Chapter 25Growth and Development of the Newborn and Infant

Fine motor 5 months

Grasps rattle

Fine motor 8 months

Gross pincer grasp (rakes)

Fine motor 3 months

Holds hand in front of face, hands open.

Gross motor skills develop in

Cephalocaudal fashion

Gross motor 9 months

Crawls, abdomen off floor.

True/False Avoid use of baby walkers for infant safety.

True.

Infant consistency and frequency of stools

-Meconium as newborn. -Change over the first year of life based on intake (breast or bottle, then solid foods).

IgG

-Most abundant type of antibody, is found in all body fluids and protects against bacterial and viral infections. -Maternal stores transmitted to infant.

Compared to the adult, the infant's Respiratory System

-Nasal passages are narrower -Larynx is more funnel shaped -Trachea and chest wall are more compliant -Bronchi and bronchioles are shorter and narrower -Alveoli are significantly fewer in number -Respiratory rate is fast (decreases as the child matures)

Systems immature at birth, maturing somewhat over first year:

-Neurologic -Respiratory -Cardiovascular -Gastrointestinal -Renal -Hematopoietic -Immunologic -Integumentary

Gross motor 2 months

-Raises head and chest, holds position -Improving head control.

Gross motor 12 months

-Sits from standing position -Walks independently

For growth measure:

-Weight -Length -Head circumference -Plot each on standardized growth chart -Also plot weight for length

Adding solids:

-When tongue extrusion reflex disappears -Soft or mashed until teeth erupt -1 new food every 3 to 4 days (observe for allergy) -May require 20 exposures to accept the food

At birth the newborn's head and chest circumference were measured. The nurse knows that the head should be about: 2 in larger than the chest. 1 in larger than the chest. ½ in smaller than the chest. Equal in size to the chest.

1 in larger than the chest. The head is about 1 inch (2.5 cm) larger than the chest and will grow rapidly during the first 6 months.

Growth

Increase in physical size.

infants have _________ absorption of topical medications

Increased

Malnutrition

Increased functionality of body systems or developmental skills.

Colic

Infant who isn't sick or hungry cries for more than 3 hours a day, more than 3 days a week, for more than 3 weeks.

Gross motor 1 month

Lifts, turns head when prone, head lag.

Peripheral capillaries in infants

*Closer to the surface of the skin.* -Newborn and young infant more susceptible to heat loss. -Thermoregulation becomes more effective over first few months.

Infant teeth

*Emerge in a predictable pattern.* First primary teeth (incisors) erupt at age 6 and 8 months.

The parent of an infant questions the nurse about the baby's teething. The nurse provides client education. Which statement by the parent indicates understanding of the information provided? "My baby's first tooth will likely appear between 5 and 6 months." "My baby will most likely have the upper middle teeth come in first." "The first teeth that will likely appear are the lower incisors." "By 1 year my baby should have about three teeth."

"The first teeth that will likely appear are the lower incisors." Teeth will begin erupting between 6 and 8 months. Traditionally, the first teeth to erupt will be the lower incisors, followed by the upper incisors. By the age of 12 months, the infant will have between 4 and 8 teeth, if progressing normally.

Introduce cup at

6 months

Infant IgM level reaches adult level by

9 months of age

Ages and Stages Questionnaire (ASQ)

Age: Birth-6yrs *Definition:* Assess communication, gross motor, fine motor, personal-social, and problem-solving skills *Nursing Implication:* A parental-report screening tool, scored completion to determine child's progress in each of the developmental areas.

Palmar grasp

An infant reflex that occurs when something is placed in the infant's palm; the infant grasps the object. *Disappears at 4-6 months*

Parachute reflex

Appears by 7 to 9 months; a protective arm extension that occurs when an infant is suddenly thrust downward when prone.

Plantar reflex

Elicited touching the soles of the feet. toes curl downward. *Disappears at 9 months*

The nurse is providing anticipatory guidance regarding the respiratory development of a 4-week-old infant for the parent. Which action is accurate? Telling the parent that abdominal breathing disappears by 9 month of age Explaining to the parent the risk for infection is high due to the lack of antibodies Informing the parent that the respiratory system reaches maturity similar to the adult's by 12 months of age. Advising the parent that the infant's usual respiratory rate should slow to about 20 breaths per minute by age 6 months

Explaining to the parent the risk for infection is high due to the lack of antibodies Attributing frequent infections to a lack of antibodies is accurate. The infant lacks IgA in the mucosal lining of the upper respiratory tract.

