Chapter 25: Growth and Development of Newborn and Infant
A client who is breastfeeding asks the nurse if she can give the newborn a pacifier. Which nursing response is most appropriate?
"It is recommended to wait until breastfeeding is well-established before introducing a pacifier." - Limits nipple confusion - Promotes adequate milk supply.
The parent of 1-week-old infant voices concerns about the infant's weight loss since birth. At birth the infant weighed 7 lb (3.2 kg); the infant currently weighs 6 lb 5 oz (2.9 kg). Which response by the nurse is most appropriate?
"Your infant's weight loss is within the expected range."
Parents of a newborn ask the nurse how to select a daycare facility that will limit the spread of germs for their newborn. Which response by the nurse is most useful?
Ask staff if they perform regular handwashing between child interactions and diaper changes. - Hand Hygiene: best way to prevent spread of bacteria and viruses.
The nurse is assessing the 18-month-old infant. The nurse notes the anterior fontanel (fontanelle) has closed. What initial action by the nurse is indicated?
Document findings as normal. - Anterior fontanel (fontanelle) closes between 12-24 months of age.
A breastfeeding mother asks the nurse about when she can begin feeding her 5-month-old infant some solids and vitamins. Which information provided by the nurse would most accurately address this mother's concerns?
First food offered to an infant is iron-enriched rice cereal and can be started now. Additionally, the infant needs to receive Vit. D and iron. - Breastfeeding is best method for feeding infants - 4-6 months: need supplements of iron and vit. D.
The nurse is conducting a physical examination of an 8-month-old infant. Which observation may be cause for concern about the infant's neurologic development?
Infant displays asymmetric tonic neck reflex (fencing reflex) - 4-7 months: Tonic neck reflex disappears - 3-6 months: Palmar grasp reflex disappears - 12-24 months: Babinski reflex disappears. page 963
The student nurse is caring for a 2 1/2-week-old in the newborn intensive care unit. Which term is most accurate when discussing this client?
Newborn - Newborn: birth-28 days - Infant: 1 year old page 960
The nurse is caring for a 5-week-old infant who is spitting up "all the time." This is the mother's first child. What should be the priority nursing intervention?
Observe mother while she feeds and burps her infant. - Mother may be overfeeding or inadequately burping child.
The nurse is assessing the sleeping practices of the parents of a 4-month old girl who wakes repeatedly during the night. Which parent comment might reveal a cause for the night waking?
Putting her to bed when she falls asleep. - Keeping child up = not creating bedtime routine for her. Need transition to sleep at this age.
Which developmental milestone would the nurse expect an 11-month-old infant to have achieved?
Sitting independently - 8 months: sitting themselves - 12-15 months: walking independently. - 18 months: building 3-4 block towers. - 24 months: turning doorknob.
What action shows an example of Erik Erikson's developmental task for the infant?
The infant cries and the caregiver picks the child up. - Erikson's psychological developmental task for infants = sense of trust. - Occurs when infant has need and need is met consistently. page 931
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?
Try bananas 2-3 months from now. - Solid foods are not recommended for infants at 2 months of age. - 4-6 months: recommended to introduce solid foods.
The nurse is assessing an infant at the 6-month well-baby check-up. The nurse notes that at birth the baby weighed 8 lb (3600 g) and was 20 in (50.8 cm) in length. Which finding is consistent with the normal infant growth and development?
Weight of 16 lb (7300 g), length of 26 in (66.0 cm) - Average newborn: 7.5 lb (3400 kg), 20 in (50 cm) long - Double birth weight @ 4-5 months - Triple @ 1 year old. - 12 months: increase 50% - page 924
Which activity is most beneficial in the development of the newborn
being sung to by his mother - interaction between caregivers and baby is most beneficial
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 - page 951
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 - infants are not born w/ teeth, sometimes 1-3. - Natal teeth and associated w/ anomalies. - 6-8 months: first primary teeth erupt.
The nurse is educating the mother of a newborn about feeding practices. The nurse correctly advises the mother that:
the newborn's stomach can hold between 0.5 oz and 1 oz. - Recommended feeding plan is use to a demand schedule. - May eat 1.5-3 hours
The nurse is assessing an infant at the 6-month well-baby check-up. The nurse notes that at birth the baby weighed 8 lb (3600 g) and was 20 in (50.8 cm) in length. Which finding is consistent with the normal infant growth and development?
weight of 16 lb (7300 g), length of 26 inch (66.0 cm)
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. - Able to lift head and look around. - Infant can roll from prone to supine. - Being pulled up = head leads. - Can make simple vowel sounds, laugh aloud, vocalize in response to voices.
The nurse is completing a developmental assessment on a 6-month-old infant. Which findings indicate the need for additional follow-up? Select all that apply.
Infant has frequent episodes of crossed eyes. Infant seems disinterested in surroundings. Infant does not pay attention to noises behind him. - Warning signs: no response to loud noises, does not focus on near object, does not start to make sounds or babbles by 4 months of age, does not turn to locate sound at 4 months, infant crosses eyes (6 months)
A mother asks the nurse where the microwave is so that she can warm up breast milk to feed her baby. What is the best respond by the nurse?
