
PSYCHOSEXUAL
Oral Stage (0 to 1
year)
SPIRITUAL
Undifferentiated (0 to
1 year)
3 MONTHS
PSYCHOSOCIAL INTELLECTUAL RECEPTIVE LANGUAGE Same as at ! and
Sense of Trust Sensorimotor Stage Looks in direction of 2 months
Recognizes and smiles Substage II: speaker Encourage infant
to raise head
in response to Primary Circular EXPRESSIVE
when in prone
caregiver's (usually Reaction (1 to 4 LANGUAGE
position
the mother's) face months) Cries less
Pull baby to
Stops crying when MORAL Shows pleasure in making sitting position,
familiar person Preconventional many sounds thus encouraging
approaches Morality Stage 0 (0 to Vocalizes in response to head control
Interested in 2 years) others: coos and chuckles Hold bright toys
surroundings
May laugh aloud in front of infant
PSYCHOSEXUAL to encourage
Babbles from 3rd to 8th reaching
Oral Stage (0 to 1 month, but it is not linked
year) with specific objects or Provide greater
SPIRITUAL persons variety of toys as
baby shows
Undifferentiated (0 to interest in
1 year) playthings
4 MONTHS

23
PSYCHOSOCIAL INTELLECTUAL RECEPTIVE LANGUAGE Hold, touch, and
to rock infant
Sense of Trust Sensorimotor Stage Responds differently
gently
pleasant or angry voice
Smiles in response to Substage II:
Smile when
smiles of others or Primary Circular Does not cry when scolded talking and
when they appear Reaction (1 to 4 EXPRESSIVE singing to Infant
nearby months) LANGUAGE
Encourage
Initiates social play by Substage III: Laughs aloud mutual eye
smiling or vocalizing Secondary Circular contact
Vocalizes socially: coos and
Shows evidence of Reaction (4 to 8 gurgles when spoken to Laugh when
wanting social months)
Very "talkative" to self, infant laughs
attention and of Repeats actions that
increasing interest in affect an object to get people, or toys Echo sounds that
other family members a response (shaking a Talking and crying follow infant makes
Shows interest in new rattle) each other quickly Observe subtle
stimuli Experiments with old Can vocalize consonants: b, clues from
infant's body
Fusses if left alone or or new responses to g, h, k, n, p
language and
bored, thereby produce
respond to them
demanding attention environmental hanges
from others or to reach a goal Light tickling
stimulates
Shows eagerness MORAL
laughter
when feeding bottle Preconventional
appears Provide variety
Morality Stage 0 (0 to
of small multi
Breathes heavily when 2 years)
textured (fuzzy,
excited
smooth) and
PSYCHOSEXUAL colored objects
Oral Stage (0 to 1 that infant can
year) hold but not
swallow
SPIRITUAL
Shake rattle
Undifferentiated (0 to placed in infant's
1 year) hand
Offer toys for
grasping
Move rattle
around the infant
so that it can be
followed visually
and grasped. This
helps develop
hand-eye
coordination and

24
 improve head
control
Provide floating
toys for bath
Encourage
splashing in bath
water
Help infant sit up
with support and
roll over
Help infant learn
balance when
sitting by tilting
the body from an
erect position to
one side
Hold infant in
standing position
Use infant seat,
swing, and
stroller
Provide safe area
for periods of
solitary play
(playpen)
Place infant
when awake
where household
activities are in
progress
Include infant in
family's
television
viewing and
activities

5 MONTHS
PSYCHOSOGAL INTELLECTUAL RECEPTIVE LANGUAGE Same as 4
Sense of Trust Sensorimotor Stage Responds when own name months
is spoken Provide
Smiles at self in Substage III:
sufficient

25
mirror (photo 27] Secondary Circular EXPRESSIVE different objects
Begins to discriminate Reaction (4 to 8 LANGUAGE for play (small
family members from months) Squeals when happy or objects that are
too large to
strangers MORAL excited
swallow)
Accepts an object Preconventional Vocalizes displeasure when
Morality Stage 0 (0 to a desired object is taken Make various
from another person
sounds near ear
2 years) away
Plays enthusiastically.
Hold infant in
Shows displeasure Consonant sounds increase
standing position
when toy is lost Sounds like vowels appear and bounce to
Plays with own feet with consonants, such as exercise legs and
"goo" to develop
PSYCHOSEXUAL
Begins to mimic sounds balance
Oral Stage (0 to I
year)
SPIRITUAL
Undifferentiated (0 to
1 year)
6 MONTHS
PSYCHOSOCIAL INTELLECTUAL RECEPTIVE LANGUAGE Same as 4 and 5
months
Sense of Trust Sensorimotor Stage Recognizes familiar words
Encourage infant
Recognizes parents Substage III: EXPRESSIVE
to look in a
Recognizes strangers Secondary Circular LANGUAGE mirror; repeat
(5th and 6th month) as Reaction (4 to 8 Actively vocalizes pleasure names of parts of
different from family months) with cooing or crowing face, such as
members mouth, nose, and
Beginning of object Cries easily on slight or no
Begins to extend arms permanence when provocation (withdrawal of eyes
to be picked up infant briefly searches a toy) Make funny
for a dropped object
Thrashes arms and Vocalizes several well- faces for infant to
legs when frustrated MORAL defined syllables imitate

Imitation of others is Preconventional Lallation or imperfect Point out people,

beginning: sticking Morality Stage 0 (0 to imitation begins (6 to 9 food, objects and
tongue out 2 years) months) repeat their
names
Knows what is liked Shows enjoyment in hearing
and disliked own vocalization Talk to infant
about own and
PSYCHOS EXUAL "Talks" to image in mirror. surrounding
Oral Stage fO to 1 May pat image of self if activities
year) close to mirror Repeat infant's
SPIRITUAL name

