Body Systems

Heart rate slows from 110-160 beats/min to 100-120 beats/min by the end of the first year

The heart is becoming more efficient as shown by a decreasing pulse rate and a slightly elevated blood pressure (from an
average of 80/40 to 100/60 mmHg

The respiratory rate of an infant slows from 30-60 breaths/min to 20-30 breaths/min by the end of the first year

Although the ability to digest protein is present and effective at birth, the amount of amylase, which is necessary for the
digestion of complex carbohydrates, is deficient until approximately the third month (this is another reason why cereals
& rice are not yet introduced as early as this time)

Until 3-4 months of age, EXTRUSION REFLEX prevents some infants from eating effectively if they are offered solid
food this early...that is why it is not recommended.

The kidneys remain immature and not as efficient at eliminating body wastes as in an adult. The endocrine system remains
particularly immature in response to pituitary stimulation, such as adrenocorticotropic hormone, or insulin production
from the pancreas. Without these hormones functioning effectively, an infant may not be able to respond to stress as
effectively as an adult. (that is why, infants easily get stressed by even a short-term separation from parents, pain, hunger
and discomfort) 

An infant's immune system becomes functional by at least 2 months of age; an infant can actively produce both immune
globulin (Ig)G and IgM antibodies by 1 year. The levels of other immunoglobulins (IgA, IgE, and IgD) are not plentiful
until preschool age, which is the reason why infants continue to need protection from infection

Extracellular fluid accounts for approximately 35% of an infant's body weight, with intracellular fluid accounting for
approximately 40% by the end of the first year. This increases an infant's susceptibility to dehydration from illnesses, such
as diarrhea, because loss of extracellular fluid could result in loss of over a third of an infant's body fluid.(that is why it is
very crucial to prevent and watch out for signs of dehydration especially in infants. That is why if mag diarrhea or
vomiting ang baby, DILI GYUD pasagdan to prevent dehydration...immediate medical attention and treatment should be
given)

Teeth

The first baby tooth or deciduous tooth usually erupts at age 6 months, followed by a new one monthly.
However, teething patterns can vary greatly among children. 

Some newborns may be born with teeth (natal teeth) or have teeth erupt in the first 4 weeks of life (neonatal
teeth). 

In most infants, natal or neonatal teeth are deciduous or are fixed firmly. These should NOT be removed
because no other teeth will grow to replace them until the permanent teeth erupt at age 6 or 7 years.

Deciduous teeth are essential for allowing proper growth of the dental arch. If they are injured, children need
conscientious follow-up to be certain there is space for permanent teeth to erupt effectively or that permanent
teeth are not discolored.

Generally, the first set of teeth to erupt are the Lower central incisors (as shown on the photo)

MOTOR DEVELOPMENT

An average infant progresses through systematic motor growth during the first year, strongly reflecting the
principles of cephalocaudal (head to toe) and gross-to-fine motor development. Control proceeds from head to
trunk to lower extremities in a progressive, predictable sequence. (Meaning, dili mahitabo nga mag-una ug
takilid or roll-over ang bata kaysa maka lift  siya sa iyang head or chest)
To assess motor development, both gross motor development and fine motor development, are evaluated. Gross
& fine motor development are measured by observing or testing prehensile ability

Gross Motor Development

Four positions—ventral suspension, prone, sitting, and standing—are used to assess gross motor development.

Ventral Suspension Position

Ventral suspension refers to an infant's appearance when held in mid-air on a horizontal plane and supported by
a hand under the abdomen/belly.

In this position, the newborn allows the head to hang down with little effort at control.

One Month-old infants lift their head momentarily and then drop it again.

Two-month-old infants hold their head in the same plane as the rest of their body, a major advance in muscle
control.

By 3 months, infants lift and maintain their head well above the plane of the rest of the body in ventral
suspension.

A Landau reflex is a new reflex that develops at 3 months. When held in ventral suspension, the infant's head,
legs, and spine extend. When the head is depressed, the hips, knees, and elbows flex.

This reflex continues to be present in most infants during the second 6 months of life, but then it becomes
increasingly difficult to demonstrate. It is an important reflex to assess because a child with motor weakness,
cerebral palsy, or other neuromuscular defects will not be able to demonstrate the reflex.

At 6 to 9 months, an infant also demonstrates a parachute reaction (shown in above photo) from a ventral
suspension position.  This means that when infants are suddenly lowered toward an examining table, the arms
extend as if to protect themselves from falling. Children with cerebral palsy do not demonstrate this response
because they flex their extremities too tightly.

Prone Position

When lying on their stomach, newborns can turn their head to move it out of a position where breathing is
impaired, but they cannot hold their head raised for an extended time. (if mag-prone position ang newborn baby,
ma-move nila ilang head if ever maglisod sila ginhawa sa ilang position but dili pa maka-raise sa ilang head for
a longer duration)

By 1 month of age, they lift their head and turn it easily to the side. However, they still tend to keep their knees
tucked under their abdomen (as shown on the photo above) just like when they were a newborn.

By 2 months, infants can raise their head and maintain the position, but they cannot raise their chest high
enough to look around yet. Their head is still held facing downward.

By 3 months, infants lifts the head and shoulders well off the surface and looks around when prone. The pelvis
is flat on the surface, no longer elevated unlike sa previous photo @2months. Some children can turn from a
prone to a side-lying position at this age. (uban bata kamao na motakilid at this age)

By 4 months, infants lift their chests off the bed and look around actively, turning head from side to side. They
are able to turn from front to back (meaning from his tummy, makabali na cya to his back but cannot yet
maneuver back to his tummy)
By 5 months, infants are able to rest weight on their forearms when prone. They can turn completely over, front
to back and back to front

By 6 months, infants can raise their chests and the upper part of their abdomens off the bed/surface.

By 9 months, a child can creep/crawl from the prone position. "CREEPING" means the child has the abdomen
off the floor and moves one hand and one leg and then the other hand and leg, using the knees on the floor to
locomote --- as shown on above photo. "CRAWLING' is when they move around using the "commando crawl"
or "army crawl" (keeping their tummy against the floor)

Sitting Position

At 1 month, when placed on his or her back and then pulled to a sitting position, extreme head lag is observed;
In a sitting position the back appears rounded and an infant demonstrates only momentary head control.

By 2 months, infants can hold their head fairly steady when sitting up, although their head does tend to bob
forward and will still show head lag when pulled to a sitting position.

By 3 months, When pulled to a sitting position, a baby this age should be able to have only slight head lag and,
when sitting, the head should be upright but there may still be some wobbling of the head. The back is still
rounded, so the baby slumps forward. Click here to watch video

By 4 months, infants reaches an important milestone by no longer demonstrating head lag when pulled to a
sitting position.By 5 months, infants can be seen to straighten his or her back when held or propped in a sitting
position. By 6 months, infants can sit momentarily without support. Infants are capable of movement by
hitching or sliding backward from this position. An infant this young is capable of moving from one spot to
another.

By 7 months, infants can sit alone but only when the hands are held forward for balance (as shown on photo)

By 8 months, infants can sit securely without any additional support. Children with delayed cognitive or motor
development may not accomplish this step at this time.

By 9 months, infants sit so steadily that they can lean forward and regain their balance. They may still lose their
balance if they lean sideways, which is a skill not achieved for another month.

Standing Position 

A newborn stepping reflex can still be demonstrated at 1 month of age.

At 1 month of age, the infant's knees and hips flex rather than support more than momentary weight.

At 3 months, infants try to support part of their weight on their feet.

At 4 months, infants are able to support their weight on their legs.

By 5 months, the tonic neck reflex should be extinguished, and the Moro reflex should be fading.

By 6 months, infants nearly support their full weight when in a standing position.
By 7 months, infants bounces with enjoyment in a standing position.

By 9 months, infants can stand holding onto a coffee table if they are placed in that position.

By 10 months, infants can pull themselves to a standing position by holding onto the side of a playpen or a low
table, but they cannot let themselves down again as yet.

At around 11 months, an infant learns to "cruise" (mo-kabat) or move about the crib or room by holding onto
objects such as crib rails, chairs, walls, and low tables.

At 12 months, the child can stand alone at least momentarily. Some parents expect children to walk at this time
and may be disappointed to see their child is merely standing still. A child has until about 22 months(1 year & 8
months)of age to walk and still be within the normal limit.

Fine Motor Development

1-month-old infants still have a strong grasp reflex so they hold their hands in fists (mag sige pa ug kumo sa
ilang kamot) so tightly that it is difficult to extend their fingers.

