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Growth and Development of the Infant

الكلية كلية التمريض     القسم قسم التخصصات التمريضية     المرحلة 3
أستاذ المادة عبد المهدي عبد الرضا حسن الشحماني       03/11/2017 09:29:25


growth and development of the infant
growth of the infant in the first year
assessment of normal growth & development of the infant
a number of methods have been proposed to assist the nurse to evaluate that growth progresses in a regular and orderly sequence.
tables, charts and grids are available to facilitate the nurse’s evaluation of physical growth.
in addition to the observation over a period of time, the periodic assessment of infants and children permits the early detection of growth deficiencies and pathologic processes, both organic and psychological.
[1]. growth during the intrauterine period.
the period of intrauterine life may be divided into two principle phases:
the embryonic period: this is considered to be the first 8 weeks during which the ovum is fertilized and beginning of the period of organogenesis.
the fetal period: 8th to 40th or 42nd week of gestation is distinguished by rapid growth and elaboration of function.
[2]. growth during the postnatal period. (newborn assessment)
1. growth of head:
the posterior fontanel closes at 1-2 months, triangular shape
the anterior fontanel closes at 12-18 months.
at birth: 3.5 - 4 cm. diamond shape.
at birth, head circumference is 33-35 cm.
at the end of the first year, it is 45 cm.
at the second year, it is 48 cm.
and the adult head circumference is 55 cm.
head circumference measurement
main fontanels on the head of the newborn
growth of chest and abdomen:
2. the chest and abdomen circumferences are equal in the first one to two years of life.
the abdomen tends to be prominent in infants and young children.
3. chest circumference:
at birth, head circumference is 2cm larger than chest circumference.
between age of 1 and 2 years both are equal.
after 2 years, the chest is larger than the head.
n.b: chest is usually measured at nipple line, with the subject sitting in the midway between inspiration and expiration.
4. growth in length:
during the first year in life, the infant gains in length roughly 2 cm/month during the first 6 months and 1.5 cm in the second 6 months.
*at birth: 48-50 cm
*at one year: 75 cm (increase by about 25 cm in 1st year)
*at two years: 87 cm (increase by about 12 cm in 2nd year)
*after 2nd year: 5cm
a formula can be used after the first year to estimate the length of the child:
(age in years x 5)+80=length in centimeters.
5. growth in weight:
there is an initial phase of loss of weight after birth for the following factors:
1. withdrawal of hormones from mother.
2. loss of excessive extra cellular fluid.
3. passage of meconium (faeces) and urine.
4. limited food intake.
most full terms regain their birth weight by the age of ten days. then the weight gain averages approximately 20 – 25 gm/day.
roughly the newborn gains ¾ kg/month during the first four months of life, ½ kg/month during the second four months and ¼ kg/month during the last four months of the first year.
thus the average birth weight (3.25 kg) is doubled between the 5th – 6th months and tripled by the end of the first year.
a formula can be used after that to calculate the weight:
(age in years x 2) + 8 = weight in kg.
b. physiological growth:
vital signs:
a - temperature: at birth newborn infant s temperature is slightly higher than the mother. it will droping immediately after birth in adjustment to delivery room temperature unless the newborn infant is kept warm immediately after birth.
temperature rises to normal within about 8 hours. temperature of newborn infant is usually 35.5 to 37.5 °c.
b - pulse: 120 to 150 / min. it is usually rapid and irregular.
c - respiration: 35 to 50 / min. it is usually irregular in depth, rate and rhythm.
d - cry with no tears.
senses:
a - touch: it is the most highly developed sense. it is most acute at lips tongue, ears and forehead.