26
Undifferentiated (0 to Encourage
1 year) response to
simple
commands
Use the word
"no" only when
necessary
Provide more
complex soft
cuddly toys
Provide harder
large toys,
possibly with
moving parts: set
of measuring
spoons, bowls,
pots, among
others
Provide fabrics
or food with
different textures
for infant to feel
Provide sound-
making toys
Encourage infant
to search for lost
objects and
obtain those out
of reach
Help infant sit up
while leaning
forward for
support
Begin to place
infant in walker
Provide a limited
area on the floor
where the infant
can move safely,
for sitting,
crawling, rolling
over

27
 7 MONTHS
PSYCHOSOCIAL INTELLECTUAL RECEPTIVE LANGUAGE Same as 4, 5, and
6 months
Sense of Trust Sensorimotor Stage Recognizes own name
Place toy under
Shows increasing fear SubstageIII: Responds with gestures to
blanket and
of strangers (7 to 8 Secondary Circular words such as "come" encourage infant
months) Reaction (4 to 8 EXPRESSIVE to find it
Actively clings to a months) LANGUAGE
Repeat simple
familiar person when MORAL Vocalizes eagerness sounds: "dada,"
distressed Vocalizes "m-m-m" when "mama"
Preconventional
Unhappy when Morality Stage 0 (0 to crying
Provide objects
caregiver, usually 2 years) Imitates simple noises and or food that can
mother, disappears speech sounds be bitten and
Responds socially to chewed safely
Makes polysyllabic vowel
own name sounds Continue to
Emotional instability encourage
Vocalizes "da," "ma," "ba"
—rapidly changes playing in water
from crying to Babbling decreasing and perhaps
laughter Some jargon (own "swimming" in
Closes lips tightly language) shallow tub or
when disliked food is pool
Vocalizes with adult like
offered inflections when others are Encourage
PSYCHOSEXUAL speaking banging of toys
and clapping
Oral Stage (0 to 1 hands on objects
year)
Continue to help
Oral aggressiveness is Infant learn
evidenced by biting balance
and chewing
Discovers genitalia
SPIRITUAL
Undifferentiated (0 to
1 year)
8 MONTHS
PSYCH OSOC1AL INTELLECTUAL RECEPTIVE LANGUAGE Hold, touch, and
Stops activity when own rock infant
Sense of Trust Sensorimotor Stage
gently
name is spoken
Greets strangers with Substage III;
Talk and sing to
coy or bashful Secondary Circular Beginning to understand infant
behavior, turning Reaction (4 to 8 meaning of "no"
away, crying or even Place infant in a
months) EXPRESSIVE
screaming (photo 41) sitting position

28
Refuses to play with Knows that objects LANGUAGE against a wall
strangers or even are separate from self and encourage
Shouts for attention
accept toys from them Searches briefly for leaning away
Imitates sound sequences from the wall to
Separation or stranger objects seen being
anxiety, to be placed elsewhere. Continues syllables; "da- improve balance
distinguished from The search is confined da," "ma-ma" (nonspecific Gently push
anaclitic depression to only one meaning) infant from a
(see p. 600), occurs modality Can vocalize consonants d, sitting position to
between the 6th and t, and w improve balance
8th months; caused by Actions to produce a
the infant's increased result have been
capacity to memorized
discriminate between Substage IV:
family members, close
friends, and strangers Coordination of
Affection for or love Secondary Schemas
of family members (8 to 12 months)
appears Abilities learned
Stretches arms to earlier are combined
loved family members and extended to deal
increased anxiety over with new situations:
loss of parent, behavioral and
especially mother perceptual patterns
Emotional instability are coordinated and
still evident applied to new
situations
Dislikes changing
clothing and diapers Object permanence
progresses and is
PSYCHOSEXUAL related to the
Oral Stage {0 to 1 increasing ability to
year) deal with matters of
time and space.
SPIRITUAL
Perceptions of space
Undifferentiated (0 to become refined
1 year) between 8 to 12
months
Beginning perception
of cause and effect
relationship
Early beginning of
anticipatory and
Intentional behavior
Problem solving

29
 beginning to develop
MORAL
Preconventional
Morality Stage 0 (0 to
2 years)
9 MONTHS
PSYCHOSOCIAL INTELLECTUAL RECEPTIVE LANGUAGE Same as 8
Sense of Trust Sensorimotor Stage Stops activity In response to months
"no" Encourage
Knows what "no" Substage IV:
Beginning to respond to exploration of
means Coordination of
simple commands given toys with eyes
Beginning to play secondary schemas (8 and fingers
verbally
simple games with to 12 months) (examine and
adult such as "so big," Able to follow objects Responds to adult anger poke)
"bye-bye" through transition EXPRESSIVE Show infant
Caregiver, usually from one place to LANGUAGE large pictures in
mother, becoming another books
Cries when scolded
more important as a MORAL
person Echolalia or correct Encourage to
Preconventional imitative expression of bang two toys
Wants to please Morality sounds made by others (9 to together
caregiver, usually 10 months) Continue to
mother Stage 0 (0 to 2 years)
Association of words with vocalize with
Beginning fears about persons or objects. Says Infant
being left alone, as "ma-ma," "da-da" as names Play infant
when put into the crib of persons games such as
Dislikes having face Intonation beginning to "so big" and
washed so covers face become patterned through "bye-bye," with
with arms and hands appropriate
imitation
PSYCHOSEXUAL motions

Oral Stage (0 to 1 Begin to play

year) "peek-a-boo"
(covering the
SPIRITUAL infant's face with
Undifferentiated (0 to a towel) and
f year) "pat-a-cake,"
with appropriate
motions
Encourage
crawling by
moving a toy
away from the
prone infant