2-month-old infants will hold an object for a few minutes before dropping it. The hands are held open, not
closed in fists (Grasp reflex fades during this time)

3-months old infants reach for attractive objects in front of them. Their grasp is unpracticed so they usually
cannot grasp those objects

4-months old infants bring their hands together and pull at their clothes. They will shake a rattle placed in their
hand. Thumb opposition (ability to bring the thumb and fingers together) begins, but the motion is not very
accurate yet. This limits the infant to handling large objects. Palmar and plantar grasp reflexes have
disappeared.

5-month old infants can accept objects that are handed to them by grasping with the whole hand. They can reach
and pick up objects without the object being offered and often play with their toes as objects. Fisting that
persists beyond 5 months suggests a delay in motor development. Unilateral fisting(one side only) suggests
hemiparesis or paralysis on that side.

6-month old infants grasp has advanced to a point where a child can hold objects in both hands. Infants at this
age will drop one toy when a second one is offered. They can hold a spoon and start to feed themselves (with
much spilling). The Moro, the palmar grasp, and the tonic neck reflexes have completely faded. A Moro reflex
that persists beyond this point should arouse suspicion of neurologic disease.

7-month-old infants can transfer toys from one hand to the other. They hold a first object when a second one is
offered. 

8-month old infants' random reaching and ineffective grasping disappear as a result of advanced eye-hand
coordination.

10-month old infants are able to bring the thumb and first finger together in a pincer grasp. This enables
children to pick up small objects such as crumbs or pieces of cereal from a high chair tray. They use one finger
to point to objects. They offer toys to people but then cannot release them. 12-month old infants can hold a
crayon well enough to draw a semi-straight line. They enjoy putting objects such as small blocks in containers
and taking them out again. They can hold a cup and spoon to feed themselves fairly well and can take off socks
and push their hands into sleeves if they have been allowed to practice. They can offer toys and release them
(unlike at 10 months nga dili  mabuhi-an  sa infant ang toy nga ilang itunol)
DEVELOPMENTAL MILESTONE

In addition to the gross and fine motor skills developing at this time, language and play behavior also reach
major milestones.

By the end of the 1st month, infants begin to make small, cooing sounds (saying vowel sounds like "uuuhh",
"aaahh", "ooohh")

By 2 months, they can differentiate their cry. Parents can begin to distinguish a cry that means "hungry" from
one that means "wet" or from one that means "lonely." (lahi-lahi na ilang cry, the parents can tell if gigutom,
nalibang or puno na ang diaper or gusto magpakugos ang baby)

A 3-month-old infant will squeal (make a long, high-pitched cry or noise) with pleasure or laugh out loud in
response to a nodding, smiling face, or a friendly tone of voice.

By 4 months, infants are very talkative, cooing, babbling (like "ba-ba-ba"), and gurgling when spoken to

By 5 months, an infant says some simple consonant sounds (e.g., "goo-goo," "gah-gah")

At 6 months, infants learn the art of imitating. They may imitate a parent's cough or say "Oh!" as a way of
attracting attention.

At 7 months, the amount of talking infants do increases. They can imitate vowel sounds well (e.g., "oh-oh," "ah-
ah," "oo-oo").

By 9 months, an infant usually speaks the first word: "da-da" or "ma-ma." 

By 10 months, an infant masters another word such as "bye-bye" or "no"

By 12 months, infants can generally say two words in addition to "ma-ma" and "da-da," and they use those two
words with meaning.

Play

1-month-olds can fix their eyes on an object, they are interested in watching a mobile over their crib. Mobiles
are best if they are black and white or brightly-colored and light enough in weight so they move when someone
walks by. Musical mobiles provide extra stimulation. One-month-old children also spend a great deal of time
watching their parents' faces, appearing to enjoy this activity so much (a face may become their favorite
toy). Hearing is a second sense that is a source of pleasure for children in early infancy. 

Two-month-old infants will hold light, small rattles for a short period of time but then drop them. They are
attuned to mobiles or cradle gyms strung across their crib.

Three-month-old infants can handle small blocks or small rattles.

Four-month-olds need a playpen or a sheet spread on the floor so they have an opportunity to exercise their new
skill of rolling over (which can serve as their toy for the entire month)

Five-month-old infants are ready for a variety of objects to handle, such as plastic rings, blocks, squeeze toys,
clothespins, rattles, and plastic keys. Check that all of these are small enough that an infant can lift them with
one hand, yet big enough that he or she cannot possibly swallow them.
A 6-month-old childcan sit steadily enough to be ready for bathtub toys such as rubber ducks or plastic boats if
carefully supervised. Because they are starting to teethe, most at this age enjoy a teething ring to chew on. 

Because 7-month-old infants can transfer toys, they are interested in items such as blocks, rattles, or plastic keys
that are small enough to be transferred easily. As their mobility increases, they begin to be more interested in
brightly colored balls or toys that previously rolled out of reach

Eight-month-old infants are sensitive to differences in texture. They enjoy having toys with different feels to
them, such as velvet, fur, and fuzzy, smooth, or rough items

The 9-month-old infant needs the experience of creeping. This means time out of a crib or playpen so there is
room to maneuver. (Ani nga time, need na sa baby ang bigger space to move around kay mo "kamang" na sila,
so dili na sila ganahan isud sa crib) Many 9-month-olds begin to enjoy toys that go inside one another, such as a
nest of blocks or rings of assorted sizes that fit on a center post. 

By 10 months, infants are ready for "peek-a-boo" and will spend a long time playing the game with their hands
or with a cloth over their head that they can easily reach and remove.

10-month olds can already clap, so they are also ready to play patty-cake. These games have a positive value on
infants because these games make the baby feel like an active part of the household. 

By 11 months children have learned to cruise (mo-kabat) or walk by holding on to low tables, chairs, walls or
nearby objects.

The 12-month-old infants enjoy putting things in and taking things out of containers. They like little boxes that
fit inside one another or dropping small blocks into a larger box: As soon as they can walk, they will be
interested in pull toys. A lot of time may be spent listening to someone saying nursery rhymes or listening to
music.

Although there is an advantage to television watching for children during the preschool age because it can help
them learn language, the AAP recommends infants NOT be exposed to television. They don't need exposure to
the amount of violence seen on TV (remember children's cartoons may be the worst offenders of this, daghan
violence e-portray sa mga cartoon shows) and interaction with real people like their parents and siblings is less
confusing and a better experience for them. Encourage parents to spend quality time bonding with their infants
rather than patan-awon lang ug TV (or play with gadgets) para ma entertain ang bata.

DEVELOPMENT OF SENSES

Vision

1-month-old infants are able to look at an object in the midline of their vision (makakita sila if something is
placed directly in front of them). They follow the object a short distance (as close as about 18 inches) if it
moves but not across the midline as yet. (dili pa mo-follow ilang eyes if ang object molapas na sa middle) Their
primary focus is on objects close to their face or the distance to  parent's face.

2-month-old infants focus well (from about age 6 weeks) and so are able to follow moving objects with the eyes
(although still not past the midline). The ability to follow and focus in this way is a major milestone in
development, indicating that an infant has achieved binocular vision, or vision wherein both eyes aim
simultaneously at the same visual target.

3-month-old infantscan follow an object across their midline. They typically hold their hands in front of their
face and study their fingers for long periods of time, this is referred to as hand regard
4-month-old infants are able to recognize familiar objects, such as a frequently seen bottle, rattle, or toy animal.
they eagerly follow-their parents' movements with their eyes.

By 6 months, infants are capable of organized depth perception. This increases the accuracy of their reach for
objects as they begin to perceive distances correctly.

7-month-olds pat their own image in a mirror. Their depth perception has matured to the extent that they can
perform such tasks as transferring toys from hand to hand.

By 10 months, an infant looks under a towel or around a corner for a concealed object (the beginning of object
permanence, or an awareness that an object out of sight still exists - a baby's understanding that when things
disappear, they aren't gone forever.)

Hearing

During the 1st year, infants appear to enjoy soft, musical sounds or cooing voices; they are startled by harsh,
raucous rattles or loud bangs.

An infant's hearing can be demonstrated at birth by the way a newborn quiets at a distinctive sound such as a
bell or a squeaky rubber toy. By 1 month, this reaction is even more marked.

By 2 months of age, hearing awareness becomes so acute that infants will stop an activity at the sound of
spoken words.

By 3 months of age, infants turn their head to attempt to locate a sound.

By 4 months of age, when infants hear a distinctive sound, they turn and look in that direction.

By 5 months, infants demonstrate they can localize sounds downward and to the side, by turning their head and
looking down.

