THE CARE OF AN INFANT

AND FAMILY
01/10/2020 1
01/10/2020 2
INFANT
1 month- 12 months

01/10/2020 3
CHANGES/ DEVELOPMENT
 Physiologic Development
• Brain grows to about half the adult size

• Body temperature stabilizes

• Motor abilities develop

• Eyes begin to focus and fixate

01/10/2020 4
PHYSIOLOGIC DEVELOPMENT

• Heart doubles in weight, heart rate

slows, blood pressure rises

• Basic task: SURVIVAL (breathing,

sucking, eliminating, digesting)

• Interaction of external stimulations in

order to grow and develop.

01/10/2020 5
PHYSICAL GROWTH
Body Systems
 Cardiovascular system- HR- slows from 120 to 160 bpm
to 100 to 120 bpm by the end of 1st year.
 BP- slightly elevated from fro 80/40 to 100/60
 RR- slows from 30 to 60 breaths/min to 20 to 30
breaths /min.
 GIT- immature in its ability to digest food and
mechanically move along
 Liver- remains immature possibly causing inadequate
conjugation of drugs.

01/10/2020 6
CHANGES AND DEVELOPMENT
Physical Growth
1 month
 Weight of 5- 7 oz.
 Height gain of 2.5 cm. monthly for 1st 6 months
 Obligatory nose breathers
 Primitive reflexes present and strong

2 months
 Posterior fontanels closed

01/10/2020 7
CHANGES AND DEVELOPMENT
3 months
 Primitive reflexes fading
4 months
 drooling begins
 Moro, Tonic neck and Rooting reflexes start to
disappear
5 months
 Moro reflex gone

01/10/2020 8
CHANGES AND DEVELOPMENT
6 months
Birth weight doubled
Teething may begin with eruption of 2 lower central
incisors
Chewing and biting occur
7 months
Eruption of upper central incisors
8 months
Begins to show regular patterns in bladder and bowel
elimination

01/10/2020 9
CHANGES AND DEVELOPMENT
9 months
Eruption of upper lateral incisor
11 months
 Eruption of lower lateral incisors may begin
12 months
 Birth weight tripled
 Birth length increased by 50 %
 Anterior fontanels almost closed

01/10/2020 10
TEETHING

01/10/2020 11
MOTOR DEVELOPMENT
Gross Motor
1 month
ASSUMES FLEXED POSITION
Can turn head from side to side when in prone position

2 months
Assumes less flexed position when prone
MOVES ARMS AND LEGS VIGOROUSLY
LIFTS HEAD TO 45 degrees WHEN IN PRONE OR ON
ABDOMEN
TURNS FROM SIDE TO BACK

01/10/2020 12
MOTOR DEVELOPMENT
3 months
Slight head lag when pulled to sitting position
LIFTS HEAD AND CHEST WHEN PRONE
4 months
Has almost no head lag when pulled to sitting
Balances head well in sitting position
ROLLS FROM BACK TO SIDE
5 months
CAN TURN OVER FROM BACK TO FRONT
ROLLS FROM SIDE TO SIDE

01/10/2020 13
MOTOR DEVELOPMENT
 6 months
Sitting pretty
Rolls from front to back
Sits in high chair with back straight
Bounces when held standing
Stretches out arms to be taken up

 7 months

When held in standing position, bounces actively

SITS, LEANING FORWARD ON BOTH HANDS
When supine, spontaneously lift head off surface

01/10/2020 14
MOTOR DEVELOPMENT
 8 months
SITS STEADILY UNSUPPORTED
Adjust posture to reach an object
 9 months
Creeps on hands and knees
Sits steadily on floor for prolonged time (10 min.)
PULLS SELF TO STANDING POSITION AND STANDS HOLDING
ON TO FURNITURE
 10 months
Can change from prone to sitting position
Stands by holding on to furniture, sits by falling down