30
 Encourage
creeping by
playing
"wheelbarrow"
(infant walks on
hands while adult
holds the body
up at the hips or
legs)
Help infant learn
to stand by
encouraging
reaching for an
object held
overhead
Provide a larger
environment In
which the infant
can move safely:
crawling,
creeping,
cruising
10 MONTHS
PSYCHOSOCIAL INTELLECTUAL RECEPTIVE LANGUAGE Same as 8 and 9
Sense of Trust Sensorimotor Stage Understand simple months
commands: gives a toy on a Obtain infant's
Expresses several Substage IV:
request that is accompanied attention when
beginning Coordination of by gestures requests are
recognizable emotions secondary schemas to
made and use
such as anger, sadness, 12 months) EXPRESSIVE
gestures to
jealousy, anxiety, LANGUAGE
indicate meaning
pleasure, excitement, MORAL May speak one word
and affection besides "ma-ma" and "da- Make
Preconventional facial
expressions and
Plays social games Morality Stage 0 (0 to da," such as "no," "hi"
sounds that
with adults, such as 2 years) Understands meaning of infant can imitate
"pat-a-cake" and "bye-bye" and waves
"peek-a-boo" (photo Show infant a
49) Imitates adult's inflection, cardboard or
pitch variations imitates cloth picture
May object to being sounds of animals book
away from parent
Continue infant
Improves in the ability
games, including
to imitate others;
"pat-a-cake" and
imitates facial
"peek-a-boo,"

31
expressions with appropriate
motions
Shows preference for
one toy over another Provide
opportunities for
Offers toy to another
holding and
but will not release or
releasing objects
give it up
Encourage
Looks at pictures in a
cruising by
book with another
placing furniture
person
in a circle
Attracts the attention
Encourage infant
of others by pulling on
to bounce in a
their clothes or fussing
standing position
Whatever action that by holding the
attracts attention is hands for support
repeated
Place infant in a
PSYCHOSEXUAL jumper seat to
Oral Stage (0 to 1 encourage
year) standing and
jumping
SPIRITUAL
Undifferentiated (0 to
1 year)
11 MONTHS
PSYCHOSOCIAL INTELLECTUAL RECEPTIVE LANGUAGE Same as 8, 9, and
Sense of Trust Sensorimotor Stage Responds to simple 10 months
questions: for example, Provide
Shows pleasure when Substage IV:
"Where is the kitty?" by opportunities for
a desired act is Coordination
of pointing and looking toward placing small
accomplished secondary schemas (8 object objects into
Becomes frustrated to 12 months) larger objects
EXPRESSIVE
when activities are MORAL and for taking
LANGUAGE
restricted them out again
Preconventional Imitates specific speech
Asserts self among Morality Stage 0 {0 to Play simple
sounds of others
family members games such as
2 years)
Jargon well established rolling a ball to
Seeks approval, avoids
disapproval infant. Show
infant how to
PSYCHOSEXUAL "throw" it back
Oral Stage (0 to 1 Encourage play
year) with other
SPIRITUAL persons

32
Undifferentiated (0 to Encourage infant
1 year) to stand alone by
gradually
decreasing
support (furniture
or adult's hands)
Place infant In a
walker and
encourage letting
go by offering a
toy to grasp
12 MONTHS
PSYCHOSOCAL INTELLECTUAL RECEPTIVE LANGUAGE Same as 8, 9, 10,
Sense of Trust Sensorimotor Stage Responds with gestures or and 11 months
theoretically achieved. actions to more complex Provide large
If not, a sense of Substage IV:
verbal requests, such as crayons for
mistrust predominates Coordination of "Please give It to me" drawing
Infant's emotion, such secondary schemas (S
as fear, jealousy, EXPRESSIVE Provide stacking
to ) 2 months)
anger, can be more LANGUAGE discs or blocks
clearly interpreted Has learned that
Attachment developed objects continue to May speak two or more Provide objects
to primary caregiver exist even when out words besides "ma-ma" and to place inside
(object "da-da" larger containers
(s) of sight
Clings to caregiver, permanence) Understands meaning of Place infant in
Beginning perception many more words than can walker
usually mother, when several
fearful be spoken times a day to
of cause and effect
Explores away from encourage
relationships Knows names of increasing
caregiver if secure walking
Responds to requests Early beginning of number of objects movements
for affection such as a anticipatory and Imitates sounds animals
Encourage infant
kiss or a hug intentional behavior make
to push a chair or
Has established Problem solving Intonation becoming more stroller around
beginning view of self beginning to develop, like adult speech (photo 60)
as a separate person although the infant Continues using jargon
"Security blanket" or Provide push-
has not learned to
favorite toy beginning Indicates "no" by shaking and-pull toys to
"think" per se
to provide comfort head encourage
MORAL walking
(photo 58) Beginning voluntary control
Cooperates in Preconventional over responses to sound Give infant
dressing: puts arms Morality stage 0 (0 to may or may not respond or "piggyback"
through sleeves, feet 2 years) may delay response to rides to improve
into shoes. Takes off another's voice balance
socks (photo 59)
Drops objects on Vocalization decreases as Encourage infant
to walk,

33
purpose so someone walking increases eventually
can pick them up holding only one
PSYCHOSEXUAL hand
Oral Stage (0 to 1 Provide
year) roughhouse
SPIRITUAL activity Provide
Undifferentiated (0 to increasing visual,
1 year) auditory, tactile,
and kinetic
stimulation

Infant Growth and Development

Introduction

34
 “Infant” is derived from the Latinword, “infans,” meaning “unable tospeak.”Thus, many
define infancy as the period from birth to approximately 2 years of age, when language
begins to flourish. It is an exciting period of “firsts”—first smile, first successful grasp,
first evidence\ of separation anxiety, first word, first step, first sentence. The infant is a
dynamic, ever-changing being who undergoes an orderly and predictable sequence of
neurodevelopmental\ and physical growth. This sequence is influenced continuously by
intrinsic and extrinsic forces that produce individual variation and make each infant’s
developmental path unique.