By 6 months, infants have progressed to being able to locate sounds made above them.

By 10 months, infants can recognize their name and listen acutely when spoken to or when someone sings to
them..

By 12 months, infants can easily locate sounds in any direction and turn toward them. A vocabulary of two
words plus "ma-ma" and "da-da" also demonstrates that an infant can hear.

Touch

Infants need to be touched so they can experience skin-to skin contact. Clothes should feel comfortable and soft
rather than rough; diapers should be dry rather than wet. Teach parents to handle infants with assurance and
gentleness. 

Taste

Infants demonstrate they have an acute sense of taste by turning away from or spitting out a taste they do not
enjoy. When infants are introduced to solid food at about 6 months, urge parents to make mealtime a time for
fostering trust as well as supplying nutrition by being certain feedings are done at an infant's pace and the
amount offered fits the child's needs and not the parent's idea of how much should be eaten.

Smell
Infants can smell accurately within 1 or 2 hours after birth. They respond to an irritating smell by turning their
head away from it. They appear to enjoy pleasant odors and learn early in life to identify the familiar and unique
smell of their mother's breast milk. Teach parents to be alert to substances that cause sneezing sprayed into the
air, such as room deodorizers or cleaning compounds, and to keep irritating odors of this nature out of their
child's environment.

EMOTIONAL DEVELOPMENT

Socialization, or learning how to interact with others, is an extensive phenomenon. One-month-old infants show
that they can differentiate between faces and other objects by studying a face or the picture of a face longer than
other objects. They are calm and feed well for the person who has been their primary caregiver. 

At 2 months, when somebody smiles or says hello to the infant, the infant smiles in return. This is a SOCIAL
SMILE and is a definite response to the interaction, not the faint, quick smile that younger infants, even
newborns, demonstrate. It is a major milestone because it reflects growing maturity in a number of areas, most
notably vision, motor control, and intelligence. Cognitively challenged children or children with spasticity may
not demonstrate a social smile until much later in the infant year.

By 3 months, infants demonstrate increased social awareness by readily smiling at the sight of a parent's face.
Three-month-old infants laugh out loud at the sight of a funny face.

By 4 months, when a person who has been playing with and entertaining an infant leaves, the infant is likely to
cry or show that the interaction was enjoyable. Infants at this age recognize their primary caregiver and prefer
that person's presence to others.

By 5 months, infants may show displeasure when an object is taken away from them. This is a step beyond
showing displeasure when a person leaves.

By 6 months, infants are increasingly aware of the difference between people who regularly care for them and
strangers. They may begin to draw back from unfamiliar people. ("mo-ila" na ang baby)

By 7 months, infants begin to show obvious fear of strangers. They may cry when taken from their parent,
attempt to cling to the parent, and reach out to be taken back. Parents may view this as a bad trait or a regression
in socialization but it is actually a big forward because it shows that the infant can differentiate between people
and also can recognize the difference between persons to trust and others.

Fear of strangers reaches its height during the 8th month, so much so that this phenomenon is often termed
eighth-month anxiety, or stranger anxiety.

By 9 months, infants are very aware of changes in tone of voice. They cry when scolded not because they
understand what is being said but because they sense their parent's displeasure.

By 12 months, most children have overcome their fear of strangers and are alert and responsive again when
approached. They like to play interactive nursery rhymes and rhythm games and "dance" with others. They also
like being at the table for meals and joining in family activities.

COGNITIVE DEVELOPMENT

Primary and Secondary Circular Reaction

By the 3rd month of life, a child enters a cognitive stage by Piaget as primary circular reaction. During this
time, the infant explores objects by grasping them with the hands or by mouthing them. Infants appear to be
unaware of what actions they can cause or what actions occur on its own. For example, if an infant's hand
should accidentally strike a mobile across the crib, the infant appears to enjoy watching the brightly- colored
objects move in front of him but makes no attempt to hit the mobile againbecause he does not realize that his
hand caused the movement.

At about 6 months of age, infants pass into a stage Piaget called secondary circular reaction. Now when infants
reach for a mobile above the crib, hit it, and watch it move,they realize it was their hand that initiated the
motion, and so they hit it again.

By 10 months, infants discover object permanence. Infants are ready for peek-a-boo once they have gained this
concept. They know their parent still exists even when hiding behind  their hands or blanket and wait excitedly
for the parent to reappear.

As infants reach 1 year of age, they are capable of reproducing new events (they deliberately hit a mobile once,
it moves, and they hit it again). They drop objects from a high chair or playpen and watch where they fall or
roll. This is a frustrating activity for parents because it involves a great deal of reaching and picking up these
objects over & over. It is an important activity for infants, however because it confirms their awareness of the
permanence of objects and how they are able to control events in their world. 

PROMOTING ACHIEVEMENT OF THE DEVELOPMENTAL TASK:

TRUST versus MISTRUST

Erikson proposed that the developmental task of the infant period is to form a sense of trust. Infants who have
numerous caregivers (like when parents are working then lahi-lahi mobantay sa baby), who may be fed one day
on a rigid schedule and the next day, only when they are hungry, who sometimes are treated roughly and
sometimes gently, or who don't always have their needs met can have difficulty learning to trust. Cultures can
vary in how they address care of an infant and promote trust.

It is important for infants to establish the ability to love, or trust, early in life in this way because development is
sequential. If a first developmental step is inadequate, this inadequacy can extend throughout all future steps. In
reference to trust, the end result could be an adult unable to instill a sense of trust in his or her own child,
perpetuating the inadequacy from generation to generation.

TRUST arises primarily from a sense of confidence that one can predict what is coming next. This does not
mean parents should set up a rigid schedule of care for their infant. However, it implies that parents should
study their infant's reaction to activities and then establish a workable schedule based on that (e.g., breakfast,
bath, playtime, nap, lunch, walk outside, quiet playtime, dinner, story, and bedtime). If parents organize their
schedule for infant care it will give the baby a sense of being able to predict what is going to happen next and
gives life consistency.

All little children thrive on routine such as the same story read over and over again, the same bedtime rituals, or
the same spoon every day for lunch (ok ra nila if balik-balik nga stories or activities) Infancy is not too early for
children to learn family traditions such as decorating for a holiday because this type of repetition can help them
feel secure in their world.Some parents have difficulty accepting routine as important to a child. They may be so
tired of their own work schedules that they want to raise their children as free spirits. Do not discourage this
philosophy but parents must suggest modifications to instill order in infant's lives.

Just as it is important that there is a rhythm to the care, it is also important that the care is mainly given by one
person. This person can be the mother, father, grandparent, a conscientious babysitter, a foster parent, or anyone
who can give consistent care. For infants ill at birth who are hospitalized for months, this person is often a
primary nurse or case manager. 
Women who work outside their home during the first year of a baby's life should try to arrange for one person to
care for their child while they are away from home or choose a daycare center that will provide a consistent
caregiver. Urge them to discuss their methods of child care with alternative caregivers to prevent disrupting an
infant's routine. 

Urge parents to make certain to limit the number of caregivers and emphasize also that caretakers will be
actively interacting with their child. Passively caring for infants—not talking to them or touching or stroking
them while feeding or changing them—amounts to little more than not being with them at all (meaning if dili
makig-interact or show affection ang caregiver or "yaya" while mag feed or magligo sa baby, mura ra pod ug
walay nag-care sa bata kay passive man kaayo ang caregiver towards the baby.The caregiver should show
affection to the baby to make the baby feel that she is being cared for or special.)

PROMOTING INFANT SAFETY

Unintentional injuries are a leading cause of death in children from 1 month through 24 years of age. These are
second only to acute infections as a cause of acute morbidity and primary care provider visits. Most
unintentional injuries in infancy occur because parents either underestimate or overestimate a child's ability.

Aspiration Prevention

Aspiration is a chief injury threat to infants throughout the first year. Round, cylindrical objects are more
dangerous than square or flexible objects in this regard. A cylinder, such as a carrot or hotdog, is particularly
dangerous because it can totally obstruct an infant's airway. A deflated balloon can be sucked into the mouth,
obstructing the airway in the same way.

Educate parents not to prop bottles. By doing this, they are overestimating their infant's ability to push the bottle
away, sit up, turn the head to the side, cough, and clear the airway if milk should flow too rapidly into the
mouth, allowing an infant to aspirate. (meaning na-overestimate ra sa parents nga maka push na ang infant sa
bottle away from his mouth or maka turn na ang baby sa iyang head to the side in case mokusog ang flow sa
milk from the bottle, mao nga mag aspiration ang baby -- milk will enter into the baby's lungs)

Other instances of aspiration happen when parents underestimate the infant's ability to grasp and place objects in
their mouth. They can even wiggle to a new position to reach objects such as a teddy bear with small button-
eyes and place it in their mouth. Caution parents not to place objects within infant's reach that may not be safe
to put into the mouth.