You should warm the milk under warm water instead. - Microwave can heat unevenly and cause burns = never heat breast milk or formula, change immune properties of breast milk.
A mother of a 9-month-old 18-pound (8.2 kg) infant asks the nurse about choosing the best car seat. What should the nurse recommend?
a rear-facing 5-point harness restraint - infant-2 years: rear-facing - children up to 40 pounds: 5-point harness seat - 40-80 lbs: booster seat.
The nurse is reviewing the medical record of an infant who is being seen for the 12-month well-child visit. Which finding(s) is normal for this infant? Select all that apply.
Infant walks independently HR: 101 bpm RR: 28 breaths/min - RR slows to 20-30 breaths/min - HR 100 bpm for 12-month old. - Walking: 12 months page 925
The nurse is educating the parents of a newborn prior to discharge home. The parents demonstrate teaching was successful when making which statement(s)? Select all that apply
"I will not be concerned if my newborn has stools that begin to have a yellowish color to them." "I understand it is normal for newborns to lose 5% to 10% of their bodyweight after birth." "My newborn can see up-close things, like our faces, better than things at a distance." - page 924, 929
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." - 1 month: recognize ppl they know best from sight.
The nurse is meeting with a group of older siblings of infants to discuss various aspects of infant care.The group will be helping the parents with infant care. Which instruction should the nurse prioritize with this group?
Infant sleeps 10-12 hours at night and can take two-three naps during day. - By being put to bed while awake and allowed to fall asleep: allow good sleeping habits.
A new mother tells the nurse that she a bought car seat for her infant at a garage sale when she was pregnant but that a friend recently told her that she should buy a new one. Which instruction would the nurse give initially?
Check the expiration date on the car seat. - Identifies when seat was manufactured; allow for routine updates.
While evaluating the development of a 10-month-old boy, a nurse hides the boy's stuffed animal behind her back. The boy crawls around the examination table to look behind the nurse's back for the stuffed animal. Which developmental phenomena has this infant demonstrated?
Object permanence - 10 months: infant looks under towel or around corner for hidden object. - 3 months: Hand regard, involves infant holding hands in front of face and studying them. - 2 months: binocular vision = fuse two images in one. - 7 months: Depth perception, transfer toys from hand to hand.
The father of a 6-week-old infant voices concerns about his son's stooling. He further shares that his son grunts and cries when having a bowel movement. What response by the nurse is most appropriate?
What does his stool look like? - Grunting, crying, straining during bowel movements by infants and newborns is normal. - B/c immature gastrointestinal system. - Concern if stool is dry and hard
The nurse comes into an infant's room on the pediatric floor. The nurse wants to try to feed the infant for the first time since her surgery. How does the nurse know what state the infant is in by what the mother says, and that it's fine to try and feed the infant?
"She has been a chatterbox and smiles just like her brother." - Best time to feed: active, alert state. Infant has normal respirations, limited movement, and eyes are bright, shiny, attentive.
The English-speaking nurse is assessing a 12-month-old child with an English-speaking father and a Spanish-speaking mother. The child does not use words like "drink" "dog" or "ball." What is the nurse's priority intervention?
Asking mother if child uses Spanish words for those items. - Infant in bilingual families may use some words from each language.
During a well-baby visit the mother of a 3-month-old infant tells the nurse that she does not understand why her baby continues to spit out food during feeding of solid foods. What is the best response by the nurse?
"Infants still have a tongue protrusion reflex until 4 to 6 months so they can't help but push out the solid food." - page 947
What is the correct amount of wet diapers a mature infant should produce each day?
6-8 wet diapers/day - Urination occurs first 24 hours - Normal = 200-300 ml/day - Intake = 140-160 ml/kg/day
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?
Infant will most likely present w/ developmental skills consistent w/ 6-month old infant. - Nurse will use infant's adjusted age to determine expected outcomes. - Subtracts # weeks infant was premature from chronological age - (8 months - 2 months = 6 months)
The nurse is reviewing the diet of an 8-month-old infant with the mother who reveals she has been using evaporated milk to make the formula. Which additional ingredient should the nurse ensure she is including in the formula?
Iron - Infants fed home-prepared formulas (based on evaporated milk): need supplemental vitamin C and iron. page 947
During a well-baby visit the mother tells the nurse that she thinks her baby has a decayed tooth and doesn't understand how this could have happened. What are appropriate questions for the nurse to ask this mother? Select all that apply.
Is your child using bottle for milk? Does your baby use no-spill sippy cups? Do you frequently put your baby to bed w/ bottle of milk or juice? - Milk and juice pool around teeth: dental carries - Using bottle after age 12-15 months: dental carries.
The student nurse is reviewing the records of a pediatric client. Which statement about the client's progress indicates the need for further instruction?
Maturation refers to the child's increases in body size. - Growth: increase in physical size. - Development: sequential process by which infant and children gain various skills and functions. - Heredity: influence growth and development by determining child's potential, while environment contributes to degree of achievement. - Maturation: increase in functionality of various body system/developmental skills.