The first 12 months may be the most dynamic period of life. Dramatic changes
are taking place in all areas of growth and development, which include:

 Physical development.

35
 Most babies double their birth weight by gaining an average of 0.5 oz
(14.2 g) to 1 oz (28.4 g) every day for the first 6 months of life. Birth weight
usually triples sometime between 9 and 12 months of age. By 12 months of
age, most babies have grown in length a total of about 10 in. (25.4 cm) since
birth. Head circumference usually increases about 0.25 in. (0.6 cm) to 0.5 in.
(1.3 cm) a month.

 Cognitive development. This is the process by which babies develop the

abilities to learn and remember. Babies begin to recognize and interact with
loved ones and start to understand that people and objects still exist even when
they are out of sight (object permanence).

 Development of sexual identity

36
 Touch is a crucial role in to infant development and plays a primary role in
sexual developmenThey enjoy skin to skin contact and explore their own body
for pleasure

 Emotional and social development. In a loving environment, babies easily

bond with their parents. In the first month, newborns express emotion mainly by
crying and grimacing or displaying an alert and bright face. By about 4 months,
they learn to smile, coo, and move their arms around when excited. By 5
months, babies show a clear preference for a loved one. In the following
months, "separation protest" and "stranger anxiety" are two of the ways babies
show this growing attachment. A close bond provides a foundation for future
relationships: babies learn from their parents how to love and how to trust.

 Language development. Babies' brains are very open to learning, and they
quickly absorb the language around them. By about 3 to 6 weeks, babies
develop a different crying sound to show a specific need (such as hunger or
discomfort). By around 2 months of age, they begin to interact with caregivers
by cooing and smiling, which proceeds to babbling and chuckling within about 6
months. Also by 6 months, most babies have learned all of the basic and
distinct sounds of their native language. By the first year most babies can say a
few words, like "mama" or "dada," and can understand many more.

Sensory and motor development.

37
 A baby's movements become more controlled and deliberate as the newborn
reflexes fade. Although seemingly stiff at times, a baby will be limber and
coordinated enough in 6 months to suck his or her toes and strong enough to sit
with light support. By 10 months, many babies can stand, although they may
need support.
Infants respond to stimuli differently in these different states.

Infants have a wide variety of reflexes, some of which are permanent (blinking,
gagging), and others transient in nature. Some have obvious purposes, some are
clearly vestigial, and some do not have obvious purposes. Primitive reflexes
reappear in adults under certain conditions, such as neurological conditions like
dementia or traumatic lesions.

Milestones

smiling

grasp

head & torso control

By about 1 month of age, a baby can lift his head when lying prone. Strength and
control normally increase so that, by 2 months of age, she can manage to lift her
chest up as well, when lying in this same prone position - and keep her head in
the midline. At 3 months, he is expected to be able to support himself with his
forearms, holding his chest up off the floor or table, and keeping his head held
steadily in the midline.

A newborn required head support and his head will lag behind if his shoulders
arer lifted. By 3 months, if the baby is pulled by her arms to a sitting position she
is able to keep her head in line with her torso, without head lag.

38
Discovering midline

A baby will bring her hands together and discover her midline by 3 months.

rolling over

Rolling over can be done in two ways: from laying on one's belly to rolling onto
the back (prone to supine), and from laying on the back to resting face down on
one's belly (supine to prone). The first (belly to back) is the first to occur and
rolling over from the prone position is expected by 4 months of age. Since some
babies do it sooner, even much sooner, it's important to keep the baby safe when
laying her down on a surface she might roll off of and not allow her first success
at rolling over to cause injury.

Rolling from back to belly is a later milestone, accomplished (on average) by 6

and a half months of age.

sitting up

By 7 months, a baby should be able to sit unsupported, at least briefly.

grasp (thumb and fingers)

The pincer grasp is not only an important developmental milestone, it has

important consequences for the child's safety. A fine motor grasp of finger to
thumb usually occurs by 8 months of age and allows a sudden increase in the
child's ability to manipulate objects.

crawling

This boy, born a full-term infant, is pictured on his first birthday. Crawling is his
preferred mode of locomotion when ground needs to be covered quickly, but ....(see
picture below)

standing up

This one year old can cruise along on his own two feet when he has a little support. He is
starting to walk, and is now becoming a toddler.

walking

Walking may begin in some children as early as 7 or 8 months, but is most often
seen to begin at about 1 year of age. When walking has not been accomplished
by 17-18 months of age, then

39
The manner of walking changes over time. At first, the baby stands with the feet
spaced further apart than she will as she becomes older, and the term "baby
steps" literally describes the small distance taken with each forward movement of
the foot. Steps are taken toe first rather than with a heel strike and shift to the
toe. As she masters the movement her forward velocity will become greater.
Those baby steps do not become longer as she gets faster at covering ground,
but instead the cadence of steps is more rapid. She gets further faster because
of better balance and quicker gait rather than with a longer stride.

By age two, the average child will show increased step length compared to his
gait at age one, and will be able to cover ground faster than before despite a
diminished cadence. "Most of the adult gait patterns are present in children by 3
yr of age, with changes of velocity, stride, and cadence continuing to 7 yr. The
gait characteristics of a 7-yr-old child are similar to those of an adult."

Those children who start later may accelerate the intermediate stage of walking,
so that by age 3 or so the early and late starters are all walking well and doing so
with changes in stride length, good balance, and a heel toe gait.

