Chapter 25: Growth and Development of the Newborn & Infant
Acrocyanosis
Blueness of the hands & feet Is normal in the newborn; it decreases over the first few days of life
By what age does the infant know he/she is separate from the parent?
By 12 months
When does full color vision, distance vision, and the ability to track objects develop?
By 7 months
Fine Motor Skills: 12 months
Feeds self with cup & spoon Makes simple mark on paper Pokes with index finger
Fine Motor Skills: 11 months
Offers objects to others and releases them
Gross Motor Skills: 3 months
Raises head to 45 degrees in prone Slight head lag in pull to sit
Gross Motor Skills: 5 months
Rolls from supine to prone and back again Sits with back upright when supported
Binocularity
The ability to fuse two ocular images into one cerebral picture Begins to develop at 6 weeks and is well established by 4 months
Newborns lose how much of their body weight over the first week of life?
Up to 10%
Root Reflex
When the infant's cheek is stroked, the infant turns to that side, searching with mouth
By what age can the stomach accommodate 3 full meals and several snacks per day?
1 year
Most infants triple their birth weight by when?
1 year
When does the babinski reflex disappear?
12 months
When do the upper & lower second molars typically appear?
25-33 months
When does the parachute (sideways) reflex appear?
6 months
Fine Motor Skills: 9 months
Bangs objects together
Fine Motor Skills: 4 months
Bats at objects
When do the first primary teeth begin to erupt?
Between the ages of 6 & 8 months
Gross Motor Skills: 9 months
Crawls, abdomen off floor
Fine Motor Skills: 8 months
Gross pincer grasp (rakes)
Fine Motor Skills: 3 months
Holds hand in front of face, hands open
How do gross motor skills develop?
In a cephalocaudal fashion (from the head to the tail) In other words, the baby learns to life the head before learning to roll over and sit.
Fine Motor Skills
Includes the maturation of hand & finger use
Which primitive reflexes are present at birth?
Moro Root Suck Aysmmetric tonic neck Plantar grasp Palmar grasp Step Babinski
Freud: Oral stage (birth to 1 year)
Pleasure is focused on oral activities: feeding & sucking
Parachute (forward) reflex
Protective extension with the arms when held up in the air and moved forward. The infant reflexively reaches forward to catch him/herself.
Parachute (backward) reflex
Protective extension with the arms when tilted backward
Parachute (sideways) reflex
Protective extension with the arms when tilted to the side in a supported sitting position
Gross Motor Skills: 10 months
Pulls to stand Cruises
Gross Motor Skills: 2 months
Raises head & chest, holds position Improving head control
Gross Motor Skills: 12 months
Sits from standing position Walks independently
Gross Motor Skills: 8 months
Sits unsupported
Babinski reflex
Stroking along the lateral aspect of the sole and across the plantar surface results in fanning and hyperextension of the toes
Newborn's prefer what taste?
Sweet
What can the newborn recognize by sight at 1 month?
The people he/she knows best
What is the newborn/neonatal period of infancy?
The period from birth until 28 days of age (page 960)
Newborn's sight
The newborn is nearsighted, preferring to view objects at a distance of 20-38 cm (8-15 in) They prefer the human face to other objects and may even imitate the facial expressions made by those caring for them They also show a preference for certain objects, particularly those with contrasts such as black & white stripes
Fine Motor Skills: 7 months
Transfers object from one hand to the other
Newborn's Smell
The sense of smell develops rapidly: the 7 day old infant can differentiate the smell of his/her mother's breast milk from that of another woman and will preferentially turn toward the mother's smell.
Development
The sequential process by which infants and children gain various skills and functions (page 960)
Due to the immaturity of the GI system, newborns & young infants often grunt, strain, or cry while attempting to have a bowel movement When should this be concerning?
When the stool is hard & dry
Asymmetric tonic neck relfex
While lying supine, extremities are extended on the side of the body to which the head is turned and opposite extremities are flexed (AKA fencing position)
Step reflex
With one foot on a flat surface, the infant puts the other foot down as if to step
Moro Reflex
With sudden extension of the head, the arms abduct and move upward and the hands form a "C"
Maturation
refers to an increase in functionality of various body systems or developmental skills
Gross motor skills
refers to those that use the large muscles (e.g., head control, rolling, sitting, and walking)
The development of object permanence is essential for the development of what?
self-image
When do the upper & lower central incisors typically appear?
