Chapter 25 Growth and development of the Infant

The mother of a 6-week-old infant reports she doesn't know if her child recognizes her face yet. What response by the nurse is most appropriate?

"Since about 4 weeks of age your child has been able to recognize those who are around him often." At 1 month of age the infant can recognize by sight the people he or she knows best. Telling the child's mother that this will come with time is not correct as this developmental milestone has already occurred. Telling her not to worry minimizes her questions and concerns.

A parent asks the nurse if the 2-month-old infant can have bananas yet. The nurse would respond and educate the parent on the nutrition stages of infants by which response?

"You can try bananas 2 or 3 months from now." The nurse will educate the parent to wait 2 to 3 months, because solid foods are not recommended for infants at 2 months of age. The age of 4 to 6 months is when it is recommended to introduce solid foods. In 1 month, the infant will be only 3 month of age. The other responses will not help the parent determine the appropriate answer.

The nurse is assessing a 1-year-old at the well-child annual visit and notes the child is meeting the growth parameters. After noting the birth weight was 8 pounds (3.6 kg) and length was 20 inches (50.8 cm) long, which measurements reflecting height/weight would the nurse expect to document for this visit?

24 pounds (10.8 kg) and 30 inches (75 cm) By 1 year of age, the infant should have tripled his or her birth weight and grown 10 to 12 inches (25 to 30 cm). If this infant was 8 pounds (3.6 kg) at birth, at 1 year, this child should weigh 24 pounds (8 x 3 = 24) and grown to 30 to 32 inches (20 + 10 to 12 = 30 to 32 inches). Most of the growing occurs during the first 6 months with the infant's birth weight doubling and height increasing about 6 inches (15 cm). Growth slows slightly during the second 6 months but is still rapid.

A nurse is preparing to administer vaccines to a 4-month-old infant. Which vaccines will the nurse administer? Select all that apply.

Haemophilus B inactivated poliomyelitis diphtheria, tetanus, and pertussis pneumococcal The nurse will administer Hib, IPV, DTaP, and PCV to a 4-month-old infant.

The nurse is educating the mother of a 6-month-old boy about the symptoms for teething. Which symptom would the nurse identify?

Increased biting and sucking The nurse would advise the mother to watch for increased biting and sucking. Mild fever, vomiting, and diarrhea are signs of infection. The child would more likely seek out hard foods or objects to bite on.

The nurse conducting a 6-month well-baby check-up assesses for the presence/absence of the asymmetric tonic neck reflex. At this age the reflex:

should have disappeared. This primitive (not protective) reflex should be present at birth and disappear around age 4 months.

A 12-month-old seen at a walk-in clinic weighed 8 pounds 4 ounces (3750 g) at birth. Weight now is 20 pounds 8 ounces (9300 g). The nurse determines:

the child weighs less than expected for age. Birth weight should triple by 12 months. The child should weigh near 24 pounds 12 ounces (11250 g). The child is underweight for age.

A newborn requires skin care that includes bathing. Besides hygiene, what is another reason for bathing the newborn?

Bathing is a time for bonding with the parents. The parents can use bath time for bonding with their newborn. This can be done with talking, cooing, and singing. Bath time should be slow-paced and nonstressful. Newborns prefer interacting with parents over toys and they love to watch people's faces. Bathing can help prevent infection, but it is a secondary response. Using soaps on the skin tends to dry the skin, not moisten it. After bathing, lotion can be applied. It is soothing to the baby and keeps the skin softened.

The nurse in a pediatric clinic is reviewing the chart of an infant who is 12 months old. The infant weighed 8 lb 3 oz (3720 g) at birth. What does the nurse anticipate the infant's weight to be in kilograms if the infant meets normal growth expectations? Record your answer using one decimal place.

11.2 Most infants triple their birth weight by 12 months of age. If the infant weighed 8 lb 3 oz (3720 g) at birth, triple that weight at 12 months would be 11160 g. 100 g = 1 kg; 11160 g = 11.16 kg, rounded to 11.2 kg.

The nurse is assessing the oral cavity of a 6-month-old child. When palpating the location in which the first primary teeth erupt, which location is being assessed?

Lower central gumline The lower central incisors are usually the first to appear, followed by the upper central incisors.

