GROWTH AND DEVELOPMENT OF AN  Standard schedule for healthcare visits:

INFANT o 2-week, 2-month, 4-month, 6-month,

9-month, and 12-month visits
 Legend
“=” – results to
“>, <” – greater than or less than
“Ø” – no, do not, prevent, wrong
“” – allowed , yes, (opp. To Ø)
 PHYSICAL GROWTH
WEIGHT
 Ave. male – 10 kg (22 lb)
 Ave. female - 9.5 kg (21 lb)
HEIGHT
 about 30 in. (50.8 to 76.2 cm)
HEAD CIRCUMFERENCE
 end of the first year - brain reaches two thirds
of its adult size.
 head is asymmetric until the second half of the
first-year d/t supine position when sleeping
o spend “tummy time” to prevent
flattening
 Immune System
o functional by at least 2 months
o produce (Ig)G and IgM antibodies by 1
year
o IgA, IgE, and IgD are not plentiful until
preschool age
o ability to adjust to cold is mature by
age 6 months
o susceptible to dehydration from
illnesses, (e.g., diarrhea) d/t loss of
extracellular fluid
o extracellular fluid – 35% of body
weight
o intracellular fluid - 40% in the end of 1st
yr.

BODY PROPORTION TEETH

 end of the period – lower jaw is prominent  first tooth - central incisor @ 6 months
 chest circumference – less than the head’s by  natal teeth - @ birth
2 cm  neonatal teeth - first 4 weeks of life
 head circumference – even same as chest  Deciduous teeth- for proper growth of dental
circumference arch
 abdomen – protuberant until has been walking
 Cervical, thoracic, and lumbar vertebral curves
develop as infants hold up their head, sit, and
walk.
 Lengthening of the lower extremities during the
last 6 months – “babylike” to “toddlerlike”

BODY SYSTEMS

 HR – from 110 to 160 beats/min to 100 to 120

beats/min
 BP - from 80/40 to 100/60 mmHg
 RR - from 30 to 60 breaths/min to 20 to 30
breaths/min