8-12 months
When does the plantar grasp reflex disappear?
9 months
When do the upper & lower cuspids typically appear?
16-22 months
How many stools does a newborn usually have a day?
As many as 8-10 or as few as 1 every day or two (infrequent stooling is considered normal if the bowel movement remains soft)
Maternal iron stores are transferred to the fetus throughout the last trimester of pregnancy. Infants born prematurely miss all or at least a portion of this iron store transfer, which puts them at risk for what?
Iron deficiency anemia
Gross Motor Skills: 7 months
Sits alone with some use of hands for support
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? A) Newborn B) Baby C) Infant D) Child
A 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. Page 960
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? A) The normal respiratory rate for an infant at this age is between 20 and 30 breaths per minute. B) An infant at this age should have regular respirations. C) The irregularity of the infant's respirations are concerning; I will notify the physician. D) The respirations of a 1-month-old infant are normally irregular and periodically pause.
D 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. Page 961
Which developmental milestone would the nurse expect an 11-month-old infant to have achieved? A) Turning a doorknob B) Walking independently C) Sitting independently D) Building a tower of four cubes
C 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. Page 968
Sucking Reflex
Reflexive sucking when nipple or finger is placed in infant's mouth
Fine Motor Skills: 6 months
Releases object in hand to take another
When does the parachute (backward) reflex appear?
9-10 months
The nurse pulls the 5-month-old to sitting position from supine and notes head lag. The nurse's response is to: A) consider this a normal response for the age. B) suggest more awake tummy time for the child. C) conclude the earlier assessments carried out fatigued the infant. D) refer the infant for developmental and/or neurologic evaluation.
D 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. All other nursing actions indicate failure to recognize the problem. Page 968
When does the newborn regain their birth weight by?
10-14 days of age
When do the upper & lower lateral incisors typically appear?
9-13 months
Gross Motor Skills: 4 months
Lifts head & looks around Rolls from prone to supine Head leads body when pulled to sit
What color are the newborn's stools usually during the first few days of life?
Yellowish or tan
When does the concept of object permanence being to develop?
Between 4 and 7 months (is solidified by about 8 months)
What age does the moro reflex appear?
Birth
What age does the root reflex appear?
Birth
When do the upper & lower first molars typically appear?
13-19 months
How much does the average newborn weigh at birth?
3.4 kg (7.5 lb)
How much does the average newborn gain per day?
30 g
What is the average head circumference for a full-term newborn?
35 cm (14 in)
Most infants double their birth weight by when?
4 months
What age does the moro reflex disappear?
4 months
When does the asymmetric tonic neck reflex disappear?
4 months
Development of locomotion
4 months: the infant pushes up from a prone position 8 months: the infant crawls with the abdomen off the floor 10 months: the infant pulls to stand 10-11 months: the infant cruises along furniture or takes steps with assistance 12 months: the infant independently stands from a crouched position and walks around (plus or minus 3 months)
When does the neck righting reflex appear?
4-6 months
When does the palmar grasp reflex disappear?
4-6 months
When does the parachute (forward) reflex appear?
6-7 months
The nurse is helping the mother of a 5-month-old boy understand the importance of developmentally appropriate play. Which one of the toys best meets the needs of this child? A) A yellow rubber duck for the bath B) Brightly colored stacking toy C) A push-pull toy D) Pots and pans from the kitchen cupboard
A The rubber duck is most appropriate. It is safe, visually stimulating while bobbing on the water, and adds pleasure to bath time. A push-pull toy promotes skill for a walking infant. Pots and pans from the kitchen cupboard are played with successfully after sitting is mastered. A 5-month-old does not have the fine motor coordination to use stacking toys. Page 975
Mottling of the skin
A pink & white marbled appearance Due to their immature circulatory system Decreases over the first few months of life
The nurse is admitting a 12-month-old to the medical unit. During the admission process the parents tell the nurse that their child is very advanced because he says "ball" when he picks up a football. How should the nurse respond? A) "If he were advanced in language skills he would be putting several words together to form short sentences." B) "That is great that he is recognizing objects and is able to name them. He is right on target for language skills." C) "He really isn't any more advanced than most 12-month-old children." D) "Parents usually think their child is far more advanced than other children."