Changes in the body that come from activities

Body parts are not static structures, they change depending on how they are
used. Weight bearing and mechanical forces thicken bone, and so muscles and
bone change together as they grow. For example, the mastoid process, which is
the thick bump that can be felt behind any adult's ear (down around the region of
the upper earlobe), does not exist in the newborn baby, instead the baby's skull
is flat behind the ear. A muscle in the neck, the sternocleidomastoid muscle,
runs, in part, from this spot on the skull, down to the collar bone and the top of
the sternum. As the muscle contracts with the greater force as the baby grows
and develops the ability to raise his head and hold it up, the bone actually
thickens and the mastoid process developes. Other changes in the body occur
with standing and walking. The spine developes what is called "lordosis", the
straight backed baby has a different back contour than the walking toddler. The
bottom of the feet in the baby who does not stand are "rocker-bottom" shape,
and change as the child puts weight on those feet and change still more with
walking. In those disabled children who never walk , the feet retain their infant
contour.

the back

the feet

Infantile reflexes includes:

 Moro reflex or startle reflex:

1. Startle

40
 2. spreading out the arms (adduction)
3. unspreading the arms (abduction)
4. Crying (usually)
 Tonic neck reflex or fencer's reflex
 Rooting reflex, sucking reflex, suckling reflex: can be initiated by scratching the
infant's cheek; the reaction is pursing of the lips for sucking.
 Stepping reflex, step-up reflex: can be initiated if you support the infant upright
from its armpits below a given surface so the baby lifts its foot and steps up on the
surface (like climbing a stair).
 Grasp reflex: can be initiated by scratching the infant's palm.
 Parachute reflex: the infant is suspended by the trunk and suddenly lowered as if
falling for an instant. The child spontaneously throws out the arms as a protective
mechanism. The parachute reflex appears before the onset of walking.
 Plantar reflex or Babinski reflex: a finger is stroked firmly down the outer edge of
the baby's sole; the toes spread and extend out.

Sleeping and eating patterns. A newborn's main routines center around these
two activities, although by about 3 weeks of age, he or she begins to socialize
more.

 Diaper habits. You can expect to change your newborn's diaper

frequently. The specific number of times a day varies and in part depends on
whether you feed your baby breast milk or formula.

 Crying. Newborns cry when they are hungry, tired, overstimulated, or

otherwise uncomfortable. They may also cry for no apparent reason and be
difficult to console.

Promoting Healthy Growth and Development

For healthy growth and development, newborns need physical and emotional
care. You enhance development and give your newborn a sense of security and
being loved by:

 Feeding on demand. Respond to your baby's hunger cues, no matter how

frequent.

 Encouraging emotional bonding. Your baby needs to be close to you and

to anticipate that you will respond to his or her needs.

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 Stimulating learning and communication. Your newborn learns through
bonding and interaction.

 Preparing for sibling rivalry. If you have an older child, prepare him or her
for the arrival of a new baby in the home.

Although your baby's needs are basic, it is important to respond promptly to his
or her cues and to recognize safety issues.

 Reduce the risk of sudden infant death syndrome (SIDS) by always

placing your baby to sleep on his or her back (not on the stomach). Make sure
that the crib mattress is firm and covered by a sheet and that there are no
pillows or blankets that could block the baby's mouth or nose. For more
information, see the topic Sudden Infant Death Syndrome (SIDS).

 Make sure all safety standards are met for your baby's nursery furniture
and equipment

 Support your newborn's head. In the first few months, your baby's neck
muscles are weak, and the head needs to be supported at all times.

 Buy a car seat that is appropriate for a newborn, and use it properly. And,
always use a car seat when traveling with your baby on an airplane.

 Do not leave your baby alone with a pet.

 Never leave your newborn alone or in the care of an older child while the
baby is: In the bathtub.

 On a changing table or other place where he or she could fall or get

injured.

 Post emergency numbers near the phone. Include information about how
to reach your doctor, friends, and neighbors. Keep your local Poison Control
Center number handy, too. Older siblings sometimes give newborns medicines
or other dangerous substances.

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 Never shake your baby. A baby's skull is not developed enough to protect
it against injury. Shaking your baby in anger or frustration can lead to shaken
baby syndrome. Get help immediately if you feel that you or another caregiver
might hurt your baby. Call 911 if it is an emergency. Call your health
professional, friend, relative, or parent hotline if you are feeling overwhelmed to
the point that you feel you are not able to care for your baby.

For more information, see the topics Shaken Baby Syndrome and Health and
Safety, Birth to Age 2..

Routine Checkups
Birth examination

Your baby's first checkup begins in the hospital right after birth when a health
professional assesses the baby's Apgar scores. This test checks certain physical
traits to help determine whether your newborn needs any interventions or special
monitoring right away. Temperature and vital signs are always closely monitored
during the baby's first 6 hours. Your baby may also have the following soon after
birth:

 A hearing assessment. Many states require hearing screening on all

babies who are born in hospitals because speech and language have a better
chance of developing normally when hearing problems are caught and treated
early. The United States Preventive Services Task Force recommends that all
newborns be screened for hearing loss. A thorough physical exam. Within 24
hours of birth, a doctor will examine your baby, check his or her breathing and
heartbeat, and assess the baby's ability to pass urine and stool.

 Measurements of length, head circumference, and weight.

 Injections, such as vitamin K, and possibly some immunizations, such as

for hepatitis B. For more information, see the topic Immunizations or the
childhood immunization record.

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 Antibiotic eyedrops. Because newborns can get eye infections from
bacteria in the birth canal, some states require that antibiotic eyedrops or
ointment be given.

 Newborn screening. Your baby has a sample of blood taken from the heel.
This sample is used to test for phenylketonuria and other inherited diseases.