The parent of a 3-month-old infant is concerned because the infant does not yet sit by oneself. Which statement best reflects average sitting ability?
Most infants do not sit steadily until 8 months. this infant is normal - 3 months: infant should not be able to raise head about 45 degrees. - Gross motor skill development does not correlate w/ tooth eruption. - Page 932
Which activity will the nurse encourage new parents to complete in order to assist their infant in accomplishing Erikson's developmental task for the first year of life?
Respond promptly when infant cries. - Developmental task of infant year: Gain sense of trust. - Accomplished by promptly meeting infant's needs during first year of life. page 931
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 - DIsappear around age 4 months - Page 925
The nurse is examining an 8-month-old girl for appropriate development during a regular check-up. Which observation points to a developmental risk?
Uses only the left hand to grasp - Favoring one hand over: proper motor development is not occuring on other. - 8 months: grasping small objects w/ entire hand is common, precedes pincer grasp. page 931
The nurse is making a home visit and observes the 7-month-old pulling the family dog's hair and ears. Which parenting skill does the nurse determine is most effective?
The parents tell the child "no" w/ stern voice and pulls child's hand away from the dog. - Provide safe environment, redirection away from undesirable behaviors, and saying "no": effective forms of discipline. page 950
The nurse is providing anticipatory guidance to the parent of a 2-month-old infant in relation to growth and development. Which statement from the parent demonstrates proper understanding?
"I can expect my infant to be able to raise the head up when on the stomach within the next month." - 3 month: can raise head to 45 degrees while prone. - 6-8 months: clingy around strangers. - 5 months: hold rattle - 4-5 months: begin to laugh out loud.
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 crib for sleeping only, not for play activities. - Consistent bedtime routine is usually helpful in establishing healthy sleeping patterns - Using crib for sleeping only helps child associate bed w/ sleep. page 941-942
The nurse is reinforcing teaching with a group of caregivers related to the nutritional needs of the infant. One caregiver asks why the 6-month-old infant needs to have solid foods when breast milk is such a good source of nutrition. What would be the best response by the nurse?
"Milk will not fully provide the child's needs for iron, which is found in solid foods." - 4-6 months: milk is not sufficient to meet caloric, protein, mineral, and vitamin needs. - page 948
The infant weighs 7 lb 4 oz (3,300 g) at birth. If the infant is following a normal pattern of growth, what would be the expected weight for this child at the age of 12 months?
21 lb 12 oz (9.9 kg) - Average weight of newborn: 7.5 lb (3400 g) - Infant gains + 30 g/day. - 1 year: tripled birth weight, grown 10-12 inch (25-30 cm(
The mother of a 11-month-old has come to the clinic with concerns. She reports to the nurse that her baby's "soft spot in the front" is now gone. The nurse assesses the infant and notes the fontanel (fontanelle) has closed. What response by the nurse is most appropriate?
Soft spot or fontanel has closed. - Anterior fontanel closes between 12-18 months. Maybe sooner
At what age would it be okay to introduce carrots to an infant's diet?
Solid food can be introduced at 4 to 6 months of age. - 4-6 months: tongue extrusion reflex present. - After reflex gone = solid foods introduced. - 7 months: should be eating solid foods regularly, drinking from cup + breast/bottle feeds. - page 942
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. - Sense of smell develops rapidly - 7-day old infant can differentiate smell of break milk from another women and turn towards mother's smell.
The clinic nurse is assessing a 9-month-old client. The parents state, "Our baby is having a really hard time teething." Which nursing action is appropriate?
Recommend the parents provide the infant a cold teeth ring to chew - can be soothing for tender gum-lines - Numbing agents increase risk of choking
A first-time mother calls the pediatrician's office to ask the nurse about her baby's tooth eruption. The baby is 8 months old and still does not have any teeth. What information can the nurse share with this mother that would correctly respond to her anxiety about her baby's dentition?
tooth eruption is often genetically based, w/ some families having babies w/ early tooth eruptions, while others have later tooth eruption. - tooth eruption begin = 6-8 months, but vary between children.
A nurse is talking to and making facial expressions at a 9-month-old baby girl during a routine office visit. What is the most advanced milestone of language development that the nurse should expect to see in this child?
Infant says "da-da" when looking at her father. - 9 months: usually speaks first word. - 3 month: response to nodding, smiling face, friendly tone = squeal w/ pleasure, LOL - 4 months: "talkative", cooing, gurgling. - 6 months: learn imitating
The nurse is teaching the parents of a 6-month-old infant about proper dental care. Which action will the nurse indicate as most likely to cause dental caries in this infant?
Putting infant to bed w/ bottle of milk or juice. - Allows for sugar content to pool around infant's teeth at night.
The nurse is teaching healthy eating habits to the parents of a 7-month-old girl. Which recommendation is the most valuable advice?
Serve new foods several times. - Be patient. - Page 948
The student nurse is reviewing the chart of a newborn. The document indicates the newborn is in the quiet alert state. Which is the best description of this sleep phase?
The newborn's eyes are open and no body movements are noted. - Normal newborn moves through 6 stages of consciousness. - Quiet alert state = eyes open, calm body. - page 925