01/10/2020 15
MOTOR DEVELOPMENT
11 months
 CRUISES OR WALK holding on to furniture or with both
hands held
12 months
 WALKS WITH ONE HAND HELD
 MAY ATTEMPT TO STAND ALONE MOMENTARILY; MAY
ATTEMPT FIRST STEP ALONE
 Can sit down from standing position without help
 Cruises well

01/10/2020 16
INFANT CRUISING

01/10/2020 17
MOTOR DEVELOPMENT
FINE MOTOR
1 month
Hands predominantly closed
Grasp reflex is strong
2 months
Hands open
GRASP REFLEX FADING AND BECOME
VOLUNTARY
3 months
ACTIVELY HOLDS RATTLE BUT WILL NOT REACH
FOR IT
GRASP REFLEX ABSENT AND BECOME
VOLUNTARY

01/10/2020 18
MOTOR DEVELOPMENT
4 months
 INSPECTS AND PLAYS WITH HANDS, PULLS CLOTHING OR
BLANKET OVER FACE IN PLAY
 Tries to reach objects with hands but overshoots
 Grasps objects with both hands
 BRINGS HAND OR TOYS TO MOUTH
5 months
 ABLE TO GRASP OBJECTS VOLUNTARILY
 Takes objects directly to mouth
 REACHING OUT

01/10/2020 19
MOTOR DEVELOPMENT
6 months
 Holds bottle
 GRASP FEET AND PULLS TO MOUTH; PLAYS WITH TOES
 Drops one cube when another is given
7 months
 TRANSFER OBJECTS FROM ONE HAND TO THE OTHER
 Bangs cubes on table
 Rakes at small objects

01/10/2020 20
MOTOR DEVELOPMENT
8 months
 Has beginning pincer grasp using index , 4th and 5th
finger against lower part of thumb
9 months
 USES THUMB AND INDEX FINGER IN CRUDE PINCER
GRASP
10 months
 Grasps bell by handle

01/10/2020 21
MOTOR DEVELOPMENT

11 months
Has neat pincer grasp
Drops objects deliberately for it to be picked up
12 months
Attempts to build 2- block tower but fails

01/10/2020 22
SENSORY DEVELOPMENT
1 month
 ABLE TO FIXATE ON MOVING OBJECT in range of 45
degrees when held at a distance of 8- 10 inches
 Follows light to midline
 Quiet when hears a voice
 RESPONDS TO SHARP SOUNDS
2 months
 Turns head to side when sound is made at level of ear

01/10/2020 23
SENSORY DEVELOPMENT
3 months
 FOLLOWS OBJECTS TO PERIPHERY (180 degrees side
to side)
 LOCATES SOUNDS BY TURNING HEAD TO SIDE AND
LOOKING IN SAME DIRECTION
4 months
 Beginning eye-hand coordination
6 months
 Will turn head to the side, then look up and down

01/10/2020 24
SENSORY DEVELOPMENT

7 months
CAN FIXATE ON VERY SMALL OBJECTS
Responds to own name has taste preference

12 months
Can follow rapidly moving object

01/10/2020 25
VOCALIZATION
1 month
 Cries to express displeasure
 Makes small, throaty sounds
 Makes comfort sounds during feeding
2 months
 VOCALIZES, distinct from crying
 Crying becomes differentiated
 COOS
 Vocalizes to familiar voice
 MAKES SINGLE SOUNDS SUCH AS “AH”, “EH”, “UH”

01/10/2020 26
VOCALIZATION
3 months
 SQUEALS aloud to show pleasure
 Vocalizes when smiling
 “talks” a great deal when spoken to
 Less crying during periods of wakefulness
4 months
 LAUGHS ALOUD
 BEGINS BABBLING

01/10/2020 27
VOCALIZATION
5 months
 Makes cooing vowel sounds with consonant sounds ( e.g.
Ah-goo)
6 months
 BEGINS TO IMMITATE SOUNDS
 BABBLING
 RESEMBLES ONE SYLLABLE UTTERANCES- ma, mu, da, di,
hi