Well-child visits

In the first weeks after birth, your baby begins a series of exams by a health
professional, sometimes called well-child visits. Health professionals have
individual approaches to the timing of these appointments. Newborns normally
have office appointments scheduled 3 to 5 days after they go home from the
hospital, and by 1 month of age. During one or more of these visits, your baby
will have:

 Length, weight, and head circumference measurements taken. These

measurements are plotted on a growth chart and are compared to previous and
later markings to make sure the baby is growing as expected.

 A physical exam. The doctor examines your baby thoroughly for any
problems. The doctor also assesses the baby's reflexes and general
development and observes how you and your baby interact. You are asked
questions about how the baby and the rest of the family are doing, how the
baby is eating and sleeping, and whether you have noticed any changes in
behavior.

 A blood sample taken from the baby's heel (called a heel prick) to test for
certain inherited diseases such as phenylketonuria (PKU). Although your baby
may have been tested for PKU at birth, there is a risk of inaccurate test results
when the test is done within 48 hours of delivery. A second PKU test should be
done several days later, usually at your baby's first well-baby visit. For more
information, see the topic Phenylketonuria (PKU).

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 Immunizations. Individual and series immunizations are started or
continued at these well-child visits. Your health professional will provide you
with a schedule so that you know how many injections to expect at each visit.
For more information, see the topic Immunizations.

Routine checkups are a good time for parents to ask about what to expect in the
weeks to come. You may find it helpful to go to your baby's checkups with a
prepared list of concerns

Special methods are used to study infant behavior.

Object permanence is an important stage of cognitive development for infants.

Numerous tests regarding it have been done, usually involving a toy, and a crude
barrier which is placed in front of the toy, and then removed, repeatedly. In
sensorimotor stages 1 and 2, the infant is completely unable to comprehend
object permanence. Jean Piaget conducted experiments with infants which led
him to conclude that this awareness was typically achieved at eight to nine
months of age. Infants before this age are too young to understand object
permanence, which explains why infants at this age do not cry when their
mothers are gone. "Out of sight, out of mind."

Erik Erikson (1902-1994) said we develop in psychosocial stages. Erikson

emphasized developmental change throughout the human life span. In Erikson’s
theory, eight stages of development unfold as we go through the life span. Each
stage consists of a crisis that must be faced. According to Erikson, this crisis is
not a catastrophe but a turning point of increased vulnerability and enhanced
potential. The more an individual resolves the crises successfully, the healthier
development will be.

Trust versus mistrust is Erikson’s first psychosocial stage, which is experienced

in the first year of life. A sense of trust requires a feeling of physical comfort and
a minimal amount of fear and apprehension about the future. Trust in infancy
sets the stage for a lifelong expectation that the world will be a good and
pleasant place to live.

Autonomy versus shame and doubt is Erikson’s second stage of development,

occurring in late infancy and toddlerhood (1-3 years). After gaining trust in their
caregivers, infants begin to discover that their behavior is their

own. They start to assert their sense of independence, or autonomy. They realize
their will. If infants are restrained too much or punished too harshly, they are
likely to develop a sense of shame and doubt

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PSYCHOSEXUAL DEVEDLOPMENT.

Oral phase

The first stage of psychosexual development is the oral stage, which lasts from
the beginning of one’s life up to 1 year. During this stage, the focus of
gratification is on the mouth and pleasure is the result of nursing, but also of
exploration of the surroundings (as infants tend to put new objects in their
mouths). In this stage the Id is dominant since neither the ego nor the super ego
is yet fully formed. Thus the baby does not have a sense of self and all actions
are based on the pleasure principle.

The ego, however, is under formation during this first stage. There are two
factors that contribute to the formation of the ego. Firstly, body image is
developed, which implies that the infant recognizes that the body is distinct from
the outer world. For instance, one will start understanding that one feels pain only
when force is applied on one’s own body. By the identification of the body
boundaries, one starts developing the sense of ego. A second factor to which
ego formation is attributed is experiences involving delay of gratification and
leads to the understanding that specific behaviors can satisfy some needs. The
infant gradually realises that gratification is not immediate and that it has to
produce certain behaviors to initiate actions that lead to gratification. An example
of such behavior is crying, which seems to be purposeless during the first 2
months of the baby’s life, but later seems to be used productively and is
connected to certain needs. The key experience in this stage is weaning, during
which the child loses much of the intimate contact with the mother and leads to
the first feeling of loss ever experienced by the baby. Weaning also adds to the
baby’s awareness of self, since it learns that not everything is under its control,
but also that gratification is not always immediate.

In this stage, the gratification of needs will lead to the formation of independence
(since the baby forms a clear idea about the limits of the self and has formed its
ego), and trust (since the baby learned that specific behaviors will lead to
gratification] . On the other hand, a fixation can lead to passivity, gullibility,
immaturity and unrealistic optimism, and also to the formation of a generally
manipulative personality due to improper formation of the ego. This can be the
result of either too much or too little gratification. In the case of too much
gratification, the child does not learn that not everything is under its control and
that gratification is not always immediate (which are the results of weaning),
forming an immature personality. On the other hand, the child’s needs may be
insufficiently met, and thus the child becomes passive since it has learned that
whether it produces behavior or not, no gratification will come.

Parental tips to increase your baby's development and emotional security:

46
Young babies need the security of a parent's arms, and they
understand the reassurance and comfort of your voice, tone, and
emotions. Consider the following as ways to foster the emotional
security of your newborn:
 Hold your baby face to face.
 Talk in a soothing tone and let your baby hear your affectionate
and friendly voice.
 Sing to your baby.
 Walk with your baby in a sling, carrier, or a stroller.
 Swaddle your baby in a soft blanket to help him/her feel secure
and prevent startling by the baby's own movements.
 Rock your baby in a rhythmic, gentle motion.
 Respond quickly to your baby's cries.
 You are telling your baby that his thoughts and feelings are important
when you react to his cues (signs). This helps build your baby's self-
esteem (how he thinks about himself). Do not worry about spoiling your
baby by giving him too much attention. You give your baby a feeling of
safety and trust when you quickly and consistently comfort your baby
when "demanded."
 .