Fine motor 11 months

Offers objects to others and releases them.

Breast- and bottlefed infants feed

On demand.

To decrease risk of SIDS, place newborns and young infants

On their back to sleep.

As primitive reflexes disappear, ___________ develop.

Protective reflexes

Fine motor skills develop in

Proximodistal fashion

Gross motor 10 months

Pulls to stand, cruises.

Gross motor 3 months

Raises head to 45 degrees in prone, slight head lag.

Galactosemia

Recessive genetic disorder; characterized by body's inability to tolerate galactose. *Cannot breastfeed.*

Development

Sequential process of skill attainment.

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: Is expected to appear within 1 month. Is a protective reflex and retained for life. Should have disappeared. Should be pronounced and easy to elicit.

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

Gross motor 7 months

Sits alone with some use of hands for support.

The nurse is assessing development of a 4-month-old infant during a well-child visit. Which observation needs further investigation? The infant makes babbling sounds, coos, and smiles. The infant shows interest in looking at near or high-contrast objects. The infant responds to the parent when the infant sees him or her but not at other times when the parent is near. The infant turns the head in the direction of a squeak toy.

The infant responds to the parent when the infant sees him or her but not at other times when the parent is near. If the infant does not respond to the parent's voice, it could indicate hearing loss.

parent is discussing the 10-month-old child with the nurse. Which comment indicates a need for teaching? "I wipe my child's teeth every day with a fresh washcloth." "My child gets a few sips of apple juice each day from a regular cup, not a sippy cup." "We have safety gates at the top and bottom of our stairs." "My child loves being in the walker and 'zips' around the house."

"My child loves being in the walker and 'zips' around the house." Walkers are safety hazards and not recommended by the American Academy of Pediatrics. They cause falls plus promote the ability to reach items on surfaces otherwise inaccessible.

A young breastfeeding parent calls the telephone nurse because the parent is concerned about the 3-month-old's stools. Which information indicates a possible problem? "The infant's stools are loose and seedy." "The infant hasn't had a stool for 3 days." "The infant grunts and squirms when filling the diaper." "The stools are foamy and smell terrible."

"The stools are foamy and smell terrible." This may indicate a digestive problem or illness.

Infant weight

-Average 3,400 g (7.5 lb) at birth -Doubles by 4 to 6 months -Triples by 12 months

Infants have a high hemoglobin level at birth

-Decreases over first 2 to 3 months. -Stabilizes by 6 to 9 months (With adequate iron intake).

Stranger anxiety

-Develops around 8 months of age. -Infant recognizes self as separate from others.

Fine motor 4 months

Bats at objects

Infant's skin relatively ________ than adults

Thinner.

Infant length

-Average 50 cm (20 in) at birth -Increases by 50% by 12 months

Fine motor 6 months

Releases object in hand to take another

The parents of a 4-day-old infant report concern about the infant's weight loss. What is the best response by the nurse? "With appropriate nutrition weight gain will commence with a return to the birth weight within 2 weeks." "Weight loss after birth is normal." "Babies may lose up to 10% of their body weight in the first month of life." "Babies will begin to rapidly regain weight and will double birth weight around 6 months of age."

"With appropriate nutrition weight gain will commence with a return to the birth weight within 2 weeks." The average newborn weighs 7 lb 8 oz (3,400 g) at birth. Newborns lose up to 10% of their body weight over the first week of life. The average newborn then gains about 30 g per day and regains his or her birthweight by 10 to 14 days of age. Most infants double their birth weight by 4 months of age and triple their birth weight by the time they are 1 year old.

Average infant pulse rate

-120 to 140 in the newborn -Decreases to about 100 in the 1 year old

Infant head circumference

-35 cm (13.5 in) at birth -Increases by about 10 cm by 12 months

Infant Blood pressure

-Average of 60/40 in the newborn -Steadily increases to 100/50 in the 12 month old

Specialized growth charts are available

-Children with Down syndrome -Breastfed infants

Early vision warning signs

-Crosses eyes most of the time at age 6 months -Does not track (follow) an interesting item -Does not try to study an object in the visual field

Separation anxiety

-Develops in later infancy. -Infant becomes distressed when parent leaves.

Breastfeeding causes a decreased incidence in

-Diarrheal diseases -Asthma -Otitis media -Bacterial meningitis -Botulism -Urinary tract infections

Warning Signs: Problems with Language Development

-Does not make sounds at 4 months of age -Does not laugh or squeal by 6 months of age -Does not babble by 8 months of age -Does not use single words with meaning at 12 months of age (mama, dada).