B
Infant development is best described by which statement? A) Development is not sequential but predictable. B) Development proceeds cephalocaudally. C) Development proceeds from fine to gross. D) Development varies greatly from infant to infant.
B 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 devolping 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. Page 968
An infant is breastfed. When assessing the stools, which findings would be typical? A) Harder stools than those of bottle-fed infants B) Less constipation than bottle-fed infants C) Fewer stools than bottle-fed infants D) A strong odor
B The first stool of the infant is meconium. It is the result of digestion of amniotic fluid and it is black-green color and sticky. Following that, in 1 to 2 days the infant's stools change to a yellowish-tan color. The stools of breastfed infants tend to be yellow-tan. They are looser in texture and appear "seedy." The stool of a bottle-fed baby has the consistency of peanut butter. The stools of breastfed babies generally have no odor since all milk is digested. Some babies will have a bowel movement with every feeding but it is small. Bottle-fed babies have less stools each day but they are larger and more likely to have an associated odor. Page 966
The nurse is caring for the family with a 2-month-old boy with colic. The mother reports feeling very stressed by the baby's constant crying. Which intervention would provide the most help in the short term? A) Educating the parents about when colic stops B) Urging the baby's mother to take time for herself away from the child C) Watching how the parents respond to the child D) Assessing the parents' care and feeding skills
B Urging the parents to get time away from the child would be most helpful in the short term, particularly if the parents are stressed. Educating the parents about when colic stops would help them see an end to the stress. Observing how the parents respond to the child helps to determine if the parent/ child relationship was altered. Assessing the parents' care and feeding skills may identify other causes for the crying. Page 984
The nurse is teaching healthy eating habits to the parents of a 7-month-old girl. Which recommendation is the most valuable advice? A) Actively urge the child to eat new foods B) Serve new foods several times C) Let the child eat only the foods she prefers D) Provide small portions that must be eaten
B 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. Page 981
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? A) Have the car seat installed by a professional B) Clean all fabric that touches the infant C) Check the expiration date on the car seat D) Inspect the car seat for any cracks or damage
C
The parent of an infant asks the nurse when to begin brushing the infant's teeth. What would be the nurse's best response? A) by 12 months of age B) when weaning is complete C) as soon as the first tooth erupts D) as soon as the infant begins to eat fruit
C Before tooth eruption occurs, parents should clean the infant's gums after feeding with a damp wash cloth. After the first tooth erupts, parents can use a soft bristle tooth brush. Dental hygiene should be part of the infant's everyday care. The American and Canadian Dental Associations recommend the first dental checkup to occur around 1 year of age. Infants should not go to bed with bottles or sippy cups to prevent dental caries. Page 983
The infant measures 21.5 in (54.6 cm) at birth. If the infant is following a normal pattern of growth, what would be an expected height for the infant at the age of 6 months? A) 30.5 in (77.5 cm) B) 29 in (74 cm) C) 27.5 in (70 cm) D) 32 in (81 cm)
C Infants gain about 0.5 to 1 in (1.25 to 2.5 cm) in length for each of the first 6 months of life. Therefore, a 21.5-in (54.6-cm) infant adding 6 in (15 cm) of growth would be 27.5 in (70 cm). Infants grow the fastest during the first 6 months of life and slow down the second 6 months. By 12 months of age, the infant's length has increased by 50%, making this infant 32 in (81 cm) at 1 year old. Page 960
At what age would it be okay to introduce carrots to an infant's diet? A) Solid food can be introduced at 7 to 9 months of age. B) Solid food can be introduced after 9 months of age. C) Solid food can be introduced at 4 to 6 months of age. D) Solid food can be introduced whenever the child seems ready.
C The tongue extrustion reflex is present until the infant is 4 to 6 months of age. After this reflex diasappears then solid food may be introduced. The infant's ability to swallow solid foods is not completely functional until this age nor are the enzymes present which are needed to process foods. The infant must be ready to handle spoon-feeding. By 7 months onward, the baby should be eating solid foods regularly and drinking from a cup in addition to breast or bottle feeds. Page 981
The nurse is conducting a physical examination of a 5-month-old boy. Which observation may be cause for concern about the infant's neurologic development? A) His toes hyperextend when the bottom of the foot is stroked. B) The anterior fontanel is open and easily palpated. C) The infant grasps a finger when it is placed in his palm. D) The infant displays an asymmetric tonic neck reflex (fencing reflex).