01/10/2020 28
VOCALIZATION
7 months
 PRODUCES VOWEL SOUND AND CHANGED
SYLLABLES- baba, dada
 “talks” when others are talking
8 months
 Listen selectively to familiar words
10 months
 SAYS “DADA”, “MAMA” WITH MEANING
 Comprehends “bye-bye”

01/10/2020 29
VOCALIZATION
11 months
 Imitates definite speech sounds
12 months
 SAYS 3- 5 WORDS BESIDES “MAMA”, “DADA”
 Imitates animal sounds
 Understand simple verbal commands (show your eyes ,
give it to me…)

01/10/2020 30
SOCIALIZATION/ COGNITIVE
DEVELOPMENT
1 month
 Is in sensorimotor phase- stage 1 (birth to 1 month), and
stage 2 , primary circular reaction (1-4 mos)
 Watches parent’s face intently as she or he talks to
infant
2 months
 SOCIAL SMILES

01/10/2020 31
SOCIALIZATION/ COGNITIVE
DEVELOPMENT
3 months
 Displays considerable interest in surroundings
 Stops crying when parents enter the room
 Can recognize familiar faces and object
 ENJOYS PLAYING DURING FEEDING
4 months
 DEMANDS ATTENTION BY FUSSING; becomes bored if
left alone

01/10/2020 32
SOCIALIZATION/ COGNITIVE
DEVELOPMENT
4 months
 Enjoys social interaction with people
 Anticipates feeding when sees bottle or mother if
breastfeeding
 Shows excitement with whole body, squeals, breaths
heavily
 Knows and imitates mother

01/10/2020 33
SOCIALIZATION/ COGNITIVE
DEVELOPMENT
5 months
 Smiles at mirror image
 Pats bottle or breast with both
hands
 Able to discriminate strangers
from family
 Understands name
6 months
 Begins to fear strangers
 BRIEFLY SEARCHED FOR A
DROPPED OBJECT
01/10/2020 34
SOCIALIZATION/COGNITIVE
DEVELOPMENT
7 months
 INCREASING FEAR OF STRANGERS
 Plays peek-a-boo
 Demonstrates dislike of food by keeping lips closed
8 months
 PEAK OF STRANGERS ANXIETY
 Responds to word “no”
 Dislikes dressing, diaper change

01/10/2020 35
STRANGERS ANXIETY

01/10/2020 36
SOCIALIZATION/ COGNITIVE
DEVELOPMENT
10 months
 DEVELOPS OBJECT PERMANENCE
 Waves bye-bye, imitates facial expressions
 Plays interactive games such as pat-a-cake
 Reacts to adult danger, cries when scolded
11 months
 Anticipates body gestures when familiar nursery rhyme
or story is being told
 Shakes head for “no”

01/10/2020 37
 Waves bye-bye Imitates facial expressions

01/10/2020 38
SOCIALIZATION/COGNITIVE
DEVELOPMENT
12 months
 SEARCHES FOR AN OBJECT EVEN IF IT HAS NOT BEEN HIDDEN BUT SEARCHES ONLY
WHERE OBJECT WAS LAST SEEN

01/10/2020 39
HEALTH PERCEPTION AND MANAGEMENT

If parents are healthy

then the infant is also
healthy
 Parents serve as the
models

Nursing responsibility:
provide health education
to the parents

01/10/2020 40
NUTRITIONAL AND METABOLIC PATTERNS

Based on what is
considered
necessary to support
life
•Iron:
Adequate 4-6
months
Iron fortified
cereals

01/10/2020 41
• Milk (breast milk,
formula):
Meets nutritional
needs up to 6
months

To determine how

much milk needed
per feeding:

01/10/2020 42
 •Solid foods to infant:
 Readiness factors:

•Has doubled birth weight

• Consumes 8 ounces formula and hungry again
less than/ after 4 hours
• 6 months old
•Consumes 32 ounces formula/ day and wants
more