A test of whether a toy could be dangerous if an infant puts it inside his mouth is whether it fits inside a toilet
paper roll.If it fits, it is small enough to be aspirated. When solid foods are introduced, encourage parents to
offer small pieces of hot dogs or grapes, not large chunks for this reason.

As infants become more adept at handling toys, parents need to reassess toys for loose pieces or parts. If parents
are going to offer an infant a pacifier, they should use one that has a one-piece construction with a flange
(projecting flat rim) large enough to keep it from completely entering the child's mouth.

Fall Prevention

Falls are a second major cause of infant injuries. As a preventive measure, no infant should be left unattended
on a raised surface. Normal wiggling can bring even a newborn to the edge of a bed, couch, or table top,
resulting in a fall. If the child sleeps in a crib, the mattress should be lowered to its bottom position so the height
of the side rails increases; rails should be narrow enough so children cannot put their head between them. Two
months is about the maximum length of time infants can safely sleep in a bassinet; they need the protection of a
crib and high side rails before they turn over.
All of these safety precautions apply to the hospital environment as well as to the home. Be sure crib sides are
raised and secure before you walk away from a crib, even for just a moment. Also ensure the space between the
mattress and headboard is small enough that an infant's head could not become trapped. (Puhon, when you go
on duty in the Pediatric ward, remember to keep side rails up to prevent injuries to your patients. Most parents
may fall asleep and ang bata awake pa. Be sure to keep the baby safe from falling.or malugpitan ang extremities
while you raise or lower the side rails.) 

Car Safety

Teaching car safety for infants is an important protective health measure. Infants should be placed in backward
facing seats in the back seat because an inflating front seat airbag could suffocate an infant. Parents should
continue to use this type of infant seat without interruption until the baby is 2 years of age or until the child
reaches the highest weight or height allowed by the car safety seat's manufacturer. If parents are firm about
keeping infants in car seats even when they are fussy or impatient, children will eventually become more
comfortable and accepting of car seats.

Safety With Siblings

As infants become more fun to play with at about 3 months of age, older brothers and sisters grow more
interested in interacting with them. You may need to remind parents that children under about 5 years of
age, are not responsible enough or knowledgeable enough about infants to be left unattended with them (Under
5 age group children dili pa jud kasaligan if ibilin sila with infants kay wa pa ni silay mga bu-ot). Older children
might introduce unsafe toys or engage in play that is too rough for an infant. Some preschoolers may be so
jealous of a new baby they will physically harm an infant if left alone.

Bathing and Swimming Safety

As babies begin to develop good back support, many parents begin to bathe them in an adult tub. Caution
parents to never leave an infant unattended in a tub, even when propped up out of the water or sitting in a bath
ring or bath seat. Normal wiggling can easily cause a baby to slip down under the water. 

Many communities offer infant swim programs for babies as young as 6 months. If an infant is enrolled in one
of these programs, parents may become overconfident about their infant's ability to operate safely in water.
Urge them to think carefully before enrolling their infant in such a program, because, although infants can dog
paddle momentarily in a swimming pool, this action does not mean they can sustain that position for any length
of time in a bathtub or pool by themselves.

As a second danger, being able to swim momentarily may cause children to lose their instinctive fear of water
and so be in more danger when around water than children who are still naturally more cautious. (Tungod kay
maka-swim na sila for a short period of time, dili na sila mahadlok sa pool or modung sa water compared sa
bata nga dili pa kamao molangoy nga mas mahadlok or mas careful). Such programs can also cause
hypothermia and spread microorganisms because infants this age are not yet toilet trained. Exposure to
chlorinated water might damage lung epithelium, which then has the possibility to become a precursor to
childhood asthma.

Childproofing

Toward the end of pregnancy, parents need to begin preparing for their infant's arrival by childproofing their
home. As soon as infants begin teething at 5 to 6 months, they chew on any object within reach to lessen gum
line pain. Thoroughly check for possible sources of lead paint, such as painted cribs, playpen rails, or window
sills before this time to avoid lead poisoning.
If an infant is going to play on the floor, urge parents to move furniture in front of electrical fixtures or buy
protective caps for outlets. Infants are especially fascinated by the holes in electric outlets and will probe them
with fingers. Parents may need to install safety gates at the top and bottom of stairways as additional safety
measures before the infant crawls.

Urge parents to move all potentially poisonous substances from bottom cupboards and store them well out of
their infant's reach and lock bottom cabinets as infants might try to get inside and lock herself. Infants of any
age should not be left unattended in carriages, high chairs, grocery shopping carts, or strollers. Baby walkers are
extremely dangerous because infants can maneuver them near stairways and fall the length of the stairs.

When infants begin creeping, remind parents to recheck bottom cupboards and stairways for safety. When the
child begins to walk, higher areas, such as coffee tables, need to be cleared of dangerous items like fragile
decors. In a hospital setting, assess low counter areas for dangerous objects. Do not leave possibly dangerous
supplies in an infant's room like needles. 

By 10 months, achievement of a pincer grasp makes infants able to pick up very small objects. Remind parents
to check play areas or areas such as tabletops for pins or other sharp objects that could be swallowed. At this
point, some of an infant's toys may now be 10 months old and need to be checked to be certain they are still
intact and safe.

Although infants can seem very independent and able to take care of themselves toward the end of the infant
year, their judgment about what situations could be dangerous is immature.As soon as they can walk, they're
able to go their way up the stairs, venture into the kitchen, street or a swimming pool if not carefully supervised.

PROMOTING NUTRITIONAL HEALTH OF AN INFANT

The best food for an infant during the first 12 months of life (and the only food necessary for the first 6 months)
is breast milk. How long mothers continue to breastfeed is an individual choice, although it is recommended
that infants be exclusively breastfed for 6 months. It is optimal if breastfeeding is then continued through the
entire first year. There is some research indicating early weaning from breastfeeding can lead to an increased
incidence of obesity. For infants whose mothers choose not to breastfeed or are unable to breastfeed, a
commercial iron-fortified formula will supply adequate nutrition for the infant year.

When breastfeeding, supplementation with iron-fortified commercial formula is generally unnecessary (because

healthy, full-term babies have enough iron stores in their bodies to last for at least the first six months). After 6
months, if the family's water supply does not contain flouride, supplements may be needed. Infants who are
changed to cow's milk before 1 year of ageshould receive a supplementary form of vitamin C and iron and
possibly fluoride because these components are deficient in cow's milk. However, the practice of  switching to
cow's milk is not recommendedbecause the protein in cow's milk is difficult to digest for infants, which may
possibly lead to intestinal irritation and that slight but continuous gastrointestinal bleeding might occur (which
may result to anemia). (meaning..dili advisable nga e-shift na to cow's milk ang milk sa baby if wala pay 1 year
kay ang protein sa cow's milk lisod ma digest sa tiyan sa bata kay immature pa ilang digestive system basin
maka-cause ug irritation sa iyang GI tract hinungdan nga magbleeding and mo-result to anemia; also, cow's
milk does not contain the necessary nutrients for optimum growth and development sa baby.) Also, changing
the babies milk before 1 year may possibly cause allergies to the baby.

Recommended Dietary Allowances for Infants

During the entire first year of life is when rapid growth happens, so a high-protein, high-calorie intake is
necessary. Calorie allowances can be gradually reduced during the first year at the end of the first year to
prevent babies from becoming overweight.
Although heredity plays a role, a baby who is overweight during the first year of life is more likely to become
an adult who is obese compared to a baby whose weight is within normal limits. Such long-term effects occur
because overfeeding in early life may produce large numbers of excess fat cells (adipocytes) used to store fat.
Because these cells are permanent and remain filled with fat, once they are present, weight regulation can
become difficult throughout life. Breastfed infants gain less weight than those who are formula fed and so
usually tend to be somewhat lighter in weight and have less risk of becoming overweight.

Introduction of Solid Food

From a nutritional standpoint, a normal full-term infant can thrive on breast milk or a commercial iron-fortified
formula without the addition of any solid food until 6 months.Delaying solid food until this time also helps
prevent overwhelming an infant's kidneys with a heavy solute load. Although difficult to document, it also may
delay the development of food allergies in susceptible infants and be yet another way to help prevent future
obesity.

