Peds Sherpath - growth and development of the Neonate and Infant

Respiratory System

- alveoli number approximately 20 million - trachea remains small, supported only by soft cartilage - vulnerable to respiratory difficulties due to immature respiratory system - eustachian tube short and horizontal increasing risk for middle ear infections

Cardiovascular System

- fetal shunts close - pulmonary circulation increases drastically - heart doubles in size and weight - HR gradually slows and BP increases

Renal System

- kidney mass increases x3 during first year - glomeruli enlarge, GFR low = not effective or efficient in concentrating urine - risk for fluid and electrolyte imbalances

Gastrointestinal System

- stomach capacity of neonate ~10-20mL but with feedings increases to 200mL by 1yr - ability to digest and absorb fat reaches adult levels at 6-9mo

Match the milestone with the corresponding age group: 1-2 months (gross motor) 3 months (gross motor) 4-5 months (gross motor) 4-5 months (fine motor) a. Bears some weight when held in the standing position b. Can lift head when held against the shoulder c. Will reach and grasp with palm d. Can lift head off the bed when in prone position

1-2 months (gross motor) b. 3 months (gross motor) d. 4-5 months (gross motor) a. 4-5 months (fine motor) c.

Physical patterns of growth: 4-5 months

- Infant can breathe when nose is obstructed - Growth rate declines - Drooling begins in preparation for teething - Moro, tonic neck, and rooting reflexes have disappeared

Physical patterns of growth: 6-7 months

- Weight gain slows to .99 lb per month - Length gain of .5 in per month is seen - Birth weight doubles; tooth eruption begins, and chewing and biting occur - Maternal iron stores are depleted

Physical patterns of growth: 10-12 months

- Birth weight triples and birth length increases by 50% - Head and chest circumference equal - Babinski reflex disappears

Cranial nerves during the first year

- CN 1 (olfactory) appears at 5-7 months. - CN 3, 4, and 6 are the oculomotor, trochlear, and abducens, which control extraocular movements. Pupils can be large and not responsive to light in babies under 30 weeks. - CN 9 and 10 (glossopharyngeal and vagus nerves) can be checked for uvula deviation: if there is a problem with vagal nerve, deviation will be to unaffected side.

Physical patterns of growth: 8-9 months

- Continue to gain weight and increase in length - Have more regular bowel and bladder elimination

Physical patterns of growth: 1-2 months

- Fast growth; weight gain of 1.49 lb per month and length gain of 1 in per month during first 6 months - Upper limbs and head grow faster - Primitive reflexes are present; strong suck and gag reflex - Infant is obligate nose breather - Posterior fontanel closes by 2-3 months

Immune System

- High risk for infection - weak response to infection - by year 1 infant has ~60% IgG levels, 75% IgM, and 20 % IgA of the adult levels

Match the age with the critical milestone in language development. Cooing with a reciprocal smile Babbling is common. Repeating sounds to self Increase interest in sounds a. 4-6 months b. 1 year c. 6-8 months d. 9 months e. 3-4 months f. 1-3 months

Cooing with a reciprocal smile f. Babbling is common. e. Repeating sounds to self a. Increase interest in sounds c.

Which sentence best describes a healthy parent-infant attachment during the first month? a. Bonding is critical for normal development and survival. b. Bonding is critical but too much love can create a needy child. c. Bonding is important but meeting every emotional need will spoil the child. d. Bonding is necessary but the infant has built-in mechanisms to help if the child's needs are not met.

a. Bonding is critical for normal development and survival. This sentence best describes the relationship that needs to exist for normal development and survival in the infant during the first few months of life.

A weight gain of 1.49 lb (0.68 kg) per month is expected from birth until which month? a. 6 months b. 8 months c. 10 months d. 12 months

a. 6 months An infant is expected to gain 1.49 lb (0.68 kg) per month from birth until 6 months.

Development

A continuous, orderly series of conditions leading to activities, new motives for activities, and new patterns of behavior

Physical patterns of growth: 3 months

Primitive reflexes fading

Growth

Increase in the physical size of a whole or any of its parts, or an increase in the number and size of cells

Which activities correspond to normal motor development during the first year of life? Select all that apply. a. 10-12 months: can stand alone b. 8-9 months: sits steadily, unsupported c. 1-2 months: can roll from front to back d. 4-5 months: turns from back to abdomen e. 6-7 months: sits and leans forward on both hands Correct Answer Exactly!

a. 10-12 months: can stand alone At 10-12 months the child has the motor development to be able to stand on his or her own. b. 8-9 months: sits steadily, unsupported The baby's motor development will be mature enough to allow the child to sit steadily, unsupported. e. 6-7 months: sits and leans forward on both hands At 6-7 months the baby's motor development will be mature enough to sit and lean forward on both hands (tripod sitting).