Early hearing warning signs

-Does not respond to loud noises -Does make sounds or babble by 4 months of age -Does not turn to locate sound at age 4 months

Infant sleep by 4 months:

-Establish a bedtime routine -Facilitates relaxation and predictable sleep time

Fine motor 12 months

-Feeds self with cup and spoon -Makes simple mark on paper -Pokes with index finger

Fine motor 10 months

-Fine pincer grasp. -Puts objects into container and takes them out.

Infant Genitourinary System

-Frequent urination -Low specific gravity -All renal functions reduced as compared to adult -More susceptible to dehydration (Poorer urine concentration ability).

Breastfeeding Benefits for Mothers

-Increased bonding with infant -Lessens maternal blood loss postpartum -Decreases risk of ovarian and premenopausal breast cancers. -Possible delay of ovulation -Economic advantage, convenience of use

Breastfeeding Benefits for Infants

-Increased bonding with mother -Immunologic protection -Possible enhancement of cognitive development -Decreased incidence of obesity later in life

Infant sleep by 3 months:

-Infants sleep 7 to 8 hours per night -Take 2 to 3 naps per day

Infant sleep by 12 months:

-Infants sleep 8 to 12 hours per night -Take 2 naps per day

Infant Integumentary System

-Lanugo and vernix may be present. -Acrocyanosis is normal; decreases over the first few days of life.

Infant/Child temperament ranges between

-Low to moderately active, regular, and predictable. -Highly active, more intense, and less adaptable.

Newborns sleep up to

20 hours per day (waking only to feed).

Heart doubles in size by

The 1st year.

The nurse is helping the parent of a 5-month-old infant understand the importance of developmentally appropriate play. Which one of the toys best meets the needs of this child? Pots and pans from the kitchen cupboard. A yellow rubber duck for the bath. A push-pull toy. Brightly colored stacking toy.

A yellow rubber duck for the bath. The rubber duck is most appropriate. It is safe, visually stimulating while bobbing on the water, and adds pleasure to bath time.

The nurse is teaching the parent of a 5-month-old boy who is concerned about thumb sucking. What should be included in the teaching plan? (Select all that apply.) A. Assuring the parent this behavior won't cause malocclusion. B. Advising the parents to draw attention to the issue as this may help child learn to stop. C. Telling the parent this behavior usually decreases by 6 to 9 months of age. D. Advising the parent this behavior is a form of self-comfort. E. Informing the parent that thumb sucking occurs more often during periods of stress.

A, B, C, E

The infant in the exam room has these signs and symptoms. Which will the nurse attribute to teething? (Select all that apply.) A. Irritability and awakening from sleep B. Refusing to eat C. Increased sucking on hands D. Fever and diarrhea E. Drooling and biting

A, B, C, E Fever and diarrhea are considered signs of illness, not teething.

Infant Development Inventory (IDI)

Asks parents to describe their baby, report the infant's activities, their questions and concerns about their baby's health, development, behavior, etc., and how they are doing as parents. They are asked to report their child's developmental skills in five areas - social, self help, gross motor, fine motor and language - by using the Infant Development Chart on the backside of the parent questionnaire

Fine motor 9 months

Bangs objects together.

Premature Infants

Born at <36 weeks' gestation. *Problems:* -Significantly immature respiratory and nervous systems -Lack of adequate iron stores -Lack of adequate immunoglobulins -Immature gastrointestinal system -May not be capable of oral feeding -May not tolerate enteral feeding

Best type of nutrition for newborns and infants?

Breastfeeding

Infant IgG level reaches adult level

By 12 months of age

Gastrointestinal System: Infant stomach

Capacity increases as the infant grows.

The nurse is preparing a list of abilities of 10-month-olds to use in teaching a parenting group. Which ability should appear at this age? Cruises around furniture. Sits from standing position. Uses two or three words with meaning. Feeds self with spoon (but spills).

Cruises around furniture.

Parents state they are "worn out" at their child's 6-month check-up because their child awakens each night and cries. The nurse suggests which measures? Unanswered optionAt bedtime, rock the child to sleep and then place in crib. Establish a quieting ritual before bed. Unanswered optionAdd rice cereal to the evening bottle to prevent hunger and awakening. Unanswered option During night awakening, do not interact with the child.

Establish a quieting ritual before bed. Bedtime rituals help both promote sleep.

Is the following statement true or false? Fine motor skills develop in a cephalocaudal fashion (from the head to tail).

