Prep-u: Chapter 3: Growth and Development of the Newborn and Infant

Debbie asks her nurse what she thinks about giving her baby a pacifier. Debbie is struggling with this issue and is very teary-eyed about making a decision. How should the nurse respond to Debbie?

"It is a personal decision, let me give you a pamphlet from the AAP."

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 an infant at his 4-month well-baby check-up. The nurse notes that at birth the baby weighed 8 lb (3.6 kg)and was 20 in (50.8 cm)in length. Which finding is most consistent with the normal infant growth and development?

The baby weighs 16 lb (7.3 kg) and is 26 in (66.0 cm) in length. -The average infant's weight doubles at 4 months and will triple at 1 year of life. The infant's length will increase by 50% by the first year.

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?

The infant will most likely present with developmental skills consistent with a 6-month-old infant. -When assessing the growth and development of a premature infant, the nurse will use the infant's adjusted age to determine expected outcomes. To determine adjusted age, the nurse subtracts the number of weeks that the infant was premature from the infant's chronological age.

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. Plot growth parameters and assess developmental milestones based on adjusted age.

The caregiver of an infant tells the nurse that her dentist told her not to let the child go to bed with a bottle of milk. The caregiver states she doesn't understand the reason for this since her baby seems to enjoy the bottle. The most appropriate response to this caregiver would be:

"Bottles given at bedtime can cause erosion of the enamel on the teeth."

The infant measured 20 inches (50.8 cm) at birth. If the infant is following a normal pattern of growth, which range would be an expected height for this child at the age of 12 months?

30 to 32 inches (76.2 to 81.3 cm) -By one year of age, the infant has tripled his or her birth weight and has grown 10 to 12 inches.

What information would you include when teaching the parents of an infant about colic?

Colic symptoms will probably fade at 3 months of age. -probably because children begin to maintain a more upright position at that time.

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 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

The mother of a 1-month-old infant voices concern about her baby's respirations. She states they are rapid and irregular. Which information should the nurse provide?

The respirations of a 1-month-old infant are normally irregular and periodically pause. -The normal respiratory rate for a 1-month-old infant is 30 to 60 breaths per minute. By 1 year of age the rate will be 20 to 30 breaths per minute. The respiratory patterns of the 1-month-old infant are irregular. There may normally be periodic pauses in the rhythm

The nurse goes in to check on a new mother to see how breast-feeding is going with her new son. The nurse observes the infant is on the mother's lap with the blanket unwrapped, and the mother is washing his face, and gently stroking the baby. The mother has had trouble breastfeeding the last few times. What is the appropriate response from the nurse?

"You are doing a wonderful job attempting to waken the baby." -The nurse should be emotionally supportive to the new mom. The mom's techniques are commonly used in breastfed infants who are sleeping. The encouragement from the nurse will support the mom through this learning period

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.

The mother of an infant asks you when to begin brushing her son's teeth. Your best response would be:

As soon as the first tooth erupts.

When preforming neurological reflexes on the infant, which primitive reflex will be present longest?

Babinski -Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. Except for the Babinski, which disappears around 1 year of age, these primitive reflexes diminish over the first few months of life, giving way to protective reflexes

Which activity is most beneficial in the development of the newborn?

Being sung to by his mother -Interaction between the newborn and his parents is the most beneficial activity. Later toys and music may have a good influence but initially the parental interaction is best.

An infant is breastfed. When assessing her stools, which findings would be typical?

Breastfed infants are less likely to be constipated than bottle-fed infants -The stools of breastfed infants tend to be yellow and looser than those of bottle-fed babies.

A teen mom asks the discharge nurse if it is okay to sleep in bed with her baby. She says her mom always did it with her siblings and it seemed okay. How should the nurse respond?

"Bed sharing has positive effects on babies, let me get you information." -The nurse should enforce that bed sharing is sometimes a positive experience if the parents are safe and responsible. When done properly, the effect can be positive on infant nutrition and physiology.

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 has closed. What response by the nurse is most appropriate?

"The soft spot or fontanel has closed." -The anterior fontanel traditionally closes between 12 and 18 months. In some infants this may close sooner. This does not indicate there is any abnormality in the development of the infant.

A parent who is feeding his child formula prepared at home using evaporated milk is concerned about whether the child is receiving all necessary nutrients. What would it be important for this parent to add to his child's diet to supplement the formula?

Iron -Infants who are fed home-prepared formulas (based on evaporated milk) need supplemental vitamin C and iron. Evaporated milk has adequate amounts of vitamin D, which is unaffected by heat used in the preparation of formula. Calcium and vitamin E would not be concerns in this infant's formula.

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:

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

The mother of a 3-month-old is concerned because her daughter does not yet sit by herself. Which statement best reflects average sitting ability?

Most babies do not sit steadily until 8 months; she is normal.

A nurse is preparing discharge teaching for a client being discharged with her newborn baby. What is the highest priority item that must be included in the teaching plan?