Which statements describe the cognitive difference in regard to object permanence between a 6-month-old and a 9-month-old? Select all that apply. a. A 6-month-old will not notice if you hide a toy. b. A 9-month-old will look for a toy if it is hidden from view. c. A 6-month-old will look for a toy if it is hidden from view. d. A 6-month-old will look for the toy and will likely show no interest once the toy is found. e. A 9-month-old will ignore the toy if it is hidden and immediately seek another object of interest.

a. A 6-month-old will not notice if you hide a toy. At 6 months the cognitive development of the child will not be mature enough to understand that the object still exists if it is hidden from view. b. A 9-month-old will look for a toy if it is hidden from view. The development of object permanence occurs in children around the age of nine months and therefore a child at this age will look for a toy if it is hidden from view.

Which can influence the development of both speech and language in infants? Select all that apply. a. Anatomical defects b. Genetics/family history c. Sociodemographic factors d. Lack of access to television and computers d. Quality of communication in the environment

a. Anatomical defects This can affect speech and language development. Children with cleft lip and palate for example may have difficulty reaching normal language milestones. b. Genetics/family history This factor can have an effect on speech and language development. Genetics and family histories will always be a consideration when evaluating a child's speech and language milestones. c. Sociodemographic factors Sociodemographic factors can have an effect on both speech and language development. e. Quality of communication in the environment This can affect speech and language development in infants, such as in a home where family members place a high value on education, with family members who are bilingual, or if the child has other siblings to converse with.

Which series of activities best reflects the motor development of an infant from 1 month of age to 4 months? Select all that apply. At 4 months, the rooting reflex disappears. At 1 month, the child will hold a fist tightly clenched. At 3 months the child will be able to crawl a minimal distance. At 3 months the child will be able to lift the head 90 degrees from a prone position. At 4 months the child can hold the head steadily erect in a sitting position.

a. At 4 months, the rooting reflex disappears. There are several primitive reflexes that disappear after the first year of life. The Moro reflex and the rooting reflex will disappear by 4 months of age. b. At 1 month, the child will hold a fist tightly clenched. At one month the child will keep the hand clenched and this will start to change by 2 months of age. d. At 3 months the child will be able to lift the head 90 degrees from a prone position. The muscle strength in the baby's head by 3 months of age will allow for lifting to 90 degrees in a prone position. e. At 4 months the child can hold the head steadily erect in a sitting position. At four months a child has motor development sufficient enough to hold the head erect in the sitting position.

What contributes to helping an infant to fight infection within the first year of life? Select all that apply. a. Breast milk b. Vaccinations c. Fully functional respiratory system d. The mother's transplacental antibodies e. Bottle-fed cow's milk supplemented with Vitamins A, C, and D

a. Breast milk The breast milk contains IgA and proteins including lactoferrin, lysozyme, and serum albumin. The infant benefits from maternal IgA since the baby's immune system can only make 20% of the adult level. b. Vaccinations Vaccinations for diseases such as rotavirus and hepatitis B are given to infants, which helps them fight infection. d. The mother's transplacental antibodies Transplacental antibodies help supplement the infant's immune system until the infant is around 4 months of age. IgG is the most significant transplacental antibody.

Which important anticipatory guidance would parents need to learn prior to the development of the infant's pincer grasp (around 9 months of age)? a. Electrical outlets should be covered with socket safety panels. b. Parents should place stove pot handles away from the child's reach. c. Parents should keep unsafe objects locked out of reach of the infant. d. The infant's food items should be cut into small, manageable pieces. e. Parents should place hand protectors on the child to help protect them from injury. grasp.

a. Electrical outlets should be covered with socket safety panels. Six-month-old infants grasp objects with all their fingers in a raking motion, but 9-month-olds use their thumbs and forefingers which allows them to grab potentially harmful things, putting them at risk for electrical injury. b. Parents should place stove pot handles away from the child's reach. This would be good anticipatory guidance to give a parent with a child who is 9 months old since the child will be reaching for dangerous objects when in the kitchen. c. Parents should keep unsafe objects locked out of reach of the infant. Infants will need to be watched closely, and since they are growing in both cognitive development and motor development, this ability provides them with a wider view of the world and creates new ways to play, but this may put them in danger. d. The infant's food items should be cut into small, manageable pieces. Nine-month-olds use their thumbs and forefingers in a fine motor skill called the pincer grasp, which allows them to grab potentially harmful things and place them in their mouth, which creates a choking hazard.