b - vision:-
1 - pupils react to light.
2 - bright lights appear to be unpleasant to newborn infant

c - hearing.
1 - the newborn infant usually makes some response to sound from birth.
2 - ordinary sounds are heard well before 10 days of life. the newborn infant responds to sounds with a cry or eye movement, cessation of activity and / or startle reaction.
d - taste: well developed as bitter and sour fluids are resisted while sweet fluids are accepted.
e - smell: only evidence in newborn infant is his search for the nipple as he smells breast milk.
development:
a. - motor development:
- his movements are random, diffuse and uncoordinated.
2 - lack muscular strength to hold head steady and erect (his head sink down known as head lag).
3 - bodily functions and responses to external stimuli are carried out by reflexes.
** reflexes: the reflexes such as: moro-reflex, swallowing and gagging reflex. sucking reflex, grasp reflex , tonic-neck reflexe.
b- cognitive development:
the cognitive (intellectual) development of newborn infant is difficult to understand or observe it.
c- emotional development:
newborn infant expresses his emotion just through cry for hunger, pain or discomfort sensation.
d- social development:
cry is his contact with environment to communicate his physiological needs as hunger, throaty sounds show interest in human face.
infant normal growth & development
assessment of normal growth.
development is assessed as:
gross motor.
fine motor (sensory motor).
personal-social.
language.
cognitive.
normal infant
physical growth :
a - weight gain:
birth to 4 months - 3/4 kg / month.
5 to 8 months - 1/2 kg / month.
9 to 12 months - 1 /4 kg /month
he will double birth weight by 5-6 months and triple it by 10-12months of age.
normal infant
length
during the first year in life, the infant gains in length roughly 2.5cm cm/month during the first 6 months of age. average height is 65 cm at 6 months and 75cm at 12 months
increase by about 25 cm in 1st year
growth of head:
the posterior fontanel closes at 1-2 months.
the anterior fontanel closes at 12- 18 months.
cranial sutures
the sutures between the cranial bones do not ossify until later childhood
head circumference increases about 1.5 cm/month during the first 6 month of age, then 1/2cm /month during the second 6 months of age.
it is 43 cm at 6 months. at the end of the first year, it is 46 cm.




chest circumference:
at the end of the first year, chest circumference and head circumference are equal .
n.b: chest is usually measured at nipple line, for greater accuracy, take two measurements-one during inspiration and the other during expiration-and record the average .
skeletal growth
• the skeletal system is completely formed in cartilage at the end of 3 months of gestation
• bone ossification and growth occur during the remainder of fetal life and throughout childhood
• “bone age” can be determined by radiologic examination
• when bone age matches the child’s chronological age, the skeletal structure is maturing at a normal rate




eruption of the milk teeth (deciduous teeth)
the development of human dentition is a continuous process from 5th month in utero to maturity
by 5–7 months of life, the first deciduous teeth usually erupt
babies may differ in the timing of tooth eruption
teething is a normal continuous process of development and does not cause fever or respiratory problems
eruption of the milk teeth

circulatory system
fetal life
high levels of hemoglobin and red blood cells are
necessary for adequate oxygenation
after birth
oxygen is supplied through the respiratory
system
hemoglobin decreases in volume
red blood cells gradually decrease in number
until the third month of life
the count gradually increases until adult levels are reached
body temperature
follows the average normal range after the initial adjustment to postnatal living 35.5-37.5?c
respirations
average 30 ±10 breaths per minute according to the infant’s activity
gross motor development
1 month raises head momentarily
when prone, hips extended
2 months when prone raises chin off
couch
3 months in a prone position, he will rest on
forearm, keep head in midline, make
crawling movements with legs, arches
back, and supports head
when held erect.
4 months sits with support.
moro reflex disappears.

