Caring of a Family with AN INFANT

Physical Growth
 Weight
o Average birth weight – 3500 grams
o First 6 months
 Average weight gain is 2 lbs/ month
 Doubles birth weight at 6 months
o Second 6 months
 Average weight gain is 1 lb/month
o Triples birth weight at 12 months
 Height
o Average birth length – 20 inches
o First 6 months – increases by 1 inch/month
o 12 months – Increases by 50%
 Head Circumference
o Average head circumference at birth – 35 cm
o First 6 months – increases by 1.5 cm/month
o Second 6 months – increases by 0.5 cm/month
o Anterior fontanelle – closes at 12-18 months
o Posterior fontanelle – closes at 2 months
 Chest Circumference
o Should be 2-3 cm smaller than head circumference
o Equals head circumference at 6-12 months

Body Systems
 Cardiovascular System
o Heart rate slows to 100-120 beats per minute
o Pulse rate slows with inhalation (sinus arrhythmia)
o Blood pressure elevates to 100/60 mmHg
o Inadequate production of RBCs to replace the hemolyzed fetal RBCs
o Fetal hemoglobin converted to adult hemoglobin at 5-6 months of age
o Serum iron decreases at 6-9 months
 Respiratory System
o Respiratory rate slows to 30-60 breaths per minute
o Inefficient mucous production
 Gastrointestinal System
o Amylase is deficient until 3 months
o Deficient lipase
o Immature liver
 Urinary System
o Immature
o Average urine output: 350-550 ml/day
 Endocrine System
o Immature to pituitary stimulation (production of various internal secretions)
  Immune System
o Functional at 2 months
o IgG and IgM produced at 12 months
o Shivers at 6 months
 Fluids and Electrolytes
o ECF accounts for approximately 35% of the body weight
o ICF accounts for approximately 40% by the end of the first year

Development of Senses
 Vision
o 1 month
 regards object at midline and 18 inches away
o 3 months
 follows object across midline
o 4 months
 recognizes familiar objects
o 6 months
 organized depth perception, may develop STRABISMUS
o 7 months
 pats image in a mirror
o 10 months
 looks for concealed object
 Hearing
o 1 month
 quiets momentarily at a distinctive sound
o 2 months
 stops an activity at the sound of spoken words
o 3 months
 turns head to locate a sound
o 4 months
 looks in the direction of a distinctive sound
o 5 months
 localizes sounds downward and to the side
o 6 months
 locates sounds made above them
o 10 months
 recognizes name and listens when spoken to
o 12 months
 locate sounds in any direction and turn toward it
 Taste
o turns away from or spits out a taste that they do not like
 Smell
o smells accurately within 1 or 2 hours after birth
o responds to irritating smell by drawing back from

Motor Development
  Gross Motor Development
o SIGNIFICANT MILESTONES
 Neonate – lifts and turns head side to side
 3 months – no head lag
 5 months – rolls from front to back
 7 months – sits leaning forward
 8 months – sits without support
 9 months – creeps, pulls self to stand
 10 months – cruises
 12 months – stands alone, walks with support
 Fine Motor Development
o SIGNIFICANT Milestones
o 1 month – strong grasp reflex
o 2 months -- grasp reflex fades
o 3 months – reaches for objects
o 4 months – brings hand together and pull clothes
o 5 months – reach and pick-up objects with the whole hand
o 6 months – holds object with both hands
o 7 months – transfers toy from one hand to another
o 10 months – uses PINCER GRASP
o 12 months – draws semi-straight line, builds tower of 2 blocks

Ways to Promote Trust

 Establish schedule
 Ensure that care be given largely by one person
 Respond to needs promptly
Fear/Anxiety
 Stranger anxiety (8TH month anxiety) - at 8 months
Ways to Minimize Anxiety
 Cuddling and warmth of caregiver
 Provide security object
Socialization
 2 months – social smile
 3 months – recognizes familiar faces
 4 months – enjoys social interaction
 5 months – smile at mirror image
 6 months – beginning stranger anxiety
 8 months – peak of stranger anxiety
 12 months – show jealousy and affection
Play and Toys
 Solitary Play (non-interactive)
Age-Appropriate Toys
 1-3 months – mobiles, mirrors, music boxes, stuffed animals, rattles
 4-6 months – squeeze toys, busy boxes, play gyms
 7-9 months – textured toys, bath toys, large blocks and large balls
 10-12 months – books with large pictures, building blocks, push-pull toys
Cognitive Development
 Language
o 1 month – coos
o 2 months – differentiates cry
o 3 months – squeal in response to smile
o 4 months – bubbles and gurgles
o 5 months – says simple vowel sounds e.g. ma-ma
o 6 months – imitates sounds
o 8 months – pronounces combined syllables
o 9 months – speaks first word, understands no-no
o 10 months – says and understands ma-ma and da-da in correct context
o 12 months – says 2 -10 words in correct context