A mother has brought in her infant for the infant's 6-month well-child checkup. You notice the infant's left eye intermittently not aligning with the right eye and an inability to focus both eyes on the same spot. What is the appropriate response? Select all that apply. Ensure the infant's "red reflex" is normal. Place the infant in isolation as this can be a sign of conjunctivitis. Do nothing, as infants do not gain extraocular eye coordination until 9 months of age. Stress the importance of eye exercises to help prevent worsening of the condition. Notify the child's provider, as extraocular eye alignment should be achieved by 6 months of age.

a. Ensure the infant's "red reflex" is normal. This is an important part of any pediatric eye exam. d. Notify the child's provider, as extraocular eye alignment should be achieved by 6 months of age. Infants under 3 to 4 months of age often lack eye coordination and alignment but should achieve proper coordination by age 4 to 6 months. By 3 months, infants should be able to track and reach for objects as their eye-hand coordination begins to develop.

What consequences may result if an infant's needs are ignored by the parent? Feelings of insecurity Emotional resilience An early development of independence Inappropriate survival mechanism development

a. Feelings of insecurity If the infant's needs are not met, the child will develop feelings of insecurity at an early age, which can continue throughout life, along with a feeling of dissatisfaction.

Which statement can the nurse use to educate the parent on leaving a child who shows emotional distress when having to leave the parent? Separations should be accomplished swiftly without dwelling on the separation. The mother should reciprocate and show the child that she too is emotionally a bit upset. Separations should not be done too fast as this can create emotional turmoil in the child. Separations should be accomplished swiftly, and with repeated emphasis on reassuring the child that the mother will return shortly.

a. Separations should be accomplished swiftly without dwelling on the separation. This statement suggesting the parent leave swiftly, yet with care, would help the parent-child interaction where the child is upset at leaving the mother.

Why is an understanding of motor development important for keeping a child safe when an infant's mobility increases around 10 months of age? Select all that apply. a. The child has no understanding of consequences. b. The child has a clear understanding of boundaries. c. The child now has an increased ability to move about. d. The child now has a naturally increased level of curiosity. The child now has an increased ability to reach for objects.

a. The child has no understanding of consequences. An increased level of curiosity without the cognitive ability to understand consequences puts the infant at great risk for accidents and injury. c. The child now has an increased ability to move about. An increased ability to move about, reach objects, and explore their world places infants at great risk for accidents and injury. d. The child now has a naturally increased level of curiosity. Now that they child can grab at objects, heavy containers will become a hazard. An increased ability to move about, reach objects, and explore their world places infants at greater risk for accidents and injury. e. The child now has an increased ability to reach for objects. They now have the ability to grasp things and an increased ability to move about, reach objects, and explore their world, placing infants at greater risk for accidents and injury.

Which aspect of ear development leads to increased susceptibility to ear infections during the first two years of life? a. The eustachian tube is short and horizontal. b. The external acoustic meatus is short and vertical. c. The auricle is narrow and can block the eustachian tube. d. The outer tympanic membrane is porous and not highly vascularized.

a. The eustachian tube is short and horizontal. The eustachian tube is short and horizontal in children, making them more prone to infection. The eustachian tube connects to the middle ear and provides air and drains fluid, which helps to fight infection.

Which is a common physical growth pattern seen in infancy during the first to second month? a. Upper limbs and head grow faster. b. Lower limbs and GI tract develop faster. c. Cardiovascular system and lower limbs develop faster. d. Respiratory and immune systems develop at a rapid pace.

a. Upper limbs and head grow faster. A faster growth of the upper limbs and head is a common pattern seen in the first two months of life. Head circumference measurements are taken at each health provider visit to ensure the infant is showing normal growth patterns.

A mother of a 10-month-old comes to the nurse concerned that her child has had two upper respiratory infections in one month and asks if something is wrong with her child. How can the nurse respond? To prevent infection the infant will need prophylactic antibiotics. Infants have an immature immune system, which makes them susceptible to infections. An infant's immune system should be developed by 6 months and so the child needs further evaluation. The infant's infections are a sign that the child will develop asthma.

b. Infants have an immature immune system, which makes them susceptible to infections. Telling the parent that the child has an immature immune system, making them more susceptible to infection, will be the best explanation for the nurse to give the parent. The nurse can explain to the parent that the airways are small and collapsible, making it easier for pathogens to cause an infection.