cont. gross motor
development.
6 months puts feet in mouth in supine
position. starts crawling.
7 months sits without support leaning forward
8 months rolls over from prone to supine.
sits well with no support
9-10 creeps and pulls self upright.
11 months stands unsupported.
12 months walks supported. toddles’ way
and cruises around furniture.
walks well.
starts crawling upstairs.
motor development in infants
9-11 months 12 months parachute walks well
creeping walks reflex 12 months
supported 6-12 months
fine motor development
1 months follows a moving object to midline. responds to sounds by blinking.
2 months hands often open. grasp reflex is fading
3 months hands mostly open. regards his hands. can hold a rattle if placed in his hand. follows 180° by eye.
4 months inspects and plays with hands. tries to reach objects with hands. grasps objects with both hands. can carry objects to mouth
5 months turns head to sound. brings hands together.
6 months able to reach object by hand and get it. grasps feet and pull to mouth
cont. fine motor development
7. months can transfer a rattle from hands to hand. reaches objects and brings them to mouth. has ambidextrous approach
8 months has beginning pincer grasp. can feed himself with a biscuit.
9 months tries picking things with fingers. preference for use of dominant hand
10 months crude release of an object beginning. grasps bell by handle.
11 months can use a thumb and finger to pick a cube. grasps by thumb and finger.
12 months can pick small objects “pellets "no longer puts objects in mouth. builds a tower of 2 blocks but fails. throw objects. holds cup to drink.
psychosocial development of the infant
first develops a sense of trust when fed on demand
by 2 months distinguishes mother or primary care giver
eventually learns that not every need is met immediately on demand
slowly becomes aware that something or someone separate from oneself fulfills one’s needs
gradually learns that the environment responds to desires expressed through one’s own efforts and signals such as crying bring the attention of mother
finally becomes aware that the environment is separate from self
by 3 to 4 months: smiles in response to smile of others .shows interest in other family members
by 7 to 8 months :shows fear of strangers (strangers anxiety).
by 9 to 10 months: play simple games with adults ,e. g. ‘’bye-bye’’. play with adult games such as ‘’peek-a-boo’’ by 10 months
’peek-a-boo’’ by 10 months
eye -to -eye contact, smiling and vocalization are the evidences of attachment between the infant and his parent, especially his mother. according to erickson, through the infant interaction with care-giver
(mainly the mother), especially during the feeding. he learns to trust others
through the relief of basic needs, i.e., to trust those who give pleasant sensations.
sense of trust will result also from being held, talked to, cuddled, warmed, and so... on.
if this sense of trust in others is not learned, the reverse, a sense of mistrust is. acquired
sequential stages of the cognitive development of the infant
first few weeks of life
actions such as kicking and sucking are reflex activities
next sequential stage
reflexes are coordinated and elaborated
latter part of first year
intentional movements to bring changes expects that certain results follow certain actions
cannot apply abstract reasoning understands through five senses
health promotion of the infant
nutrition requirements
promoting sleep
dental care
accident prevention
toy selection
supplemental nutrients that may be prescribed for the infant
vitamins c and d
iron
breast-fed infants need supplements of iron, as well as vitamin d
by 6 months of age, iron-rich foods are needed as supplements
fluoride
introducing solid foods
protect the baby’s clothes
give part of the formula before giving solids
start foods in small amounts, 1 or 2 tsp daily
prepare the food smooth, thin, lukewarm, and bland
offer new foods one at a time
allow 4 or 5 days before introducing another food to detect any allergy or intolerance
add chopped foods at about 9 or 10 months of age (if teeth have erupted)
self-feeding
7 or 8 months of age
may grab spoon from the caregiver, examine it, and mouth it
may stick fingers in the food to feel the texture and to bring it to the mouth for tasting
this is an essential, although messy, part of the learning experience
after preliminary testing
the infant’s next task is to try self-feeding
components of health promotion and maintenance of the infant
routine checkups
immunizations
family teaching
education about accident prevention
well-baby visits
occur at 2 weeks, and at 2, 4, 6, 9, 10 and 12 months
the nurse collects data regarding:
growth and development (weight, height, head circumference)
nutrition and sleep
the caregiver–infant relationship
any potential problems
immunizations are given to guard against disease
family teaching is provided
health protection of the infant
immunization
bcg (tuberculosis)
hepatitis a and b
polio
dpt (diphtheria, pertussis, and tetanus
measles
german measles (rubella)
mumps