Most parents are eager to begin feeding their infant solid food, hoping this will help their child sleep through the
night. Some parents do begin food before the recommended time without apparent ill effects, possibly because
much of the food is not processed by the gastrointestinal tract, but rather passes through undigested because of
the immaturity of the digestive system, and decreased amounts of amylase and lipase (digestive enzymes).

Generally speaking, parents can tell infants are physiologically ready for solid food when they are
nursing/breastfeeding vigorously 3 to 4 hours and do not seem satisfied or when they are taking more than 32 oz
(960 ml) of formula a day and do not seem satisfied.

Introducing Solid Food

Infants are not ready to digest complex starches until amylase is present in saliva at approximately 2 to 3
months. Biting movements begin at approximately 3 months. Chewing movements do not begin until 7 to 9
months. Therefore, foods that require chewing should not be given until this age.

In addition to these cautions, the extrusion reflex needs to fade before infants accept food readily. With the
extrusion reflex intact, when anything is placed on the anterior third of an infant's tongue, it is automatically
extruded or thrust out of the mouth by the tongue. This is a lifesaving reflex in early infancy because it prevents
infants from swallowing or aspirating foreign objects that touch the mouth. The reflex fades at 3 to 4 months at
about the same time the gastrointestinal tract has matured to be ready to digest solid food.

Techniques for Feeding Solid Food

The introduction of solid food begins a new type of interaction between parents and their infant and can require
a period of adjustment. A typical pattern for the introduction of solid food beginning at 6 months includes:

Iron-fortified infant cereal mixed with breast milk, orange juice, or formula; it aids in preventing iron-deficiency
anemia, is the least allergenic type of food, and is the most easily digested so it is usually the first food
offered.Vegetables; these are a good source of vitamin A and add new texture and flavors to the diet (added
next to cereals)Fruit; these are the best sources of vitamin C and a good source of vitamin A.Meat is a good
source of protein, iron, and B vitamins.  By 6 months of age, egg yolk, a good source of iron, can be added.

Teach parents to offer new foods one at a time and to allow their child to eat that item for about 3 to 7 days
before introducing another new food. This system helps parents to detect a possible food allergy in addition to
allowing the infant to get used to the new experience.
A newborn's stomach can hold approximately 2 tablespoons (30 ml). By 1 year, a baby's stomach can hold no
more than about 1 cup (240 ml). For this reason, when they begin eating solid food, infants rarely take more
than 2 tablespoons (30 ml) at a time.

For the first solid food feeding, it is best if an infant is held in the parent's arms as if for breastfeeding or bottle
feeding. This reduces the newness of the experience (aron dili mabag-uhan ang infant sa way of feeding) and
minimizes the amount of stress associated with it. If an infant does not take readily to solid food, advise parents
to wait a few days and then try again.

Babies have distinct taste preferences even at young ages and may spit out a food because they do not like the
taste. Even after the extrusion reflex has faded, some infants continue to spit out food. This is because, when
infants drink from a bottle or breast, they press their tongue and the nipple against their hard palate. When an
infant tries to eat solid food using the same technique, it appears the child is spitting out the food. 

If a parent is going to prepare baby food, the parent needs to avoid preparing spinach, carrots, beets, green
beans, and squash because these can contain excessive amounts of nitrates that are not processed well by
infants. Commercial baby food has the nitrates removed and so does not present this problem.

Also, parents should never use honey as a sweetener because it may contain botulism spores and never use
cow's milk because it can cause microscopic intestinal bleeding.

Cereal

Infant cereal is fortified with B vitamins and iron. It is supplied as a precooked, fine dry powder to which
expressed breast milk, infant formula, or juice is added. Adding sugar to cereal is unnecessary. Extra sugar in
the diet can lead to diarrhea in young infants and beginning caries in older infants.

The first cereal introduced is usually rice cereal because fewer children are allergic to rice products than to
wheat and corn products. Usually, this is offered twice a day, in the morning and evening. Once the child has
taken rice cereal for 1 week, if they wish, parents can try another kind.

Infant cereal is so rich in iron that parents should continue feeding it at least through the first year. Ideally,
children should eat infant cereal until age 3 or 4 years because few popularly advertised products can match the
nutrients of fortified infant cereal.

Caution parents not to mix cereal into the infant's bottle because, as it is necessary to cut a larger hole in the
bottle nipple for the cereal and milk mixture to flow freely, there is a danger an infant may aspirate if the hole
cut is too big or if the parent then uses that nipple for formula without cereal added. This practice also denies
the child the opportunity of learning to eat from a spoon and experiencing different food tastes and textures.

Vegetables and Fruits

Because the iron content in vegetables is generally higher than that of fruits,vegetables are usually the second
food added to the diet (after 6 months of age). Butter, sugar, or salt should not be added to the preparation
because infants have difficulty digesting fats until almost the end of the first year. By filling ice-cube trays with
the blended vegetables, parents can make a 1-week supply and defrost a cube at a time. 

If parents use commercial baby food, they should begin with level 1 types (single ingredient and pureed) and
feed from a bowl rather than directly from the jar. This is because, if the spoon carries salivary enzymes from an
infant's mouth back to the food jar, the enzymes will quickly liquefy what remains in the jar. Also, there is a
danger of transferring bacteria (principally streptococci) from an infant's mouth to the jar.Baby food jars should
be refrigerated once they are opened, and manufacturers recommend they be used no longer than 48 hours after
they were first opened.
When vegetables are added to the diet, they are usually offered at lunch. Remind parents to offer both green and
yellow vegetables. Help them to remember that their own dislike of a particular vegetable does not mean their
child will feel the same way about it. If they do convey distaste for a food, their child will pick up on the feeling
and may not like the vegetable either.

Fruit is usually offered 1 week after beginning vegetables (after 6 months of age). It can be given in addition to
cereal for breakfast and dinner.  As with vegetables, parents should offer a selection so an infant is exposed to
different tastes and textures. 

Meat and Eggs

Meat is usually introduced at 9 months of age because this is the time an infant's iron stores are beginning to be
depleted. Parents can grind a portion of the meat they have prepared for their own meals so it is tender, or they
can use commercially prepared baby food. Beef and pork have more iron than chicken, so encourage parents to
offer a variety. When meat is added to an infant's diet, it is usually added as part of the evening meal in place of
cereal.

Egg yolks are offered after 6 months of age. Egg yolks contain the bulk of the iron content of eggs; the white
contains the bulk of protein.Egg yolk alone should be given at first because the protein of the egg white can lead
to allergy or can be difficult for an infant to digest. Eggs may be hard boiled (then a little formula or breast milk
can be added to the mashed yolk to make it more liquid) or purchased as commercial baby food. Soft boiling or
poaching is not usually recommended because salmonella, the chief offending microorganism that may be in
eggs, may not be killed by these methods. Also, thorough cooking makes protein easier to digest.

Table Food

Encourage parents to establish a three-meal-a-day pattern, if that is the family's lifestyle, and to have the infant
join the family at the table. If an infant is too distracted at a family table to eat well, parents may find the infant
to eat more if fed first and then given a cracker to chew on while just sitting at the table and being with the
family. 

Encourage parents to use homemade foods rather than relying on commercially prepared junior or toddler
foods as much as possible so the infant will have less difficulty switching to a parent's cooking when older.

Mashed potatoes or peas and cut-up meatloaf are examples of table foods that infants older than 6 months of age
like to eat and busy parents can prepare quickly. If hot dogs are offered, caution parents to cut them into small
bite-size portions; otherwise, their shape is dangerous if aspirated. 

Establishment of Healthy Eating Patterns

The rules for infant feeding are only guidelines based on what seems to work well with most infants. Encourage
parents to individualize their approach according to the cues their child is giving them for readiness.

If an infant refuses to eat, ask the parents what foods they are offering. Have them list exactly the types and
amounts of foods the child ate the day before (a 24-hour dietary recall history). It may be apparent from their
list that enough is being eaten in a day's time and the parents' expectations are not realistic for the child's size
and age. 

If intake is inadequate and the child is, indeed, a fussy eater, ask about the parents' methods of feeding. Infants
generally accept the new experience of eating from a spoon better when they are hungry, not when their
stomach is full. Some babies, however, particularly those with an intense temperament, may be so hungry at
mealtime that they cannot tolerate the frustration of spoon feeding until some of their hunger is relieved. They
may need to drink 2 or 3 oz of formula or nurse at the breast for a few minutes before they will eat a spoonful of
food. (Ubang bata if gigutom na kaayo, dili mokaon hungitan sa ilang food...gusto nila mo inom una ug milk
para makuha-an gamay ilang kagutom ayha pa mokaon)

If infants are fatigued or overstimulated, they also may not eat well. Providing a quiet environment away from
older brothers or sisters or other distractions before mealtime might be a solution to this problem.