 Be sure to make and keep appointments with your child's caregivers

for routine medical checkups and vaccinations.

 Put your baby on his back for sleeping.

 Keep all medicines, cleaning products and other household chemicals

locked and out of reach.

 Keep small objects that may cause choking away from your child. This
includes food, such as hot-dogs, whole grapes, whole raw carrots, raw
celery, peanuts, popcorn, chips or candy. Cut all foods into small size
bites.

 Make sure your house is childproofed if you haven't already done so.
Use childproof locks, safety gates, and window guards to prevent
accidents and falls. Smoke and carbon monoxide detectors are also
important.

47
 Keep matches, cigarette lighters, and guns locked and out of reach.

 Never leave your child home alone. Also, never leave your baby
alone in the car. The temperature inside the car can change a lot. And,
never leave your toddler alone near water.

 Never leave your baby alone up high like on a changing table, the
couch, a chair, or the bed. Always keep a hand on your baby and never
walk away when your baby is on a high place.

 Do not use walkers. They are dangerous and have caused serious
injuries and even death when they fall down stairs.

 Use approved car seats correctly. Before you choose a child safety seat for
your child, check the age and weight limits for the seat. Put the car seat in the
back seat of the car and secure it facing backwards. Never put your child in a
front seat with a safety airbag.

o Rear-Facing Infant Seat: Your baby can use this child

safety seat from birth up to 20 to 22 pounds. Your baby must be
rear-facing until 1 year old AND at least 20 pounds. Some seats
of this type can hold babies up to 30 or 35 pounds.

o Convertible (Rear-Facing and Forward-Facing): Your

baby must be rear-facing from birth up to at least 1 year old. You can
use this seat until your baby weighs 20 to 35 pounds. It is safest to
keep your baby rear-facing as long as possible.

48
 To prevent choking, do not attach pacifiers or other objects to the crib
or body with a string or cord. Keep small objects away from your baby.
This includes toys or stuff animals that have small breakaway parts.
Baby's can suffocate if they play with plastic bags. Never leave plastic
bags or wrappings where your baby can reach them.

 Always keep your baby in a smoke-free area. Do not allow people to

smoke around your baby.

 To prevent burns, do not hold your baby when smoking, drink hot
liquids or when cooking. Do not heat formula or breast milk in the
microwave. Your baby skin is also very sensitive to the sun. Keep your
baby out of direct sunlight to prevent sunburn.

 Check the water temperature before putting your child in the tub.
Have your water heater set to less than 120° F to lessen the chance of
an accidental burning. Never leave your baby alone in the water. Do not
leave your baby to answer the phone or doorbell. Either let it ring or wrap
your baby in a towel and take your baby with you.

 Keep anyone with a cough, cold, or infectious disease (spreadable

illness) away from your newborn.

 Call caregivers if your baby seems sick. Fever, refusing to eat,

vomiting (throwing up), or diarrhea (runny, watery BMs) are good
reasons to call. Also call if your baby is more fussy or quieter than usual

49
 or looks jaundiced (yellow skin and eyes).

 And, call your baby's caregiver if you are worried or have questions
about your baby's growth or development.

Reaction of sick infants

Separation and stranger anxiety are very strong by the time your baby is 6
months. Your baby cannot describe his pain, like where it is and how bad it hurts.
Following is list of signs that can tell you your baby is stressed (not OK).

 Breathing and heartbeat are very fast.

 Eating poorly or regurgitation (food keeps coming up and vomiting).

 Your baby does not look at you or he keeps looking away and doesn't
want to be touched.

 Fussier than normal or listlessness (not moving much at all).

 Hiccoughs, sneezing, and yawning a lot.

 Shaking.

 Skin changes from his normal color to red, pale, gray or blue.

Care of an hospitalized infants

Following are ways to help lessen your baby's fear at being in the hospital.

 Be involved in caring for baby each day, like helping with feedings,
baths, dressing, and diapering. Try to keep your baby's schedule as
much like it is at home as possible.

 Ask for the same caregiver to lessen the number of people caring for
your baby. Soon your baby will recognize his caregivers and won't be so
afraid.

 Always try to be present when your baby is getting medical care. Hold
your baby in your lap during procedures if at all possible. This helps calm
your baby and make him feel safe. Comfort your baby and provide
support by stroking (touch) your baby and talking in a soothing way.

 Make sure your baby has things that remind him of you and make him
feel safe, like his blanket. Leave a picture of you or a recording of your
voice to be played if you can't be with him.

50
 Praise your baby as often as possible.
 recently born; "a newborn infant"
 neonate: a baby from birth to four weeks
 having just or recently arisen or come into existence; "new nations";
"with newborn fears"
 The term "infant" derives from the Latin word in-fans, meaning "unable
to speak." There is no exact definition for infancy. "Infant" is also a legal
term with the meaning of minor;[2] that is, any child under the age of
legal adulthood.

A human infant less than a month old is a newborn infant or a neonate.

[3]
The term "newborn" includes premature infants, postmature infants
and full term newborns.
 HEALTH PROBLEMS

 Nutritional disturbances
 Vitamin and mineral disturbances
 Protein energy malnutrition
 Regurgitation and spitting up
 Paroxysmal abdominal pain
 Rumination
 SKIN DISODERS
 Diaper dermetitis
 Seborrheic dermetitis
 Atopic dermetitis
 Sudden infant death syndrome
 apnea

CONCLUSION

From the flu to broken bones, illnesses and medical emergencies seem
to be inevitable parts of raising kids. It can be stressful any time your
child needs medical attention, but even more so when you're worried
about where to get that care and how much it will cost.