 physiologic anemia at 2 to 3 months

o life of RBC is 4 months and cells begin
to disintegrate this time
 5 – 6 months – hemoglobin → adult
hemoglobin
 6-9 months – decreased serum iron levels
 GI tract
o immature; amylase is deficient,
o lipase is decreased the entire first year
 Liver
o immature; inadequate conjugation of
drugs ,
o inefficient CHO, CHON, and vitamins
 Kidneys
o immature; not as efficient at
eliminating body wastes as in an adult
 Endocrine System
o immature d/t pituitary stimulation
(adrenocorticotropic hormone, insulin)
 MOTOR DEVELOPMENT
 gross motor development (ability to
accomplish large body movements) and fine
motor development - measured by observing
or testing prehensile ability (ability to
coordinate hand movements)
GROSS MOTOR DEV’T
1. Ventral Suspension Position
o infant’s appearance when held in
midair on a horizontal plane and
supported by a hand under the
abdomen
o newborn allows the head to hang
down with little effort at control
 1 month old - lift their head
momentarily and then drop it
again.
 2 month old – hold their
head in the same plane as the
rest of their body; muscle
control
 3 month old - lift and maintain
their head well above the
plane of the rest of the
 body
o Landau Reflex
 3-6 months
 To know if has motor
weakness, cerebral palsy, or
other neuromuscular defects
2. Prone Position
o 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
o 1 month old
 lift their head and turn it easily
to the side
 keep their knees tucked under
their abdomen
o 2 month old
 can raise their head and
maintain the position, but
cannot raise their chest high
enough to look around yet
o 3 moth old
 lifts the head and shoulders
well off the table and looks
around
 pelvis is flat on the table, no
longer elevated
 some can side-lie
o 4 month old
 lift their chests off the bed and
look around actively, turning
their head from side to side
 can turn from front to back
with a neck-righting reflex =
lose balance and roll sideways
o 5 month old
 Can rest weight on their
forearms
 can turn completely over, front
to back and back to front
o 6 month old –
 can raise their chests and the
upper part of their abdomens
off the table
o 9 month old
 can creep
3. Sitting Position
o the back appears rounded and an
infant demonstrates only momentary
head control
o 1 month old
 When placed on his or her
back and then pulled to a
sitting position = head lag
o 2 month old
 can hold their head fairly
steady
 head does tend to bob forward
and will still show head lag
when pulled to a sitting
position
o 4 month old
 No head lag in sitting position
o 5 month old
 Can straighten back
o 6 month old
 can sit momentarily without
support
 anticipates being picked up
and reach up with their hands
o 7 month old
 can sit alone but only when
the hands are held forward for
balance
o 8 month old
 Can sit securely without
support
 Cannot = delayed cognitive or
motor development
o 9 month old
 Can sit so steadily that they
can lean forward and regain
their balance
 lose their balance if they lean
sideways
 4. Standing Position
o the infant’s knees and hips flex rather
than support more than momentary o 4 month old
weight.  bring their hands together and
o 1 month old pull at their clothes
 Stepping reflex  Thumb opposition (ability
o 3 month old tombring the thumb and
 tries to support part of their fingers together)
weight on their feet  Palmar and plantar grasp
reflexes have disappeared
o 5 month old
o 4 month old  can accept objects that are
handed and can reach objects
not offered to them
 able to support their weight on
 delayed motor dev’t = Fisting
their legs; stepping reflex
that persists beyond 5 months
fades
 hemiparesis or paralysis on a
o 5 month old
side = unilateral fisting
 Tonic neck and Moro reflex
o 6 month old
fade
 can hold objects in both hands
o 6 month old
 can hold a spoon and start to
 nearly support their full weight
feed themselves (with much
o 7 month old
spilling)
 bounces with enjoyment
 Ø Moro, Palmar Grasp, Tonic
o 9 month old
neck
 Can stand holding onto a   Moro Reflex = neurologic
coffee table disease
o 10 month old o 7 month old
 Can stand by holding onto the  can transfer toys from one
side of a playpen or a low hand to the other
table, but cannot let o 8 month old
themselves down again
 Ø random reaching and
o 11 month old
ineffective grasping d/t
 Can “cruise” or move about advanced eye coordination
the crib or room by holding o 10 month old
onto objects such as the crib
 Can bring the thumb and first
rails, chairs, walls, and low
finger together in a pincer
tables
grasp
o 12 month old
o 12 month old
 can stand alone at least
 can hold a crayon well enough
momentarily
to draw a semi-straight line
 N - until 22 months to walk
 puts and takes outblocks in a
FINE MOTOR DEV’T container
 can hold a cup and spoon to
o 1 month old feed themselves fairly well
 strong Grasp reflex = they
hold their hands in fists so
tightly that it is difficult to
extend their fingers
o 2 month old
 Grasp reflex fades = holds an
object for a few minutes
before dropping it; hands are
held open, not closed in fists
o 3 month old
 reach for attractive objects in
front of them
LANGUAGE DEVELOPMENT  peek-a-boo, clap

o 1 month old o 11 month old

 small, cooing (dovelike)  cruise or walk by holding on to
sounds low tables
o 2 month old o 12 month old
 Can differentiate their cry  putting things in and taking
(sound of cry if hungry, wet, or things out of containers
lonely vary)
o 3 month old DEVELOPMENT OF SENSES
 nodding, smiling face, or a VISION
friendly tone of voice = squeal
with pleasure or laugh out  binocular vision – 1 -2 month old
loud o the ability to fuse two images into one
o 4 month old o e.g., able to regard an object in the
 very talkative, cooing, midline of their vision and follows it
babbling, and gurgling  hand regard – 3 month old
o 5 month old o e.g., hold their hands in front of their
 says some simple vowel face and study their fingers for long
sounds (e.g., “goo-goo,” “gah- periods of time
gah”)  object permanence – 10 month old
o 6 month old o an awareness that an object out of
 Learns to Imitate (usual words sight still exists
heard) o e.g., looks under a towel or around a
o 7 month old corner for a concealed object
 imitate vowel sounds well
HEARING
o 9 month old
 speaks a first word, e.g., “da-  1 month – marked sound reaction
da” for daddy  2 month – acute hearing awareness
o 10 month old  3 month – turns head to locate sound
 Masters another word such as  4 month – turns in the direction of distinct
“bye-bye” or “no.” sound
o 12 month old  5 month - can localize sounds downward and
 says two words to the side
PLAY  6 month – locate sounds above them
 10 month – recognize their name
o 1 month old  12 month – can easily locate sound
 watches a mobile over their
crib or playpen, parents’ faces TOUCH
o 2 month old  Infants need to be touched so they can
 stir and seem apprehensive at experience skin-to-skin contact.
the sound of a raucous rattle
o 3 month old TASTE
 can handle small blocks or
 Spits out a taste they do not enjoy
small rattles
o 4 month old  Solid foods are introduced – mealtime
 Rolls over SMELL
o 5 month old
 ready for a variety of objects  can smell accurately within 1 or 2 hours after
to handle birth
o 6 month old
 can sit steadily
o 7 month old
 can transfer toys
o 8 month old
 sensitive to differences in
texture
o 9 month old
 Creeping
o 10 month old
 EMOTIONAL DEV’T
 social smile
o e.g., when an interested person nods
and smiles at a 6-week-old infant, the
infant smiles in return
 eighth-month anxiety, or stranger anxiety
o fear of strangers
 By 12 months, most children have overcome
their fear of strangers and are alert and
responsive again when approached; dances