Encourage parents not to force infants to eat if they do not seem hungry. Healthy, happy infants will be hungry
at mealtime and will eat. Those who refuse a meal may be tired, distracted, or perhaps ill. Forcing only leads to
regurgitation or, if they are ill, may cause vomiting.

Weaning

Mothers are advised to exclusively breastfeed for the first 6 months and continue breastfeeding for the full first
year with complementary solids. Infants are capable of drinking effectively from a cup at about 9 months of
age. The sucking reflex begins to diminish in intensity between 6 and 9 months, which makes this the time to
consider weaning from a bottle.

To wean from either formula or breast milk, the parent needs to choose one feeding a day and begin offering
fluid by the new method (e.g. by a cup) at that feeding. Choosing a time of day that is not an infant's fussy
period is helpful. After 3 days to 1 week, when an infant has become acclimated to the one change, the parent
then changes a second feeding and so on. Should an illness such as an upper respiratory infection occur or
should the child have teething discomfort, there will be setbacks. Infants also usually need more fluid during hot
weather than cold weather because of increased perspiration. No set number of weeks should be prescribed to
complete weaning.

Self-Feeding

At approximately 6 months of age, infants become interested in handling a spoon and beginning to feed
themselves. Their coordination has not developed enough for them to use a spoon without a great deal of
spilling, so they are much more adept at feeding themselves with their fingers. When an infant becomes fatigued
or frustrated at attempts of self-feeding, a parent can then help without making an issue of it.

When infants play with their food by squeezing it through their fingers or dabbing it in their hair, it is time to
end the meal. Infants who are hungry eat; those who are full, play. (If magduwa-duwa ang bata sa iyang food,
it's a sign nga wala gigutom ang baby, so better stop feeding rather than pugson and saputon ang parent or
caregiver)

A Vegetarian Diet

An infant eating a vegetarian diet should continue to be breastfed or ingest an iron-fortified commercial formula
for the entire first year. If a milk allergy is present, a soy-based formula can be substituted. As soon as they are
introduced to solid food, they can begin vegetarian foods. As with all infants, an assortment of foods should be
provided, including vegetables such as peas, potatoes, and carrots; fruits such as apples, prunes, and bananas;
infant cereal; tofu; wheat germ; legumes; brewer's yeast; and synthetic vitamin D. Feeding fortified cereal
throughout the first year will ensure that iron stores are built, If the diet is to include dairy products, these can be
added toward the end of the first year as usual.

Because vegetarian diets are high in fiber, infants who eat them may have more frequent and looser than usual
bowel movements. Teach parents to change diapers frequently to avoid skin irritation. Using less fibrous, more
concentrated forms of protein, such as tofu and powdered nuts rather than green vegetables, can minimize this
problem.

PROMOTING INFANT DEVELOPMENT IN DAILY ACTIVITIES

In the first year, caring for an infant—feeding, bathing, dressing, and so forth—occupies nearly all of the
parents' waking hours. All of these basic care-related activities  provide important opportunities for parents and
infants to get to know one another and to become used to each other's unique personalities and patterns. Nurses
can play a key role in teaching parents about these activities and stressing their importance.

Bathing

Except in very hot weather, an infant does not need a bath every day. If a parent is tired and would not enjoy
bath time or if some days are just too rushed, a complete bath can be omitted, with only the infant's face, hands,
and diaper area washed.

Some infants need their head and scalp washed frequently (i.e., everyday or every other day) to prevént
seborrhea, a scaly scalp condition often called cradle cap. If seborrhea lesions develop, they adhere to the scalp
in yellow, crusty patches. The skin beneath them may be slightly red. The patches can be softened by oiling the
scalp with mineral oil or petroleum jelly and leaving it on overnight. The crusts can then be removed by
shampooing the hair the next morning. A soft toothbrush or fine-toothed comb can be used to help remove
them. 

Bath time should be enjoyable for an infant and can serve many functions other than just cleanliness. Bath time
also helps an infant learn different textures and sensations and provides an opportunity to exercise and kick as
well as a good opportunity for a parent to touch and communicate with the child. Teach parents NEVER to
leave infants alone in a tub even if they are supported by an infant seat because they could easily slip under the
water and drown. 

Diaper-Area Care

The most effective means of promoting good hygiene in the baby's diaper area is to change diapers frequently,
about every 2-4 hours. However, it is rarely good practice to interrupt the child's sleep to change diapers (so,
teach parents to change diapers before the baby sleeps to ensure nga the baby is dry thorughout her sleep) If an
infant develops a rash from sleeping in wet diapers, air drying or sleeping without a diaper may be a solution.

At each diaper change, parents should wash the skin with clear water or a commercial alcohol-free diaper wipe
and then pat or allow the skin to air dry (Emphasize to parents nga mas best to use water unya e-PAT lang dili
e-WIPE inag pa-dry ang skin to prevent irritation). Routinely using an ointment such as zinc oxide or petroleum
ointment to keep urine and feces away from an infant's skin is good prophylaxis. Parents should NOT use baby
powder, as it is a potential source of aspiration. Following a diaper change, remind parents to wash their hands
to reduce the possibility of spreading infection.

Dental Care

Exposing developing teeth to fluoride is one of the most effective ways to promote healthy tooth formation and
prevent tooth decay. In communities where the water supply does not provide enough fluoride or where parents
prefer to drink unfluoridated bottled water, the use of an oral fluoride supplement (fluoride drops) beginning at
6 months of age or the use of fluoride toothpaste or rinses after tooth eruption is recommended. Toothbrushing
can begin even before teeth erupt by rubbing a soft washcloth over the gum pads. This eliminates plaque and
reduces the presence of bacteria, creating a clean environment for the arrival of first teeth. Once teeth erupt, all
surfaces should be brushed with a soft brush or washcloth once or twice a day. Children lack the coordination to
brush effectively until they are school age, so parents must be responsible for this activity. Toothpaste is not
necessary for an infant because it is the scrubbing that removes the plaque. An initial dental checkup should be
made before 2 years of age and checkups should continue at 6-month intervals until adulthood.

According to the AAPD, it is very important to keep primary (or “baby”) teeth in place until they are lost
naturally. The primary teeth are important for many reasons including:
Involvement in speech development.

Helping children chew properly to maintain good nutrition.

Helping save space for permanent teeth (because the permanent teeth will start to erupt only when the child is 6-
7 yrs old)

Promoting a healthy smile that helps children feel good about the way they look

Dressing

Clothing for infants should be easy to wash and simply constructed, so that dressing and undressing will not be
a struggle for both parents and babies. When they begin to creep, infants need long pants to protect their
knees. They need only soft-soled shoes or merely socks or booties to keep their feet warm until such time nga
kamao na molakaw ang bata. Even when they begin walking, the soles of their shoes need only be firm enough
to protect their feet against rough surfaces. 

Sleep

Sleep needs and habits vary greatly among infants, but most require 10 to 12 hours of sleep at night and one or
several naps during the day.

Parents are advised to let a baby sleep in a separate space close by rather than in their bed so the parents do not
awaken at every toss and squeak and possibly avoid infant suffocation. (recommended nga ibutang ang baby
ug crib nga duol sa parents para dili madisturb ang parents/baby and avoid infant suffocation kay basin
matabunan sa blanket or pillow sa parents or maybe maipit inag lihok sa parents)

Doing so also allows infants to learn to quiet themselves and go back to sleep should they awaken briefly.

Caution parents not to place pillows in an infant's crib. Always place an infant on his or her back to sleep
(supine position or maghayang ang baby) because this position reduces the incidence of Sudden Infant Death
Syndrome (SIDS) or "crib death" (unexplained death of a baby under 1 year old)

Other ways to prevent SIDS include:

Placing infant to sleep in a firm sleep-surface (dili sa soft, cushiony surface kay possible nga ma-umod ilang
face sa soft mattress unya ma suffocate)

Breastfeeding (kay if bottle-fed, naay tendency nga e-prop ang bottle sa parents during feeding)

Room sharing without bed sharing (ilahi sa crib ang baby but same room sa parents)

Routine immunizations (gives babies protection against diseases)

Avoidance of closed spaces, exposure to tobacco smoke (maglisod ginhawa ang baby; smoke can cause
respiratory problems for the baby)

Avoid overheating the room & baby (don't over-bundle the baby with extra layers of clothing or caps when
sleeping or taking naps kay initan kaayo ang bata especially during summer; keep room temperature at
comfortable levels)

Exercise
Infants benefit from outings in a carriage or stroller because sunlight provides a natural source of vitamin D. In
hot weather, caution parents to protect an infant from sunburn by exposing the child to the sun for only very
short periods. The sun is most intense between 10 AM and 3 PM, so early mornings and late afternoons are the
best times for infants to be outside. These short time spans are necessary because the use of sunscreen is not
recommended in children until they are at least 6 months old.