HEALTH PROMOTION GUIDELINES

VACCINE MIN. AGE GIVEN DOSES INTERVAL DISEASES
BETWEEN PREVENTED
DOSES
BCG Birth or any time 1 Tuberculosis
DPT 6 weeks 3 4 weeks Diphtheria,
Pertussis and
Tetanus
OPV 6 weeks 3 4 weeks Poliomyelitis
HEPATITIS B Birth or any time 3 4 weeks Hepatitis B
MEASELS 9 months 1 Measels

Nutrition
 RECOMMENDED DIETARY INTAKE FOR INFANT
o GUIDELINES IN INFANT NUTRITION
 BREAST MILK is the best food during the first 12 months of life
 Soy milk may be given if there is milk allergy
 Commercial iron-fortified formula may be given if not breastfeeding
 Vitamin C and iron should be given if taking cow’s milk before 1 year of age
 Breast-fed infants gain less weight than those who are formula fed
 A newborn can hold approximately 30 ml (2 tablespoons)
 Infant feeding should not exceed 240 ml (1 cup)
o DEVELOPMENTAL CONSIDERATIONS
 A normal full-term infant can thrive on breast milk or iron-fortified formula
exclusively until 4-6 months
 Biting movements begin at approximately 3 months
  Chewing begins at 7-9 months
 Extrusion reflex fades at 3-4 months
o TECHNIQUES FOR FEEDING SOLID FOODS
 Introduce one food at a time
 Wait 5-7 days before introducing new item
 Introduce the food before formula or breastfeeding
 Introduce only small amount of new food (1-2 tsp) at a time
 Respect food preferences
 Minimize additives like salt or sugar
 Do not initiate feeding until the infant is already 4-6 months old
 Do not place food in bottles with formula
 Introduce food with a positive attitude
 Use dish in feeding commercial baby food
 Baby food jars should be refrigerated once opened
 Do not use food opened 48 hours ago
o SOLID FOODS TO BE INTRODUCED

FOODS AGE INTRODUCED ADVANTAGES/ BENEFITS

CEREAL 5-6 months  Fortified with B vitamins and minerals
 Least allergenic type of food
 Prevents iron deficiency anemia
 Easily digested
VEGETABLES 7 months  Has higher iron content than fruits
 Usually offered at lunch
 Offer yellow and green vegetables
FRUITS 8 months  Best source of Vitamin C and A
 Adds texture and flavors to diet
 Added to cereal for breakfast and dinner
 Typical fruits include banana & peaches
MEAT 9 months  Good source of protein, iron & vitamin B
 Beef and pork are priority (have more iron than chicken)
 Typically added as part of an evening meal in place or
cereal
EGGS 10 months  Egg yolk contain iron while egg whites has the proteins
 Egg yolk alone should be given first