01/10/2020 43
  Sequence of introducing solid foods
a. Cereals (rice, cerelac, gerber)
b. Mashed fruits
c. Vegetables
d. Strained meat

01/10/2020 44
Nursing responsibilities:

• Don’t give eggs until the

infant reaches 1 year old

• Introduce new/ solid food

one at a time

• Feed solid food before milk

feeding

01/10/2020 45
WEANING- gradual and
caring process that
introduces infant to a
cup (5-6 months)

01/10/2020 46
ELIMINATION PATTERN

Cannot control/ involuntary reflex

Infant has 40% extracellular fluid compared to adults
who have 20% extracellular fluid
•INDICATION: diarrhea and improper feeding may
lead to fluid imbalances
Breastfed infants can go for several days without
eliminating

01/10/2020 47
ACTIVITY & EXERCISE PATTERN

Exercise through
PLAYING
First toys: Visual toys
 Toys that will help them use
their senses, relate to other
people & develop physical
abilities

01/10/2020 48
  e.g: Stimulation
 Sing a song /lullaby to
them
 Seeing mobile,
colorful objects
 Being rocked in a
rocking chair/crib

01/10/2020 49
SLEEP & REST PATTERN

Sleeps 80% of the time

(18-20 hours)
12 months- 12 hours
Nursing responsibility:
• Provide a quiet room
• Do not feed when sleepy
• Infants should be put to
sleep on their backs or
sides NEVER in
ABDOMEN.

01/10/2020 50
COGNITIVE PATTERN

Visual
Sensory/ cognitive
 Primary circular reaction
e.g thumb suck (1-4 mos.)
 Secondary circular
reaction
e.g pick up toys (4-8 mos.)
 Coordination of secondary
schema
*actions are repetitive

Motor functions
 Gross motor
 Fine motor

01/10/2020 51
SELF CONCEPT & SELF PERCEPTION PATTERN
4 months:
 can identify self
through mirror

 Fascinated with their

reflection in mirror

 Smiles more at
themselves than others

 Interested with self

01/10/2020 52
ROLE & RELATIONSHIP PATTERN

Attachment to primary care providers

5 principle factors in growth and development:
1. Adequate nutrition
2. Sleep and rest
3. Activity
4. Adequate secretion of hormone
5. Satisfactory relationship with significant others
who provides loving, human contact and
stimulation

01/10/2020 53
VALUE- BELIEF PATTERN

Not developed
Parents serves as their
role models

01/10/2020 54
DDST

Denver Developmental Screening Test

Test for children 0-6 years old
Same with MMDST

01/10/2020 55
 Four Aspects of A Child’s Developmental

1. Personal- Social
- Tasks which indicate the child’s ability to get along with people and to take care of
himself.
- Dress self, laughs

2. Fine Motor Adaptive

- child’s ability to see & to use his hands to pick up objects & to draw.
- Tower of eight cubes, drawing

3. Language
- child’s ability to hear, follow directions & to speak

4. Gross Motor
- child’s ability to sit, walk & jump

01/10/2020 56
 Health seeking behavior
Altered parenting
High risk for injury

01/10/2020 57
INFANT COLIC

Uncontrollable, extended crying in an

otherwise healthy and well- fed baby

Occurs during 1st 3 months of life

*100 day syndrome

Continuous cry can occur anytime but usually

worsens in the evening

01/10/2020 58
 FAILURE TO THRIVE
Condition of inadequate growth in height and weight resulting
from infant’s inability to obtain or use calories needed for
growth

Signs of malnutrition and delayed development

Causes:
• Inadequate funds to buy sufficient food
• Use of fad diet
• Inadequate nutritional knowledge
• Insufficient breast milk
• Disturbances in maternal-child attachment

01/10/2020 59
SUDDEN INFANT DEATH SYNDROME

Sudden death of infant under the age of 1 year

Unexpected in light of the infant’s history

Post mortem examination fails to reveal a cause of

death

01/10/2020 60
CHILD ABUSE

Physical neglect or abuse

Emotional neglect or abuse

Sexual abuse

01/10/2020 61
 Every child has individual variations and short-term spurts and
lags in growth

Atypical infants, such as those who are premature or have low

birth weight, are taken into account in such charts

Growth charts might be ethically and socioeconomically

weighted in favor of white, middle class children

01/10/2020 62
 Dressing
 Easy to launder and simply constructed
 Dressing and undressing are not a struggle
Exercise
 Infants need space to crawl and to walk such as in an enclosed
outdoor play space.

