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What factors influence growth and development? What is the most important factor?
- Genetics
- Environment
- Culture
- Nutrition: most important factor
- Health Status
- Play
- Family
- Parent Attitudes
- Client Rearing Philosophies
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What age encompasses infancy?
1mo - 1yr
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Describe how an infants weight, height, head circumference, and fontanels change within the first year
- Posterior fontanel closes by 6-8 wks, anterior fontanel closes by 12-18 mo
- Weight should be doubled by 6 mo, triples by 1 yr with a weight gain of 5-7 oz per ounce
- Height increase by 50% by 1 yr
- Infants head circumference increases 0.6 in per month for first 6 mo, then 0.5 until 1 yr
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Physically, what should an infant accomplish by the time it is 12 mo old?
- Head and chest circ equal by 1 yr
- 6-8 teeth
- Post fontanel closed and ant font closing
- Babinski reflex may last up to 2 yrs
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At what age does teething begin? What supportive measures can be used during this time?
- 6-8 teeth by 1 yr with first teeth at 6-10 mo
- Use cold teething rings
- Rinse with cold wash cloth
- Acetaminophen or Ibuprofen (>6 mo old) should not be used for more than 3 days
- Do not prop bottles
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How does the neurological system adapt during the first year?
- Brain grows rapidly, 2.5x weight by 12 mo
- Primitive reflexes diminish by 4 mo (moro, tonic neck, rooting, grasps)
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How does the Respiratory system adapt during the first year?
- Size of resp tract increases
- Vulnerable to respiratory difficulties
- Elastic trachea
- Eustachian tubes are short and horizontal, putting infants at risk for otitis media
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How does the cardiovascular system adapt within the first year?
- Shunt close
- Heart doubles in size and weight by 1 yr
- Heart rate slows and BP rises
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How does the immune system adapt within the first year?
- Passive immunity for 3-4 mo
- Begins production of immunoglobulins
- Has approx 4% of adult levels by 1 yr
- Max protection not avail until early childhood
- Due to short RBC lifespan, physiologic anemia occurs at 2-3 mo of age
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How do the gastrointestinal system and the liver adapt within the first year?
- Stomach capacity increases to 200 ml by 12 mo
- Enzymes for digestion increase (Vit K shot at birth prevents hemorrhage due to lack of clotting enzymes in gut)
- Fat digestion by 4-5 mo
- Complex carbs at 4-6 mo
- The Liver is the most immature of all systems
- Liver has a decreased capacity for gluconeogenesis, formation of plasma proteins and ketones, and storage of vitamins
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Why are body fluids important for the infant (include renal function)?
- Infants have increased extracellular fluids (40% of body) which predisposes them to rapid dehydration
- Renal system has low glomerular filtration rate, putting the infant at risk for f/e imbalances
- Should have 6-10 wet diapers a day
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What is the formula to calculate fluid resuscitation for the infant?
- 100 ml/kg/hr up to 10 kg
- For each kg over 10, add 50 ml/kg up to 20 kg
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What are some motor milestones of the infant by month?
- 1 mo: demonstrates head lag and has grasp reflex
- 2 mo: lifts head off mattress when prone, holds hands in open position
- 3 mo:Lifts head, hands open position, hold rattle by will not reach
- 4 mo: rolls from back to side, places objects in mouth, plays by putting blanket over face
- 5 mo: Rolls from stomach to back voluntary palmar grasp
- 6 mo: rolls from back to belly, holds bottle
- 7 mo: bears full weight on feet, sits leaning forward on hands, transfers objects from one hand to the other
- 8 mo: sits unsupported, begins crude pincer grasp
- 9 mo: pulls self into standing position, creeps on hands and knees, has crude pincer grasp
- 10 mo: pincer grasp, moves from prone to sitting
- 11 mo: walks holding onto something, placed objects in container, neat pincer grasp
- 12 mo: sits from standing position, tries to build 2 block tower w/o success
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What Piaget stage is the infant in?
- Sensorimotor stage (birth to 24 mo) progresses from reflexes to simple repetitive to imitative activities
- Ability to differentiate self from others (separation)
- Develops object permanence by 9mo
- Mental representation of symbols
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What are some cognitive milestones for the infant?