Restrain the baby in a car seat.

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?

They put her to bed when she falls asleep. -If the parents are keeping the child up until she falls asleep, they are not creating a bedtime routine for her. Infants need a transition to sleep at this age.

The nurse is completing a developmental assessment on a 6-month-old infant. Which findings indicate the need for additional follow-up?

• The infant has frequent episodes of crossed eyes. • The infant does not pay attention to noises behind him. • The infant seems disinterested in the surrounding environment.

Which milestone would you expect an infant to accomplish by 8 months of age?

Sitting without support -Most babies sit steadily at 8 months, creep at 9 months, and pull to standing at 10 months.

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." -Introducing solid food with a spoon prior to 4 to 6 months of age will result in extrusion of the tongue. The parent may think that the infant does not want the food and is spitting it out intentionally, but the extrusion reflex is still present

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

Bathing is a time for bonding with the parents. -The parents can use bath time for bonding with their infant. This can be done with talking, cooing, and singing. Bath time should be slow-paced and nonstressful.

Anticipatory guidance for an infant for the 4th month should include the fact that she probably will:

Be able to turn over onto the back.

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 -When introducing a new food to an infant, it may take multiple attempts before the child will accept it. Parents must demonstrate patience. Letting the child eat only the foods she prefers, forcing her to eat foods she does not want, or actively urging the child to eat new foods can negatively affect eating patterns

The nurse is assessing development of a 4-month-old boy during a well-child visit. Which observation needs further investigation?

The infant responds to his mother when he sees her but not at other times when she is near. -If the infant does not respond to his mother's voice, it could indicate hearing loss. Infants recognize parents' voices from 1 month of age

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 parent tells the child "no" with a stern voice and pulls the child's hand away from the dog

A father asks you what symptoms he can expect with normal teething in his infant. What would you tell him?

The child's gumline will be tender.

Which measure would you suggest an infant's parents use to relieve teething discomfort?

Give her a cold teething ring to chew. -Cold can be very soothing for the tender gumlines during teething.

A 2-month-old body has inconsolable crying, is gassy, and constantly draws his legs up. It has been determined that the boy has colic. What is the best intervention to treat colic?

He needs to try a different formula to assess for sensitivity. -Colic peaks between 3 weeks and 6 months of age. Treatment is a restful, soothing environment. Changing an infant's formula or having a breastfeeding mom decrease her intake of gassy foods may alleviate the symptoms.

Which developmental milestone would the nurse expect an 11-month-old infant to have achieved?

Sitting independently -Infants typically sit independently, without support, by age 8 months. Walking independently may be accomplished as late as age 15 months and still be within the normal range. Few infants walk independently by age 11 months. Building a tower of three or four blocks is a milestone of an 18-month-old. Turning a doorknob is a milestone of a 24-month-old

A frustrated mother comes to a 9-month well-baby check-up because her son is refusing all of the solid food she gives him. When talking with this mother, the nurse discovers that she has struggled all her life with a weight problem. She attributes this problem to being forced to eat all of the food she was served as a child, even when she was full. Because she doesn't want to cause the same problem in her child, she tells the nurse that each time her son pushes food away with his tongue she believes that he doesn't want it. Which statement would be most appropriate for the nurse to say to this mother?

"The baby needs to learn how to move the food to the back of the mouth for swallowing, so catch the food and offer it again until the baby learns this." -The infant knows only one way to take food: namely to thrust the tongue forward as if to suck. This is called the extrusion (protrusion) reflex and has the effect of pushing solid food out of the infant's mouth. The process of transferring food from the front of the mouth to the throat for swallowing is a complicated skill that must be learned. If the food is pushed out, the caregiver must catch it and offer it again. The baby soon learns to manipulate the tongue and comes to enjoy this novel way of eating

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 and straining during bowel movements by infants and newborns is normal. This is due to the immaturity of the gastrointestinal system. The most important thing to do initially is to determine the appearance of the stool. The grunts and cries are not of concern unless the stool is dry and hard, so asking about the characteristics is the initial response.

The nurse is providing a nutrition workshop for the parents of infants. The nurse understands that further instruction is required when hearing which comments from the parents?

• "Food is so expensive. I can't afford for my child to leave any food on the plate." • "I have tried at least 10 times with every green vegetable and I can't get my son to like them." • "I let my child eat whatever he wants right now so that we don't argue about food. Hopefully he will like healthy foods when he grows up." -Encouraging children to eat everything on their plate can lead to overeating and obesity. Children may need to be exposed to new food at least 20 times before determining if they like it or not. Letting a child eat whatever he wants does not lead to good choices as the child matures

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 -A more accurate term for this child would be newborn rather than infant because the newborn or neonatal period of infancy is defined as the period from birth until 28 days of age. Infancy is the period of time up to 1 year old. Child and baby don't refer to the client's age accurately.