D The tonic neck reflex normally disappears by age 4 months, the palmar grasp reflex by age 6 months, and the Babinski reflex (fanning of toes when sole of foot stroked) by 12 months. Retaining these primitive reflexes may indicate a neurologic abnormality. The anterior fontanel, which remains open for brain growth, closes between 12 and 18 months of age. Page 963
The parents of an 8-month-old boy voice concern to the nurse that their child is not developing motor skills as he should. What question would be appropriate for the nurse to ask in determining if their fears are warranted? A) "Does he place toys into a box or container and take them out?" B) "Is he able to hold a pencil and scribble on paper?" C) "Is he able to drink with a cup by himself?" D) "Does he move a toy back and forth from one hand to the other when you give it to him?"
D Transferring an object from one hand to the other is expected at 7 months of age, so this would be expected of an 8-month-old. The other options are not expected until later months, so questioning the parents about these skills would not help in determining if he was at the motor skill developmental level that should be expected. Page 972
What are some warning signs that may indicate problems with sensory development?
Young infant does not respond to loud noises Child does not focus on a near object Infant does not start to make sounds or babble by 4 months of age Infant does not turn to locate sound at age 4 months Infant crosses eyes most of the time at age 6 months.
When does the step reflex disappear?
4-8 weeks
How long is the average newborn at birth?
50 cm (20 in)
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? A) "Infants still have a tongue protrusion reflex until 4 to 6 months so they can't help but push out the solid food." B) "A lot of babies do this at first. Just give it some time and I'm sure your baby won't continue spitting out solid food." C) "I will make sure to let the physician know." D) "Maybe if you make your own baby food your infant will like it better."
A 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. Page 981
The nurse is assessing the oral cavity of a 4-month-old infant. Which finding is consistent with a child of this age? A) No teeth B) 1 upper tooth C) 1 to 2 lower teeth D) 1 to 3 natal teeth
A 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.
What age does the sucking reflex appear?
Birth
Neck righting reflex
Neck keeps head in upright position when body is tilted
What age does the root reflex disappear?
3 months
The infant's length has increased by how much by 12 months?
50%
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? A) "The soft spot or fontanel has closed." B) "This closure of the fontanel is very premature and warrants some further testing." C) "We will need to do additional neurological testing to make certain your infant is developing normally." D) "This may signal your baby's calcium levels are elevated."
A 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. Page 961
Primitive reflexes
Are subcortical and involve a whole-body response
Which milestone would the nurse expect an infant to accomplish by 8 months of age? A) Sitting without support B) Being able to sit from a standing position C) Creeping on all fours D) Pulling self to a standing position
B Physical development of infants occurs in a cephalocaudal fashion. That means they must learn to control and lift their heads first. This is followed by the ability to turn over. Once this occurs the remainder of development occurse quickly. Most infants are able to sit unsupported by 8 months. They are able to creep at 9 months and pull to a standing position by 10 months. At 12 months the infant is able to sit from a standing position and is learning to walk. Page 968
When does the asymmetric tonic neck reflex appear?
Birth
When does the babinski reflex appear?
Birth
When does the palmar grasp reflex appear?
Birth
When does the plantar grasp reflex appear?
Birth
When does the step reflex appear?
Birth
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? A) Lower lateral gumline B) Upper lateral gumline C) Lower central gumline D) Upper central gumline
C The lower central incisors are usually the first to appear, followed by the upper central incisors. Page 965
Protective reflexes
Gross motor responses related to maintenance of equilibrium These responses include the righting and parachute reactions These responses are prerequisites for appropriate motor development and remain throughout life once they are established
Palmar grasp reflex
Infant reflexively grasps when palm is touched
Meconium
Newborn's first stools - the result of digestion of amniotic fluid swallowed in utero They are usually dark green to black & sticky
Growth
Refers to an increase in physical size (page 960)
How do you determine an infant's adjusted age?
Subtract the number of weeks that the infant was premature from the infant's chronologic age
What do you use to determine expected outcomes when assessing the growth & development of a premature infant?