01/10/2020 63
TEETHING

6 months- first tooth erupts

Gums are sore and tender causing pain- infant is irritable

Teether (cold)- to lessen the pain

Creams are not recommended

If accompanied with high fever and convulsion it is not a sign of
teething

01/10/2020 64
 Thumb sucking (8 months)
 does not deform the jaw line
 Normal for infants
 Stops at school age (permanent
appearance)

01/10/2020 65
CONSTIPATION

Breastfeed
• Add more fluids to formula

5 to 6 months- can
introduce bulk foods
(vegetables & fruits,
fiber) and can increase
fluids

01/10/2020 66
LOOSE STOOL

Subtract fluid to formula

Follow instruction in the

can

01/10/2020 67
COLIC

Disappears after 3 months

Burp the baby

When infant is still being breastfed, advice the

mother to avoid eating gassy foods (onions, camote)
 Tell mother to change diet

01/10/2020 68
DIAPER DERMATITIS

Caused by
diapers(rashes)
Put petroleum jelly or
vandol ointment
Let area be exposed
from time to time
Wash reusable diapers
properly
Change diaper every 4
hours

01/10/2020 69
SPITTING UP

Sour bile, undigested

food

Burp baby every feeding

time

01/10/2020 70
MILIARA

Prickly heat rash-

overdressed

Petroleum jelly- sleeping over

heated room

Do not put powder

Remove clothes

01/10/2020 71
BABY-BOTTLE SYNDROME

Dental carries due to

prolonged use of bottle

Lessen bottle use

Do not prop the bottle

01/10/2020 72
 Vaccine Minimum Age at Number of Doses Minimum Interval
1st dose between doses

BCG Birth or anytime 1

after birth

DPT 6 weeks 3 4 weeks

OPV 6 weeks 3 4 weeks
Hep B At birth 3 6 weeks interval
from 1st dose to 2nd
dose, and; 8 weeks
interval from 2nd
dose to 3rd dose

Measles 9 months

01/10/2020 73
FALLS

Happens when the infant is:

•Common at 4 months
•Unattended/ no support or supervision
•Prevention:
 Raise the side rails of crib
 Do not leave the baby unattended
 Put up rails /fence in stairs and doors

01/10/2020 74
ASPIRATION OF FOREIGN OBJECTS

Prevention
•Keep small objects away (marbles, coins,
safety pins, buttons, small and inappropriate
toys)
•Avoid propping of bottles
•Discourage use of powder
•Adults should not set bad examples

01/10/2020 75
BURNS
Prevention:
•Keep infant out of the sun from 10 am- 3 pm
(SUNBURN)
•Avoid handling hot liquids near the infant
•Keep all matches, candles, lighters out of
their reach
•Do not play with fire or cook with the baby
•Check water temperature before bathing
•1-6 months- place a cover to electrical
sockets.

01/10/2020 76
DEVELOPMENTAL THEORIES
FREUD ERICKSON PIAGET KOHLBERG
Oral (Id) Trust vs. Mistrust Sensorimotor

Intellect
Mouth is the develops Amoral
center Mother is the most (rightness or
of gratification important person wrongness)
Infant gains
knowledge of
environment
through senses

01/10/2020 77
 Common Fear: Stranger Anxiety

Play: Solitary

Common Problems: Falls

Aspiration

01/10/2020 78
01/10/2020 79