During the first visit to the pediatrician's practice the nurse is performing an admission interview and assessment of a 4-week-old infant. The mother states, "I am sure my baby girl knows my smell because she is much more settled in my arms rather than my mother's arms when she is upset." What is an appropriate response by the nurse?

"You may be right, since infants can sense their mother's smell as early as 7 days old." The sense of smell develops rapidly: the 7-day-old infant can differentiate the smell of his or her mother's breast milk from that of another woman and will preferentially turn toward the mother's smell.

A 9-month-old has been brought to the clinic for a well-child visit. The mother reports her son was born 6 weeks prematurely. During the data collection, the child's mother reports her son seems to be a few months "behind" what she recalls from her older children. What is the best response by the nurse?

"Delays are normal when a child is premature." When infants are born prematurely delays may be noted. When assessing the growth and development of a premature infant, use the infant's adjusted age to determine expected outcomes. To determine adjusted age, subtract the number of weeks that the infant was premature from the infant's chronological age. Plot growth parameters and assess developmental milestones based on adjusted age. Delays will not necessarily be resolved by the age of 6 months. While the mother should talk with the physician about concerns, this is not the best initial response by the nurse.

A first-time mother, who is breastfeeding, phones the clinic nurse because she is concerned about her 3-month-old infant's stools. Which statement by the mother would alert the nurse to further assess the situation?

"The stools are foamy and smell terrible." Stools from a breastfed infant are different than from those of a formula-fed infant. The breastfed infant has more frequent bowel movements, the stools appear yellow and seedy, and there is little or no odor to the stool. Foamy or foul-smelling stools may indicate a digestive problem or illness. The health care provider or nurse practitioner should be contacted. All the other statements describe normal stooling for this infant.

The mother of a newborn reports she does not think her baby likes his formula since he spits up after only taking a small amount. Which response by the nurse is most appropriate?

"Your baby's stomach is small and can only hold about 1/2 to 1 ounce at birth." At the time of birth an infant's stomach can only hold 1/2 to 1 ounce. This will gradually increase. While it is true that the infant does not eat much this does not meet the educational needs of the mother and is not the best response. Burping is a part of normal newborn feeding practices but is not the best response. There is no indication there is a milk intolerance from the information reported.

Infant development is best described by which statement?

Development proceeds cephalocaudally. Growth and development both proceed from head to toe, or in a cephalocaudal sequence. The baby needs first to learn to lift the head. Once that developmental milestone has been achieved then progression can occur to rolling over and then learning to sit. Development proceeds in a proximodistal fashion. Skills are learned in a gross motor fashion before developing fine motor skills. Infants may develop skills at different ages but the process is always sequential. Unless there are other problems to interfere with development, all children will develop in the same manner.

The nurse is assessing the 10-month-old infant. The nurse notes the anterior fontanel has closed. What initial action by the nurse is indicated?

Document the findings as normal. The anterior fontanel most often closes between 12 and 18 months of age. It may normally close as early as 9 months of age. The closure of the fontanel at 10 months of age, while somewhat early, does not signal any health issues for the infant.

The nurse is assessing the oral cavity of a 4-month-old infant. Which finding is consistent with a child of this age?

No teeth Normally infants are not born with teeth. Occasionally there are one or more teeth at birth. These are termed natal teeth and are often associated with anomalies. The first primary teeth typically erupt between the ages of 6 and 8 months.

A new mother reports that she is exhausted and that the little sleep she gets is determined by her baby. Which suggestion should the nurse prioritize to help the mother establish healthy sleeping patterns in her infant?

Use the crib for sleeping only, not for play activities. A consistent bedtime routine is usually helpful in establishing healthy sleeping patterns and in preventing sleep problems. Using the crib for sleeping only helps the child associate the bed with sleep. Depriving the baby of sleep during the afternoon or evening will make the baby over-tired and less able to establish a healthy sleeping pattern. While letting a baby cry for a while is acceptable, this does not promote consistency in the baby's sleeping pattern.

Anticipatory guidance for an infant for the 4th month should include the fact that the infant will be able to achieve which developmental milestone?

be able to turn over onto the back At four months of age, the infant is able to lift the head and look around. The infant can roll from prone to supine. When being pulled up, the head leads. The 4-month-old infant can make simple vowel sounds, laugh aloud, and vocalize in response to voices. A fear of strangers does not occur until the child is older; a 4-month-old infant has not developed emotionally to have "moody" periods and is dependent on parental care.