COGNITIVE DEVELOPMENT
PRIMARY AND SECONDARY CIRCULAR
REACTION by Piaget

 Primary Circular Reaction - 3rd month of life

o Grasps and mouths objects
o unaware of what actions they can
cause or what actions occur
independently
 Secondary Circular Reaction – 6th month
o 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
 PROMOTING ACHIEVEMENT OF THE
DEVELOPMENTAL TASK: TRUST VERSUS
MISTRUST
 PROMOTING NUTRITIONAL HEALTH OF AN
INFANT
RECOMMENDED DIETARY ALLOWANCES FOR
INFANTS
 1ST year
o high-protein, highcalorie intake
o caloric allowance is reduced to 100
calories per kilogram (45 calories per
pound) of body weight at the end of
the first year = Ø overweight
INTRODUCTION TO SOLID FOOD
 foods that require chewing should not be given
until 7-9 months
 extrusion reflex must completely fade
 Iron-fortified infant cereal + breast milk +
orange/formula juice
o aids in preventing iron-deficiency
anemia
 Vegetables - Vit. A
 Fruits – vit. A and C
 Meat – CHON, iron, B vitamins @ 9 months
 Egg yolk - @ 6 months
 Cereal – b vitamins and iron
ESTABLISHMENT OF HEALTHY EATING
PATTERNS
 Remind parents that there are no hard-and-
fast rules for infant feeding. The rules are only
guidelines based on what seems to work well
with most infants – individualize approach
 Feed according to child’s age and size.
 Choose methods of feeding according to cues.
 Provide a quite environment away from
distractions if infant is fatigued or
overstimulated, or may not eat well.
 Encourage parents not to force infants to eat if
they do not seem hungry.
WEANING
 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 at that
feeding.
 Choose a time favorable for infant.
SELF-FEEDING
 Let the infant practice holding spoon even
though much more is spilled. Parents
concerned with neatness can spread
newspapers, a plastic tablecloth, or a towel on
the floor around a high chair to catch most of
the dropped food.
A VEGETARIAN DIET
 Still continue breastfeeding or formula milk if
vegetarian diet is chosen for child.
 Because vegetarian diets are high in fiber,
infants who eat them may have more frequent
and looser than usual bowel movements.
PROMOTING INFANT DEVELOPMENT IN DAILY
ACTIVITIES
BATHING
 Except in very hot weather, an infant does not
need a bath every day.
 Seborrhea/cradle cap – do not wash head and
scalp frequently.
 Bath time should be enjoyable for an infant
and can serve many functions other than just
the obvious one of cleanliness.
DIAPER-AREA CARE
 change diapers every 2-4 hours
 At each diaper change, parents should wash
the skin with clear water or a commercial
alcohol-free (and perfume-free if an infant has
sensitive skin) diaper wipe and then pat or
allow the skin to air dry.
 zinc oxide or petroleum ointment – good
prophylaxis for urine or feces attachment
DENTAL CARE
 0.3 ppm fluoride – Ø tooth decay
 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 clean
environment for the arrival of first teeth.
 Brush teeth twice a day when the teeth erupts
 Ø toothpaste
DRESSING
 Clothes – easy to launder and simple
 Long pants – protect knee when creeping
 soft-soled shoes or merely socks or booties –
to keep warm
SLEEP
 10 to 12 hours of sleep at night and one or
several naps during the day.
 No pillows on crib
 Sleep in supine position – Ø SIDS
EXERCISE
 Expose to sun for Vit. D in early morning –
begin at 3 to 5 minutes the first day, a little
more the next day, and so on up to 15 to 20
minutes at a time.
 PROMOTING HEALTHY FAMILY FUNCTIONING
HEAD BANGING
SLEEP CONCERNS
TEETHING
 High fever, seizures, vomiting or diarrhea, as
well as earache are never normal signs of
teething = infection or disease
 Rubbing the gumline with a finger or a soft
cloth can help a new tooth erupt and so can be
CONSTIPATION
effective.
 over-the-counter medicines for teething pain,
containing benzocaine = could interfere with a
gag reflex
 liquid acetaminophen/paracetamol (Tylenol)
may be given for teething discomfort
THUMB-SUCKING
 thumb-sucking peaks at about 18 months
 Thumb-sucking is normal and does not
deform the jaw, nor cause “baby talk”, or any
speech concern in infancy.
 Thumbsucking @ school age - changes in
their dental arch that leads to asymmetric
concerns such as crossbite
PACIFIERS
 Benefits:
LOSE STOOLS
o comforting to an infant,
o they may aid in pain relief, and
o there is a decreased risk of SIDS
 Risks:
o acute otitis media (ear infection),
o negative impact on breastfeeding, and
o dental malocclusion (>2-3 years)
 When to use:
o If Infant still searches for something to
put in mouth after a complete
breastfeeding
o Colic crave sucking babies
o Stop the use after 3 months, or when
sucking reflex fades at 6-9 months.
 Head banging in this limited fashion—
beginning during the second half of the first
year of life to the preschool period,
associated with naptime or bedtime, and
lasting under 15 minutes—can be considered
normal = infant’s relaxation to fall asleep.
 Suggestions for eliminating or at least coping
with night waking:
o delay bedtime by 1 hour,
o shorten afternoon naps,
o do not responding immediately to
infants at night so infants can have
time to fall back to sleep on their own,
and
o provide soft toys or music to allow
infants to play quietly alone during this
wakeful time
 difficulty of falling or staying asleep = Ø long-
term sleep disorder
 When to check in a healthcare provider:
o hard bowel movements are present
beyond 5 or 6 months of age
o All infants with a history of true
constipation (exceedingly hard or no
bowel movements)
 Hirschsprung disease
o aganglionic megacolon, or lack of
nerve innervation to a portion of the
colon)
o + If no stool is present in the rectum of
a constipated infant on rectal
examination
 Chronic constipation
o occurs in children with congenital
hypothyroidism
 Breastfed - softer than those of formula-fed
infants
 Mother taking laxative – very loose stool
 Symptoms of celiac disease/malabsorption
syndrome, the inability to process gluten:
o Ø Digest fat and fat-soluble vitamins
with distended abdomen