Toward the end of the first year, infants need space to crawl and then to walk, such as in an enclosed outdoor
play space. In addition to providing fresh air, going for leisurely walks while pointing out the sights of the world
—trees, birds, dogs, houses, neighbors—helps children develop language and allows for quality time with a
parent.

PROMOTING HEALTHY FAMILY FUNCTIONING

A primary task of parents during the infant year is to learn to interpret infants' cues so they can better decipher
their needs. This becomes an easier task by 2 months of age, when infants can indicate by their particular cry
whether they are feeling cold, hungry, wet, or lonely (Differentiates cry).

Parental Concerns and Problems Related to Normal Infant Development

Both novice and experienced parents may need reassurance and answers to questions about child care
procedures or health during the infant period because they have not yet learned to interpret infant cues. The
unique characteristics of each child require at least some adjustment from parents.

Teething

Most infants have little difficulty with teething, but some appear very distressed by the process. Generally,
gums are sore and tender (painful when touched) before a new tooth breaks the surface. As soon as the tooth is
through, the tenderness passes.

Because of this pain, infants can be resistant to chewing for a day or two and be slightly cranky, possibly
because they are a little hungry from not eating as much as usual. High fever, seizures, vomiting or diarrhea, as
well as earache are NEVER normal signs of teething. An infant with any of these symptoms has an underlying
infection or disease process that requires further evaluation.

Rubbing the gum line with a finger or a soft cloth can help a new tooth erupt and so can be effective. Teething
rings that can be placed in the refrigerator or freezer provide soothing coolness against tender gums. Remind
parents that an infant who is teething will place almost any object in the mouth to chew on, so parents must
screen articles within the baby's reach to be certain they are edible or safe to chew on.

Many over-the-counter medicines are sold for teething pain. These should be discouraged, especially if they
contain benzocaine, a topical anesthetic. If applied too far back in the throat, this could interfere with a gag
reflex. Infant's or children's liquid acetaminophen (Tylenol) may be given for teething discomfort after parents
check with their primary care provider for the correct dose.

Thumb-Sucking

Sucking is a surprisingly strong need in early infancy: Sonograms demonstrate thumb-sucking as early as in
utero. Many infants begin to suck a thumb or finger at about 3 months of age and continue the habit through the
first few years of life. The sucking reflex peaks at 6 to 8 months, whereas thumbsucking peaks at about 18
months.
Parents can be assured that thumb-sucking is normal and does not deform the jaw in infancy. It does not cause
"baby talk" or any of the other speech concerns commonly attributed to it. Children who continue the habit into
school age, however, can have changes in their dental arch that leads to asymmetric concerns such as crossbite.
The best approach for parents is to be certain an infant has adequate sucking pleasure and then to ignore thumb-
sucking. Making an issue of it rarely causes a child to stop; if anything, it may intensify and prolong it.

Use of Pacifiers

An infant who completes a feeding and still seems restless and discontent, who actively searches for something
to put into the mouth, or who sucks on hands and clothes may need a pacifier. Babies who have colic crave
sucking and enjoy pacifiers because their abdomen hurts, and they interpret this as a hunger sensation. If a child
is formula fed, parents should check nipples to be certain the holes are small and the rubber is sturdy so their
infant can suck hard enough to derive pleasure.

Parents should attempt to wean a child from a pacifier any time after 3 months of age and certainly during the
time the sucking reflex is fading at 6 to 9 months. Weaning after this age is difficult because a pacifier becomes
a comfort mechanism, like a warm blanket or fuzzy toy to which a child may continue to cling. 

Benefits: They appear to be comforting to an infant, they may aid in pain relief, and there is a decreased risk of
SIDS.

Risks:

an increased incidence of acute otitis media,AOM ( an ear infection) - attributed to the constant sucking action
which may lead to Eustachian Tube Dysfunction, ETD (swelling of the mucosal lining of the ET & improper
opening & closing of the ET which can cause entry of bacteria into the middle ear.)

possibly a negative impact on breastfeeding

dental malocclusion, particularly if usage is greater than 2 to 3 years (misalignment or incorrect relation
between the teeth of the two dental arches)

A major drawback of pacifiers is the problem of cleanliness. They tend to fall on the floor or sidewalk and are
then put back into an infant's mouth. If not well constructed, they may come apart and the nipple part may be
aspirated. Hanging a pacifier on a string around an infant's neck could cause strangulation (possible nga matu-
ok ang baby if ibitay ang pacifier sa iyang neck, so this is not advisable)

Head Banging

Some infants rhythmically bang their head against the bars of a crib for a period of time before they fall asleep,
an action that can be a distressing behavior for parents. Besides fearing their children will hurt themselves, they
may have heard blind children or those with mental illness or an autism spectrum disorder do this and worry
their child is ill in some way.

Head banging in this limited fashion—beginning during the second half of the first year of life and continuing
through to the preschool period, associated with naptime or bedtime, and lasting under 15 minutes—can be
considered normal. Children use this measure to relax and fall asleep. 

Advise parents to pad the rails of cribs so infants cannot hurt themselves and reassure them this is a normal
mechanism for the relief of tension in children of this age. No therapy should be necessary. Excessive head
banging done to the exclusion of normal development or activity, head banging past the preschool period, or if
associated with other symptoms suggests a pathologic basis; such children need a referral for further
investigation.

Sleep Concerns

Infants should be placed on their backs to sleep until they are able to roll over on their own at around 4 months
of age. Breastfed babies tend to wake more often than those who are formula because breast milk is more easily
digested, and so infants become hungry sooner.

In late infancy, the problem of waking at night and remaining awake for an hour or more can become common.
Suggestions for eliminating or at least coping with night waking include delaying bedtime by at least 1 hour,
shortening afternoon naps, not responding immediately to infants at night so infants have time to fall back to
sleep on their own, and providing soft toys or music for allow infants to play quietly alone during this wakeful
time. Infants take varying lengths of time to adjust to night sleeping; this does not mean the child is ill. 

Constipation

When infants defecate, their faces do turn red, and they grimace and grunt. As long as stools are not hard and
contain no evidence of fresh blood (as might occur with a rectal fissure), this is not constipation but normal
infant behavior.

Breastfed infants are rarely constipated because their stools tend to be naturally loose. Constipation may occur
in formula-fed infants from something as simple as if their diet is deficient in fluid. This can be corrected
simply by offering more fluid.

If hard bowel movements are present beyond 5 or 6 months of age, encourage parents to check with the infant's
primary healthcare provider about measures to relieve this. Adding foods with bulk, such as fruits or vegetables,
and increasing fluid intake generally relieves the problem. Apple juice or prune juice may be given as a
temporary measure. 

Chronic constipation also may occur in children with congenital hypothyroidism (decreased functioning of the
thyroid gland). An infant with constipation should be carefully observed for characteristic signs of
hypothyroidism, such as lethargy, protruding tongue, and failure to meet developmental milestones. Infants with
either of these disorders need therapy to correct the disorder.

Loose Stools

Stools of breastfed infants are generally softer than those of formula-fed infants. If a mother takes a laxative
while breastfeeding, an infant's stools may be very loose. An infant who is formula fed can have loose stools if
the formula is not diluted properly. Occasionally, loose stools may begin with the introduction of vegetables or
fruit.

A serious reason for loose stools is celiac disease or the inability to process gluten (sometimes termed
malabsorption syndrome). The inability to digest fat and fat-soluble vitamins, accompanied by a distended
abdomen, are other common symptoms of celiac disease.

Infants with associated signs and symptoms such as fever, cramping, vomiting, loss of appetite, a decrease in
voiding, and weight loss should be examined by their healthcare provider because this suggests an infectious
process. Dehydration occurs rapidly in a small infant who is not eating and is losing body fluid through loose
stools

Colic (Kabag in Tagalog; Panuhot in Cebuano)

Colic is paroxysmal (sudden/uncontrolled) abdominal pain that generally occurs in infants under 3 months of
age and is marked by loud, intense crying. Infants pull their legs up against their abdomen, their faces become
red and flushed, their fists clench, and their abdomens become tense. If offered a bottle, an infant with colic will
suck vigorously for a few minutes as if starved and then stop as another wave of intestinal pain occurs.