- 2 mo: social smile in response to stimuli
- 6 mo: object permanence beginning
- 7 mo: increased stranger anxiety (plays peek a boo)
- 10 mo: object permanence is developed
- 12 mo: searches for object even if it has not been hidden, but only searches where object was last seen; recognize they are distinct from parents
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How does the sensory system adapt during the first year?
- Eye growth is rapid and acuity improves
- Preference for high contrast colors, such as black and white
- Uncoordinated eye movements after 4-6 mo needs eval (binocularity by 4mo)
- Hearing is relatively acute, even at birth
- With myelinization, hearing response becomes more specialized
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What are some sensory milestones for the infant?
- 1 mo: able to fixate on moving objects
- 3 mo: follows objects to 180 degrees (located sound by turning head and looking in same directions)
- 7 mo: can fixate eyes on very small objects
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How does language develop for the infant?
- Can understand more than they can express
- By age 1, can comprehend "no" and say 3-5 words
- Siblings can enhance development
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What are some language milestones for the infant?
- 2mo: vocalizes; coos
- 3 mo: squeals to show pleasure
- 4 mo: laughs out loud
- 6 mo: imitates sounds; babbles one syllable
- 7 mo: babbles 2 syllable sounds
- 10: says mama, dada with meaning
- 12 mo: says 3-5 words besides mama or dada
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Describe what Freudian stage and stag of Erikson the infant is in
- Erickson: Trust vs Mistrust
- Freud: Oral Stage
- Parent-infant attachments begin in utero (reactive attachment disorder is most commonly diagnosed by age 5)
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What play activities appeal to the infant?
- Involves sensorimotor skills and is a major socializing agent
- Pictures
- bright colored toys
- mirrors
- mobiles
- nesting cups
- *Solitary play
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Describe separation anxiety and stranger anxiety
- Separation anxiety: begins4-8 mo, by 12 mo they can anticipate parent leaving and will protest
- Stranger anxiety: increases around 7 mo (lack of stranger anxiety may indicate FTT)
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What are the different infant temperaments?
- Difficult child: respond best to structured routine
- High Distractable child: responds to soothing measures
- High Activity Child: provide opportunities for increased gross motor activities
- Slow to warm up child: needs additional time to adjust to new situations
- Easy Child: sometimes easy to forget their needs
- *child rearing practices related to temperment
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What is an infant's sleep pattern like?
- sleep/wake styles are established by 3-4 mo and need to learn self regulation behaviors
- Encourage bed time rituals early and place awake infant in their own crib
- Infants who learn to fall asleep on their own have longer periods of sleep than those whose parents put them to sleep
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What is the concept of graduated extinction?
- Used to develop independent sleeping pattern
- When babies cry in crib, wait and then comfort them and then leave. This process will need to be repeated in order to promote independent sleeping habits
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Describe the necessary nutrition for a newborn
- Breast milk provides complete nutrition for the first 6mo
- Formula should be iron fortified if being formula fed, iron supplements can be given to all after 6 mo
- Solid foods can be introduced starting at 4-6 mo and should be introduced 5-7 days apart to assess for allergies
- Cow's milk, eggs, wheat, peanuts/butter, citrus & honey should not be given until 1 yr
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What are common safety concerns for the infant?
- Suffocation
- MVA
- Drowning
- Aspiration of foreign objects
- Falls
- Poisoning
- Burns
- *Constant supervision, vigilance, and awareness are essential to prevent injuries & death
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What vaccines are given during the first year of life (vaccine schedule)?
- Birth: HepB
- 2 mo: Hep B, Rotavirus, DTap, HiB, pneumococcal, Inactivated polio virus
- 4 mo: Rotavirus, DTap, HiB, pneumococcal, Inactivated polio virus
- 6 mo: Hep B, Rotavirus, DTap, HiB, pneumococcal, Inactivated polio virus and Flu vaccine (dead)
- 12 mo:pneumococcal, HiB,
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Who creates the vaccine recommendations?
- Advisory Committee on Immunization Practices (ACIP)
- Center for Disease Control & Prevention (CDC)
- Committee on Infectious diseases of the American Academy of Pediatrics (AAP)
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What is VAERS and what is VIS?
- VAERS is the vaccine adverse event reporting system where any adverse effects can be reported
- VIS is a vaccine information statement that every parent needs to be given so that they can give informed consent
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