COLIC
 paroxysmal abdominal pain that generally
occurs in infants under 3 months of age and is
marked by loud, intense crying
 S/S:
o legs are pulled up against their
abdomen, face become red and
flushed, fists clench, and abdomens
become tense.
o 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.
o Abdominal pain – 3 hours/day, 3
days/week
o Normal bowel movements
 What to do:
o burp every after feeding
o small, frequent feedings = Ø
abdominal distention
o pacifier
o (distractions) that stimulates sounds of
heartbeat
SPITTING UP
 Normal:
o smells at least faintly sour, but it
should not contain blood or bile
o spits up a mouthful of milk (rolling
down the chin) two or three times a
day (or sometimes after every meal)
 Pyloric stenosis
o an abnormally tight valve between the
stomach and duodenum
o milk is projected 3 or 4 ft away
 Gastroesophageal reflux
o lax cardiac sphincter and esophagus
allow for the regurgitation of gastric
contents into the esophagus
o spitting up is a large amount with each
feeding
DIAPER DERMATITIS/diaper rash
 d/t:
o Ø frequent changing of diaper
o feces is left in contact with skin
o ammonia—broken down from urine
 to do:
o Frequent diaper changing,
o apply an ointment,
o expose the diaper area to air
o let the baby sleep without diapers at
night
o Change the brand or type of diaper or
washing solution
 fungal (monilial or candidiasis)
o lesions that are bright red, with or
without oozing, that last longer than 3
days, and appear as red pinpoint
lesions
MILIARIA/prickly heat rash
 occurs most often in warm weather or when
babies areoverdressed or sleep in overheated
rooms
 pinpoint, reddened papules with occasional
vesicles and pustules surrounded by erythema
usually appear on the neck to ears, face and
trunk
 Ø bathe baby with baking soda in water
  reduce amount of clothes, or lower temp. to
eliminate sweat
BABY-BOTTLE TOOTH DECAY 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
 advise parents never to put their baby to bed
with a bottle
OBESITY IN INFANTS
 obese - greater than the 90th to 95th
percentile
 obesity d/t overingesting milk = iron-deficiency
anemia
 an infant should take no more than 32 oz of
formula daily and shouldn’t be breastfeeding
more often than every 2 hours.
 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.
 add a source of fiber
 Ø high amounts of refined sugars