A mother of a 3-month-old infant is requesting information on the motor milestones she can expect to see in her child. The nurse can tell the parent to expect to see which activities at 3 months? Select all that apply. Puts foot in mouth Places hand in mouth Turns from back to abdomen Turns from abdomen to back Can lift head off bed in prone position.

b. Places hand in mouth The nurse can tell the parent that at 3 months the child will attempt to place their hand in the mouth. e. Can lift head off bed in prone position. By 3 months the infant should be able to lift the head off a bed in prone position, so the nurse can tell the parent to expect this activity.

The nurse is observing a mother who is interacting with her infant and notices the infant trying to imitate the sounds that the mother is making. The nurse knows that the child must be at least what age? 3-4 months 4-6 months 6-8 months 1-3 months

c. 6-8 months An infant who is 6-8 months of age will be able to imitate the sounds the mother is making and therefore the nurse knows the patient must be at least this age.

Parent--infant attachment is the most important association for which type of development? Biological Physiological Psychosocial Sociocultural

c. Psychosocial Psychosocial development needs to be reinforced in the infant's life. This is one of the most important aspects in the development of parent-infant attachment.

Which situation best describes a 6-month-old's ability to maintain a standing position? a. The 6-month-old will kick slightly to avoid bearing weight. b. The 6-month-old will stand on his or her own and bear full weight. c. The 6-month-old can bear significant weight when held in a standing position. d. The 6-month-old's knees will bend and they will bear no significant weight.

c. The 6-month-old can bear significant weight when held in a standing position. At 6 months the baby's muscles are developing and have reached a point where they are strong enough to allow the baby to bear significant weight when held in the standing position.

The mother of a newborn child enquires about having her child's hearing checked. What is the best response by the nurse? All newborns should be screened before 1 year of age. At 6 months you can return and we will screen your infant. Your newborn will be screened at the four-month well-baby visit. All newborns should be screened for hearing before one month of age.

d. All newborns should be screened for hearing before one month of age. Stating that the child will be screened for hearing before one month of age is accurate and therefore this is the best response for the nurse to make.

At which age should infants achieve proper eye coordination? a. Infants should achieve proper eye coordination by 2 weeks to 1 month. b. Infants should achieve proper eye coordination by 1-2 months. c. Infants should achieve proper eye coordination by 2 to 4 months. d. Infants should achieve proper eye coordination by 4 to 6 months.

d. Infants should achieve proper eye coordination by 4 to 6 months. Infants under 3-4 months of age often lack eye coordination and alignment but should achieve proper coordination by 4 to 6 months. By 3 months infants should be able to track and reach for objects as their eye-hand coordination begins to develop.

Which statement reflects the consequence of a mother suffering from postpartum depression in regard to an infant's psychosocial development? a. The child will not be affected by the mother's depression. b. The infant will develop empathy and respond to the mother's sadness. c. The infant will develop a preference for other caregivers and may avoid eye contact until two years of age. d. The infant will struggle to develop the basic sense of trust that the infant's needs will be met and instead develop a sense of suspicion or mistrust.

d. The infant will struggle to develop the basic sense of trust that the infant's needs will be met and instead develop a sense of suspicion or mistrust. The child needs to develop a sense of trust with the mother and the mother's depression will interfere in the positive reciprocal process that enables psychosocial development in the infant.

A mother brings her 5-month-old infant to the clinic and is concerned that the child does not seem to smile as much as her niece, who is the same age. How will the nurse respond? This is normal as you can expect to see a smile at 6 months of age. All children start to smile at a different age, so be patient. There is no need to worry. This is a concern since the child should be showing a social smile by no later than 1 month of age. This is a concern since the child should be showing a social smile by no later than 3 months of age.

d. This is a concern since the child should be showing a social smile by no later than 3 months of age. Since the child should be showing a social smile by no later than 3 months, this is the correct response that the nurse should make to this parent.

How can the parent-infant attachment be strengthened immediately after birth? The mother needs to have time alone to ensure she does not overwhelm the child. A mother should cuddle with the baby but allow the child to cry alone if the baby is upset. The mother should give the infant some space to allow for natural biological development. Reciprocal interactions that include holding the child, touching the child, and speaking gently to the child.

d.. Reciprocal interactions that include holding the child, touching the child, and speaking gently to the child. This is an example of how the parent-infant interaction can be strengthened after birth and therefore a lot of positive physical and emotional interactions between the parent and child should be encouraged.

A new mother at the clinic asks at what age her baby will be able to actively participate in a game of pat-a-cake with her. Which would be the correct response from the nurse? 4 months 6 months 9 months 12 months

e. 12 months At 12 months the child is likely to participate in pat-a-cake with the mother. This is considered a critical developmental milestone.