False. Fine motor skills develop in a proximodistal fashion (from the center to the periphery). Rationale: Gross motor skills develop in a cephalocaudal fashion (from the head to the tail).

Asymmetric Tonic Neck Reflex

Fencing reflex. When your baby is lying down and their head is turned to the right or left, the corresponding arm extends while the other arm bends next to their head. This makes them look like they're about to start fencing. *Disappears at 4 months*

Lanugo

Fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn.

IgM

First antibody produced in an immune response.

Fine motor 1 month

Fists mostly clenched, involuntary hand movements.

Significant deviations from their previous percentiles may indicate

Further assessments are indicated

Infant-Toddler Checklist (ITC)

Identifies children between the ages of 6 to 24 months of age who have any type of communication delay, including Autism Spectrum Disorder (ASD). It is available freely on the internet and is used in both research and clinical settings.

Gastrointestinal System: Infant tongue

Large relative to oral cavity size, allows for nipple latch so infant can feed.

Gross motor 4 months

Lifts head and looks around, rolls from prone to supine.

Neck righting

Log rolling of entire body to maintain alignment. *Age at development: 4-6 months*

A staff nurse is talking about Piaget's theory with a nursing student. Infants are in the sensorimotor stage of cognitive development during which object permanence is mastered. An example of an infant displaying this ability is: Pushing a spoon from the high chair tray to the floor. Looking for a toy in the crib at the last place the infant saw it. Shaking a rattle to enjoy the sound. Smiling at oneself in the mirror.

Looking for a toy in the crib at the last place the infant saw it. Looking for the toy where it was last seen indicates object permanence. The infant knows the object still exists even though the infant cannot see it.

Percentiles

Measurements usually in approximately the same growth percentiles over time.

The nurse is teaching the parent of a 2-month-old infant about the social and emotional developments that will occur in the next 8 weeks. Which behavior is most likely to occur? Mimicking parent's facial expressions. Participating in a game of peek-a-boo. Crying when the parent is out of sight. Becoming clingy around strangers.

Mimicking parent's facial expressions. Infants will mimic the facial expressions of their parents when they are 3 to 4 months old. Becoming clingy around strangers probably won't occur until the child reaches 6 months. Engaging in peek-a-boo becomes fun between 6 and 8 months. Crying when the parent is out of sight indicates separation anxiety and is common after 6 to 8 months of age.

The nurse is caring for a 5-week-old infant who is spitting up "all the time." This is the parent's first child. What should be the priority nursing intervention? Observe the parent during feeding and burping the infant. Recommend the parent offer smaller and more frequent feedings. Describe the capacity of a 5-week-old infant's stomach. Offer assurance that spitting up is normal.

Observe the parent during feeding and burping the infant. Assessing the parent's feeding and burping technique is the first nursing action needed. The parent may be overfeeding or inadequately burping the child.

Parents' Evaluation of Developmental Status-Developmental Milestones (PEDS-DM)

Only evidence-based screen that elicits and addresses parents concerns about children's language, motor, self-help, early academic skills, behavior and social-emotional/mental health. Tells you when parents' concerns suggest problems requiring referral and which concerns are best responded to with advice or reassurance. Also reduces 'oh by the way' concerns, focuses visits, ensures a 'teachable moment', and is known to improve attendance at well-visits.

What feeding practice used by the parents of an 8-month-old should the nurse discourage? Giving the child soft table food and finger foods. Continuing to offer foods the child rejects. Including the infant at family meals in the high chair. Placing all liquids given the child in a "no spill" sippy cup.

Placing all liquids given the child in a "no spill" sippy cup. No spill sippy cups promote sucking rather than teach cup drinking. Reserve these for times avoiding spills is essential.

The nurse is promoting a healthy diet to the parent of a 6-month-old infant. What action would have the most effect on the infant's neurologic development? Adding fruit juice daily. Establishing an adequate level of dietary iron intake. Requiring more solid foods in the diet. Promoting continuation of breastfeeding.

Promoting continuation of breastfeeding. Continuing to breastfeed ensures the proper level of nutritional fat for myelination of the nervous system.

The nurse pulls the 5-month-old to sitting position from supine and notes head lag. The nurse's response is to: Refer the infant for developmental and/or neurologic evaluation. Consider this a normal response for the age. Suggest more awake tummy time for the child. Conclude the earlier assessments carried out fatigued the infant.