The cause of colic is unclear and probably results for several reasons. It may occur in susceptible infants from
overfeeding or from swallowing too much air while feeding. Formula-fed babies tend to have more symptoms
than breastfed babies, possibly because they swallow more air while drinking or because formula is harder to
digest.

With colic, symptoms of abdominal pain typically last up to 3 hours a day and occur at least 3 days every week;
bowel movements are normal. Constipation; narrow, ribbonlike stools; and the presence of blood or mucus
suggest other problems. Although infants continue to thrive despite colic, the condition should not be dismissed
as unimportant. 

A number of interventions can be helpful to recommend to relieve colic symptoms. For example:

both breastfed and formula-fed infants may feel more comfortable with small, frequent feedings to prevent
distention and discomfort.

Offering a pacifier can be comforting.

Taking infants for car rides, or playing a music box that simulates the sound of a heartbeat are often reported as
being helpful. 

Dietary changes have little effect, although using hydrolyzed protein; probiotics prebiotics, or a soy-based
formula for bottle-fed babies may be helpful.

Some parents try placing a hot water bottle on their infant's stomach for comfort, but this should be discouraged.
A basic rule for any abdominal discomfort is to avoid heat in case appendicitis is developing. This is highly
unlikely in young infants, but parents will remember they once used heat and may use it again when the child is
older. Hot water bottles and heating pads also might burn the delicate skin of infants

In about 85% of infants, colic disappears almost magically at 3 months of age, probably because it becomes
easier to digest food and an infant maintains a more upright position by this time, which allows less gas to form.

Spitting Up

Almost all infants spit up, although formula-fed babies ape pear to do this more than breastfed babies, possibly
due to overfeeding. Almost all milk that is spit up smells at least faintly sour, but it should not contain blood or
bile

The baby who spits up a mouthful of milk (rolling down the chin) two or three times a day (or sometimes after
every meal) is experiencing normal, early-infancy spitting up. Associated signs such as diarrhea, abdominal
cramps, fever, cough, cold, or loss of activity suggest illness. Burping the baby thoroughly after a feeding often
limits spitting up. Parents may try sitting an infant in an infant chair for half an hour after feeding. Spitting up
decreases in amount as the baby becomes better at coordinating swallowing and digestive processes (the cardiac
sphincter matures). After a few months, the child will naturally stay in an upright position longer, and gravity
will help to correct the problem.

Diaper Dermatitis
Some infants have such sensitive skin that diaper dermatitis (diaper rash) is a problem from the first few days of
life. When parents do not change a child's diapers frequently, feces is left in contact with skin, and irritation
may result in the perianal area. Urine that is left in diapers too long breaks down into ammonia, a chemical
extremely irritating to infant skin. Ammonia dermatitis of this type is generally a problem in the second half of
the first year of life, when an infant is producing a larger quantity of urine than before. 

Ways to help relieve diaper rashes: 

frequent diaper changing

applying an ointment

exposing the diaper area to air

sleeping without diapers at night.

If a diaper area is covered with lesions that are bright red, with or without oozing, that last longer than 3 days,
and appear as red pinpoint lesions, suspect a fungal (monilial or candidiasis) infection that will also need
therapy (an antifungal medicine such as Nystatin). 

Whenever the entire diaper area is erythematous and irritated so the outline of the diaper on the skin can be
identified, an allergy to the material in the diaper or to laundry products if a commercially washed or home-
washed diaper is being used is suggested. Changing the brand or type of diaper or washing solution usually
alleviates this problem.

Miliaria

Miliaria, or prickly heat rash, occurs most often in warm weather or when babies are overdressed or sleep in
overheated rooms. Clusters of pinpoint, reddened papules with occasional vesicles and pustules surrounded by
erythema usually appear on the neck first and may spread upward to around the ears and onto the face or down
onto the trunk.

Ways to improve and prevent further eruptions:

Bathing an infant twice a day during hot weather, particularly if a small amount of baking soda is added to the
bath water

Eliminating sweating by reducing the amount of clothing on an infant

Lowering the room temperature

Baby-Bottle Tooth Decay Syndrome

Putting an infant to bed with a bottle can result in decay of all the upper teeth and the lower posterior teeth.
Decay occurs because, while an infant sleeps liquid from the propped bottle continuously soaks the upper front
teeth and lower back teeth (the lower front teeth are protected by the tongue). The problem, called baby-bottle
syndrome, is most serious when the bottle is filled with sugar water, formula, milk, or fruit juice. The
carbohydrate in these solutions ferments to organic acids that demineralize the tooth enamel until it decays.

To prevent this problem, never put the baby to bed with a bottle. If parents insist a bottle is necessary to allow a
baby to fall asleep, encourage them to fill it with water and use a nipple with a small hole to prevent the baby
from receiving a large amount of fluid. If the baby refuses to drink anything but milk, the parents might dilute
the milk with water more and more each night until the bottle contains water only.

Obesity in Infants

Obesity in infants is defined as a weight greater than the 90th to 95th percentile on a standardized height/weight
chart.

Obesity occurs when there is an abnormal increase in the number of fat cells because of excessive calorie intake.

Preventing obesity in infants is important because the extra fat cells formed at this time are likely to remain
throughout childhood and even into adulthood.

If a child becomes obese because of overinvesting milk, iron-deficiency anemia may also be present because of
the low iron content of both breast and commercial milk. Once infant obesity begins, it is difficult to reverse, so
prevention is the key.

Overfeeding in infancy often occurs because parents were taught to eat everything on their plate, and they
continue to instill this concept in their children.

This appears to be the case most often with formula-fed infants whose parents urge  them to empty their bottle
or finish a cereal serving. It can occur any time parents automatically feed an infant when the child cries rather
than investigating what the cry might really mean.(Because most parents, ipahurot jud ang food kay sayang and
dretso taga-an ug food basta mihilak ang baby without finding out ngano hing hilak ang bata)As a general rule,
an infant should take no more than 32 oz of formula daily and shouldn't be breastfeeding more often than every
2 hours. When solid food is introduced, a bottle of water can be substituted for formula at one feeding to reduce
calories.

Nonfat milk should not be given because it contains so little fat that essential fatty acid requirements may not be
sufficient to ensure cell growth.

Another way to help prevent obesity is to add a source of fiber, such as whole-grain cereal and raw fruit, to an
infant's diet. These prolong the stomach-emptying time, so they can help reduce food intake. Caution parents
about giving infants  who are obese foods with high amounts of refined sugars, such as pudding, cake, cookies,
and candy.

KEY POINTS FOR REVIEW

The infant period is from 1 month to 12 months of age. Children typically double their birth weight at 4 to 6
months and triple it at 1 year.

Infants develop their first tooth at about 6 months; by 12 months, they have six to eight teeth.

Important gross motor milestones during the infant year are lifting the chest off a bed at 2 months, sitting at 6 to
8 months, creeping at 9 months, cruising at 10 to 11 months and walking at 12 months.

Important fine motor accomplishments are the ability to pass an object from one hand to the other (7 months of
age) and a pincer grasp (10 months of age). 

Important milestones of language development during the first year are differentiating a cry (2 months of age),
making simple vowel sounds (5 to 6 months of age), and saying two words besides "ma-ma" and "da-da '' (12
months of age). The more infants are spoken to, the easier it is for them to acquire language.
Providing infants with proper toys for play helps development. All infant toys need to be checked to be certain
they are too large to be aspirated (wider than a toilet paper roll). 

Important milestones of vision development are the ability to follow a moving object past the midline (3 months
of age) and ability to focus securely without eyes crossing (6 months of age).

According to Erikson (1993), the developmental task of the infant year is the development of a sense of trust
versus mistrust. Helping parents spend quality time with their infant helps a sense of trust to develop and helps
in planning nursing care that not only meets QSEN competencies but that also best meets the family's total
needs. 

Safety is important. Infants must be protected from falls and the aspiration of small objects. Skills an infant
cannot accomplish one day, such as crawling (which can lead to danger), may be accomplished the next.

Solid food is generally introduced into an infant's diet at 6 months of age. Before infants can eat solid food,
they  must lose their extrusion reflex

Common concerns related to infant development include teething, thumb-sucking, use of pacifiers, sleep
problems, constipation, colic, diaper dermatitis, baby-bottle syndrome (decayed teeth from sucking on a bottle
of formula while they sleep), and obesity. Nurses play a key role in teaching parents about these problems and
suggestions to deal with them. 

Remember that parent—infant attachment is critical to mental health. Urge parents to continue to give as much
care as possible to ill infants to maintain this important relationship.