We have more options for getting health care and paying for it than
ever before. There is a movement toward consumer-directed health
care, health insurance that is designed to get those who use health
care — like parents — to play a bigger part in keeping costs in check

BIBLIOGRAPHY

BOOK REFERANCE

51
DOROTHY R MARLOW ,TEXTBOOK OF PEDIATRIC NURSING,6TH EDITION
W B SAUNDERS PUBLICATIONS PAGE NO;624-700

 GHAI “ESSENTIAL PEDIATRICS 6TH EDITION CBS PUBLISHERS PaGE

NO;432-561

 WONGS “ESSENTIALS OF PEDIATRIC NURSING 7TH EDITION

ELSIEVER PUBLICATION PAGE NO;645-723

NET REFERANCES

 http://www.drugs.com/cg/normal-growth-and-development-of-newborns.html

 http://www.epi.umn.edu/let/pubs/img/adol_ch1.pdf

 http://health.yahoo.com/parenting-infant /growth-and-development-ages-
healthwise--te7233.html

RESEARCH STUDYS

Abstract

Objectives: To examine the relationship between infant and parental characteristics and
parental report of infant cyanosis and also hospital admission for apnoea/cyanosis.
Methods: A prospective cohort study was conducted. It involved the one-fifth of

52
Tasmanian live births who were assessed, using a perinatal score, as being at higher risk
of sudden infant death syndrome (SIDS). From 1 May 1988 to 30 April 1993, 6213
infants (89% of eligible infants) participated in the hospital (4 days postnatal age) and
home interview (5 weeks postnatal age). Data on usual sleep position and infant history
of cyanosis were collected at home interview. Hospital admission records for
apnoea/cyanosis in the first year of life were linked to data on cohort infants in Southern
Tasmania. Results: Several factors were related to parental reports of cyanosis, with
strong associations observed for very premature infants < 28 weeks (adjusted odds ratio
[AOR] 6.06, 95% confidence interval [2.47, 14.85]), history of fits (AOR 5.59 [2.35,
13.13]); and the administration of antihistamine medication during the first month of life
(AOR 3.03 [1.12, 8.18]). The median age at hospital admission was 7 weeks postnatal
age. A family history of asthma, a history of fits, a history of turning blue while feeding
or trouble breathing while feeding were associated with parental reports of cyanosis,
breathing difficulties and also with hospital admission for apnoea/cyanosis. Other factors
such as prematurity, maternal smoking, bottle feeding and a history of fever were
significantly related to the infant history of cyanosis but not to hospital admission. This
may partly reflect the low incidence rate (1.37%) for hospitalization for apnoea/cyanosis
in the first year of life among these cohort infants. Conclusions: Several infant and
parental characteristics are associated with increased risk of infant apnoea/cyanosis in
this study but further population-based work with a larger group of infants hospitalised
for apnoea/cyanosis should be conducted. The finding of an association between the
administration of antihistamine medication and infant cyanosis highlights the possibility
of adverse side-effects if antihistamine medication is administered to young infants.

The impact of infant crying on young women: A randomized controlled

study

Abstract

Infant crying is a common source of distress in parents. This study used an

experimental paradigm to explore the impact of infant crying on mood, perceptions of
temperament and caregiving behaviours in young women. The use of a life-like

53
 programmable baby doll with a real infant's cry sound recorded within it enabled
rigorous control of the amount and intensity of crying exposure. Dependent variables
included state anxiety, negative affect change after exposure and doll handling
behaviour during exposure. Participants were 80 female undergraduate students (mean
age = 19.62 years, SD = 2.02, all non-mothers). Results showed that exposure to infant
crying had an immediate impact on young women's negative affect, state anxiety and
was related to more negative perceptions of infant temperament. The study predictions
regarding negative caretaking responses to crying could not be tested, but participant
comments about feelings of self-efficacy in caretaking are discussed. The substantial
short-term impact that infant crying had on women's mood and affect confirms the
need for health professionals working with new parents to be sensitive to the impact of
persistent infant crying, both with regard to mood state and confidence in caretaking.
Keywords: emotional; infant; perceptions; crying; women
)

Sleep and physical growth in infants during the first 6 months.

Tikotzky L, de Marcas G, Har-Toov J, Dollberg S, Bar-Haim Y, Sadeh A.

Department of Psychology, The Adler Center for Research in Child Development and
Psychopathology, Tel Aviv University, Tel Aviv, Israel.

Summary The aim of this study was to explore the relationships between infant sleep
patterns and infant physical growth (weight for length ratio) using both objective and
subjective sleep measures. Ninety-six first-born, healthy 6-month-old infants and their
parents participated in the study. Infant sleep was assessed by actigraphy for four
consecutive nights and by the Brief Infant Sleep Questionnaire (BISQ). In addition,
parents were asked to complete background and developmental questionnaires. Questions
about feeding methods were included in the developmental questionnaire. Infants' weight
and length were assessed during a standard checkup at the infant-care clinic when the
infants were 6 months old. Significant correlations were found between infant sleep and
growth after controlling for potential infant and family confounding factors. Actigraphic
sleep percentage and reported sleep duration were correlated negatively with the weight-
to-length ratio measures. Sex-related differences in the associations between sleep and
physical growth were found. Breast feeding at night was correlated with a more
fragmented sleep, but not with physical growth. These findings suggest that sleep is
related significantly to physical growth as early as in the first months of life. The study
supports increasing evidence from recent studies demonstrating a link between short
sleep duration and weight gain and obesity in young children.

54