Refer the infant for developmental and/or neurologic evaluation. There should be no head lag by 4 months. Head lag in the 5-month-old may indicate motor or neurologic problems and needs immediate follow-up.

Babinski reflex

Reflex in which a newborn fans out the toes when the sole of the foot is touched. *Disappears at 12 months*

Moro reflex

Reflex in which a newborn strectches out the arms and legs and cries in response to a loud noise or an abrupt change in the environment. *Disappears at 4 months*

Gross motor 5 months

Rolls from front to back, sits upright with support.

Gross motor 8 months

Sits unsupported

A parent mentioned to the nurse that the usually smiling, happy 8-month-old child was clingy and intensely serious when the grandparent visited from a distant city. The nurse explained the child was experiencing: Colic. Changes in temperament. Cephalocaudal development. Stranger anxiety. Separation anxiety.

Stranger anxiety.

To calculate adjusted age (prematurity)

Subtract number of weeks infant was premature from infant's chronologic age. Example 6 month old born at 32 weeks' gestation 6 months minus 8 weeks—4 months This infant's growth and developmental skills should be that of a 4-month-old

A 12-month-old seen at a walk-in clinic weighed 8 lb 4 oz (3.75 kg) at birth. Weight now is 20 lb 8 oz (9.3 kg). The nurse determines: The child weighs the expected amount for age. The weight assessment is blatantly inaccurate. The child weighs more than expected for age. The child weighs less than expected for age.

The child weighs less than expected for age. Birth weight should triple by 12 months. The child should weigh near 24 lb 12 oz (11.25 kg). The child is underweight for age.

A 5-month-old infant being assessed was born at 32 weeks. The nurse doing the well-child check-up should compare the baby to what norms? The development of a 10-week-old The growth of a 2-month-old The development of a 3-month-old The growth of a 5-month-old

The development of a 3-month-old.

The nurse is conducting a physical examination of a 5-month-old infant. Which observation may be cause for concern about the infant's neurologic development? The infant grasps a finger when it is placed in the palm. The anterior fontanel is open and easily palpated. The toes hyperextend when the bottom of the foot is stroked. The infant displays an asymmetric tonic neck reflex (fencing reflex).

The infant displays an asymmetric tonic neck reflex (fencing reflex). This should disappear by 4 months.

The nurse is performing an assessment on a 8-month-old infant. The infant's medical history notes that he was born at 32 weeks' gestation. The infant is progressing normally. At what adjusted age should the nurse expect the infant's developmental accomplishments? By 8 months of age, the child's skill level will vary greatly and cannot be predicted. The infant can be expected to display developmental skills consistent with a 8-month-old infant. The infant will most likely present with developmental skills consistent with a 6-month-old infant. The infant will likely show the skills of an infant with the adjusted age of 7 month.

The infant will most likely present with developmental skills consistent with a 6-month-old infant. To determine adjusted age, the nurse subtracts the number of weeks that the infant was premature from the infant's chronologic age.

Root reflex

This reflex begins when the corner of the baby's mouth is stroked or touched. The baby will turn his or her head and open his or her mouth to follow in the direction of the stroking. This helps the baby find the breast or bottle to begin feeding. *Disappears at 3 months*

Step reflex

This reflex is also called the walking or dance reflex because a baby appears to take steps or dance when held upright with his or her feet touching a solid surface. *Disappears at 4-8 weeks*

Fine motor 7 months

Transfers object from one hand to the other

Gross motor 6 months

Tripod sits

The nurse is examining an 8-month-old child for appropriate development during a regular check-up. Which observation points to a developmental risk? Cannot pull self to standing. Picks up small objects using entire hand. Crawls with stomach down. Uses only the left hand to grasp.

Uses only the left hand to grasp. This should develop by 7 months.

Suck reflex

When the infant is awake and a clean nipple or finger is placed in the infant's mouth they will begin to ______. *Disappears at 2-5 months*

The nurse is assessing a 7-month-old premature infant born at 28 weeks' gestation. What would be the adjusted age upon which the nurse would base assessment of the infant growth and developmental milestones? a. 2 months b. 3 months c. 4 months d. 5 months

c. 4 months. The nurse assessing developmental milestones for a 7-month-old premature infant born at 28 weeks' gestation would adjust the age to 4 months. Rationale: The infant was born 12 weeks early (3 months); therefore, the nurse would subtract 3 months from the chronologic age of 7 months to obtain an adjusted age of 4 months. Healthy growth would be demonstrated if the infant were the size of a 4‐month‐old and achieved the developmental milestones of a 4‐month‐old.