varicella (chickenpox)
haemophilus influenza meningitis (hib)
pneumococcal disease
injury prevention
falling down
aspiration
poisoning
suffocation
burns
motor vehicle accidents
injury prevention
1. accidental injuries are a major cause of death during infancy common causes include:
a) falls off beds and down stairs
b) aspiration of small objects
c) poisoning from overdose of medications or ingestion of toxic household substances
d) suffocation due to unintentional covering of the nose and mouth, pressure on the throat or chest, or prolonged lack of air such as in a closed parked car
e) burns from hot liquids or foods, scalding bath water, excessive sun exposure, or electrical injury
f) motor vehicle accidents, most commonly linked to improper use or non-use of an infant car seat.
nursing considerations associated with accident
prevention include:
a) instructing parents to maintain a safe environment for the infant by keeping breakables, sharp objects, and harmful substances out of reach.
b) alert parents to age-specific potential injury sources and accident-prevention strategies.
c) encourage parents to avoid repetitive negative expressions for the sake of safety and to stress positive aspects of the infant s behavior, such as playing with suitable toys.
health promotion of the infant
a. toy selection
infant toys serve several purposes, including:
a) stimulation for psychosocial development
b) diversion for relieving boredom, pain, and discomfort
c) a means of communicating and expressing feelings
d) aid in the development of sensor motor skills
2. infant toys should be safe and age appropriate.
examples of safe, age-appropriate infant toys include:
a) age 1 to 3 months: mobile, music box, stuffed animal with no detachable parts, and rattle
b) age 4 to 6 months: squeeze toys, busy box, and play gym
c) age 7 to 9 months: various cloth textures, splashing bath toys, blocks and balls
d) age 10 to 12 months: durable books with large pictures, building blocks, nesting cups, large puzzles and push-pull toys.
3-toy safety considerations include.
a) no sharp part edges
b) no detachable parts (e.g. wheel tops)
b. sleeping patterns
1. during the first month after birth, an infant sleeps most of the time not spent in eating. with age, daily sleep time decreases as awake and alert times increase.
2. in the first year of life, an infant typically takes morning and afternoon naps.
3. bedtime rituals began in infancy help prepare the infant for sleep and prevent future bedtime and sleeping problems.
4. parents should establish that the infant s crib is for sleeping, not for playing, and prevent reinforcing wakefulness during the night by picking up the infant whenever he or she wakes and cries.
nutrition requirement
1. consistent oral intake of sufficient calories provided by a caring parent sets a positive pattern for an infant s future eating behaviors.
2. feeding schedule suggestions for an infant from birth to age 6 months receiving breast milk or formula on demand include:
a) age 1 month: 4 oz(1oz:30 ml). six times a day
b) age 2 months: 4 oz five times a day (one night feeding is eliminated)
c) age 5 months: 5.8 oz five times a day
d) age 6 months: 4.2 oz five times a day (as solid food feedings begin, milk feedings decrease)
3. at age 6 to 12 months, solid food becomes appropriate because of the infant s developmental readiness (e.g. the infant can assume an upright position, the extrusion reflex lessens, and the digestive tract matures
4. solid food should be introduced progressively: first, cereal with iron, followed by pureed fruits, then vegetables, then meats. each new food should be added to the infant s diet separately at intervals of 4 to 7 days each to determine allergies.
5. suggestions for complementary feeding include:
a) eliminate one breast feeding at a time for one cup feeding
b) begin practicing with sips from a cup at age 5 to 6 months, when motor ability has developed.
c) introduce juice in a cup to help prevent dental caries.
dental health
1. an infant s primary (deciduous) teeth erupt at about age 6 months. assessment guide: age of child in months minus 6 months equals number of primary teeth.
2. clean an infant s teeth with a damp cloth brushing is too harsh for the infant s tender gums.
3. assess the need for a fluoride supplement consult with the physician.
4. despite a widespread belief to the contrary, fever, vomiting, and diarrhea usually are not associated with teething but rather indicate illness.
nursing care during hospitalization of the infant
encourage continued stimulation, empathetic care, and loving attention from family caregivers
encourage caregivers to feed, hold, diaper changing , and participate in their infant’s care as much as they can
collect data regarding the needs of the caregivers and the infant and plan care with these needs in mind
identify and acknowledge the caregivers’ apprehensions and develop plans to resolve or eliminate them
make arrangements for rooming-in for the family caregiver

have a nice day


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