Safety
 Common Accidents
o 1. ASPIRATION
 Objects to avoid
 1-inch cylinder objects like carrot or hotdog
 deflated balloons
 teddy bear with small button eyes
 clothing with small decorative items
 toys or rattles with small parts
 Do not prop bottles for feeding
 Offer small pieces of hotdogs or grapes
  Avoid offering popcorn or peanuts until 5 years’ old
 Offer only pacifiers that has one-piece construction
o 2. FALL
 Do not leave the infant unattended on a raised surface
 Do not place infants 2 months and older in a bassinet
 Make sure that side rails of cribs are high enough and 2 3/8 apart
 Place a gate at the top and bottom of stairways
 Avoid using infant walker
o 3. VEHICULAR ACCIDENT
 Use car seats until preschool or until child reaches 40-60 lbs
 Place infants up to 20 lbs in rear-facing seats in the back seat
o 4. SUFFOCATION
 Avoid plastic bags within infant’s reach
 Do not use pillows in cribs
 Store unused appliances such as refrigerators or stoves with the doors removed
 Remove constrictive clothing such as bib from neck at bedtime
o 5. Drowning
 Do not leave infants alone in bathtub or unsupervised near water (even buckets
of cleaning water)
o 6. POISONING
 `Never present a medication as candy
 Buy medications in containers with safety caps
 Place all medications and poisons in locked cabinets
 Avoid lead-based paint in any area of the home
 Hang plants or sets on high surfaces
o 7. BURNS
 Test warmth of formula and food before feeding
 Do not smoke or drink hot liquids while holding or caring for infant
 Use sunscreen on a child over 6 months when in direct or indirect contact to
sunlight
 Do not expose to sunlight to more than 30 minutes at a time
 Turn handles of pans toward back of stove
 Use cool-mist instead of hot-mist vaporizer
 Keep a screen in front of a fireplace or heater
 Keep electric wires and cords out of reach
 Cover electrical outlets with safety plugs
Sleep
 Developmental Considerations
o Neonates: sleep when not eating
o 3-4 months: sleep 9-11 hours at night
o 12 months: morning and afternoon naps
 Promoting Healthy Sleep Patterns
o Place infant in a separate space
o Do not place pillows in bed to avoid suffocation
o Allow bedtime rituals
o Place in supine position
Dentition
 Promoting Dental Health
o Give fluoride at 6-12 months
o Brush gum pads with soft washcloth - should be done prior to tooth eruption
o Use soft tooth brush in cleaning the teeth twice a day
o Avoid breastfeeding or bottle-feeding at bedtime

Dressing
 Use clothes that are easy to launder and simply constructed
 Avoid constrictive and binding clothing
 Use long pants once creeping
 Use soft-soled shoes or socks or booties prior to walking
 Use shoes with firm soles once walking
Skin Care
 Bathing
o Wash the scalp and head daily
o Apply mineral oil or petroleum jelly on scalp overnight to relieve seborrhea
o Use soft toothbrush or fine-toothed comb to remove crusts
 Diaper-Area Care
o Change diapers every 2-4 hours
o Expose the diaper area to air
o Use hypoallergenic wipes or clean water during diaper change
o Apply Desitin, A & D ointment or baby powder to prevent diaper rashes

Activity and Exercise

 Expose the child outdoors in a carriage or stroller
 Provide space outdoors to crawl and practice walking
 When outdoors, point out different persons, objects and animals
COMMON CONCERNS AND HEALTH PROBLEMS
 Teething
o Management
 Acetaminophen (Tylenol) 10-15 mg/kg every 4 hours for pain
 Provide chilled teething rings
 Thumb sucking
o Management
 Avoid stopping the child
 Use pacifier as an alternative until 3 months
 Headbanging
o Management
 Pad rails of cribs
 Report to pediatrician if excessive
 Sleep Problems
o Management
  Delay bedtime by 1 hour
 Shorten afternoon naps
 Do not respond immediately to infants at night
 Provide soft toys or music
 Constipation
o Management
 Increase fluids
 Increase fruits and vegetables to diet
 Give apple juice (3-4 oz) or prune juice (0.5-1 oz daily)
 Examine infants for anal fissure or tight anal sphincter if constipation lasts
beyond 1week
 Stool may be softened to be easily excreted
 Manual dilatation of sphincter 2-3 times daily (for tight anal sphincters)
 Loose Stools
o Management
 Give supportive management as needed
 Offer fluids to prevent dehydration
 Spitting Up
o Management
 Burp infant after feeding
 Sit the infant for half an hour after feeding
 Colic
o Management
 Feed baby upright
 Burp baby after feeding
 Ask mothers to avoid gas producing foods if breastfeeding
 Small frequent feedings
 Avoid hot water bottles on stomach
 Use feeding bottles with disposable bags that collapse as the baby sucks
 Diaper Dermatitis
o Management
 Frequent diaper change
 Application of A and D or Desitin ointment
 Expose diaper area to air
o Signs of Fungal Infection
 Bright red and pinpoint lesions
 Not relieved after 3 days
 Miliaria (Prickly Heat)
o Management
 Bath the baby twice a day
 Add small amount of baking soda to bath water
 Eliminate sweating
 Baby Bottle Syndrome
o Management
 Do not put the baby to bed with a bottle
 Fill the bottle with water
 Use nipple with smaller hole
 Obesity
o Management
 Avoid giving more than 32 oz of formula daily
 Add sources of fiber such as whole-grain cereal and raw fruit to infant’s diet
 Give refined sugars such as pudding, cake, cookies and candy minimally