The infant's adjusted age
States of Counsciousness
1. Deep sleep: Sleeping with eyes closed & no movement 2. Light sleep: Sleeping with eyes closed; rapid eye movements and irregular movements may be noticed 3. Drowsiness: Eyes may close of be half-lidded; the infant may be dozing 4. Quiet alert state: The infant's eyes are wide open & the body is calm 5. Active alert state: The infant's eyes are open; body movements occur 6. Crying: The infant cries or screams and it is difficult to gain the infant's attention
What age does does the sucking reflex disappear?
2-5 months
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? A) "Delays are normal when a child is premature." B) "We will need to check this out since any delays related to prematurity should be resolved by the time a child is 6 months old." C) "You should talk with the doctor about getting your son tested." D) "All children mature and develop at different rates so it is unwise to compare them in this way."
A 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. Page 960
The infant weighs 7 lb 4 oz (3,248 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? A) 14 lb 8 oz (6.6 kg) B) 21 lb 12 oz (9.9 kg) C) 25 lb (11.3 kg) D) 28 lb 4 oz (12.8 kg)
B The average weight of a newborn is 7.5 lb (3400 g). The infant gains about 30 g each day. By four months of age, the infant has doubled the birthweight. By 1 year of age, the infant has tripled the birthweight and has grown 10 to 12 in (25 to 30 cm). 7.25 lb × 3 = 21.75 lb or 21 lb 12 oz Page 960
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 infant state the child is in by what the mother says and that it is okay to try and feed the infant? A) "She is so quiet today, that is not like her." B) "She has been a chatterbox and smiles just like her brother." C) "She is still sleeping, I guess she is worn out." D) "She has been crying every time someone picks her up."
B The best time to feed an infant is when the child is in the active alert state. This infant is talking and smiling, which shows she is calm and actively awake. In the active alert state the infant has normal respirations, limited movement, and eyes that are bright and shiny and attentive. The other choices put the infant in a crying state, quiet alert or deep sleep, or drowsing. These stages are not optimal for interacting with the child. page 961
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? A) "Grunting is normal with infant stool formation." B) "We will need to collect a stool specimen for analysis." C) "What does his stool look like?" D) "Is he in pain?"
C 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. Simply indicating this is normal without having additional information is not the appropriate response. There is no need for a stool specimen based upon the infomation provided Page 966
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? A) The infant's eyes are partially open and there are small movements in the extremities. B) The infant is awake but appears drowsy. C) The newborn's eyes are open and no body movements are noted. D) The newborn's eyes are open and he is smacking his lips.
C The normal newborn moves through 6 stages of consciousness. The quite alert state is when the infant's eyes are open but the body is calm. Open eyes accompanied by body movements is characteristic of the active alert state. Page 961
Anticipatory guidance for an infant for the 4th month should include the fact that the infant will be able to achieve which developmental milestone? A) have many "blue" or moody periods B) insist on things being done the infant's way C) develop a fear of strangers D) be able to turn over onto the back
D 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 reponse to voices. A fear of strangers does not occur until the child is older and a 4-month-old infant has not developed emotionally to have "moody" periods and is dependent on parental care. Page 968
The nurse is providing anticipatory guidance to the mother of a 2-month-old in relation to interpersonal development. Which behavior is most likely to occur over the next 8 weeks? A) Becoming clingy around strangers B) Crying when the mother is out of sight C) Participating in a game of peek-a-boo D) Mimicking mother's facial expressions
D 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 mother is out of sight indicates separation anxiety and is common after 6 to 8 months of age. Page 973
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? A) The parent allows the child to continue pulling at the dog and states, "If the dog bites her she will learn." B) The parent tells the child "no" with a stern voice and pulls the child's hand away from the dog C) The parent spanks the child while taking the child into another room away from the dog D) The parent places the child in time-out and explains the reason for the time-out
B Providing a safe environment, redirection away from undesirable behaviors, and saying "no" in appropriate instances are effective forms of discipline for an infant's developmental level. Infants are at an increased risk for injury from spanking and do not understand the reason for the spanking. Infants do not understand time-outs or the reason for this type of discipline. Page 984
What action shows an example of Erik Erikson's developmental task for the infant? A) The infant plays the game peek-a-boo. B) The infant smiles as people walk past the crib. C) The infant cries when he or she has a wet diaper. D) The infant cries and the caregiver picks the child up.
C Erikson's psychosocial developmental task for the infant is to develop a sense of trust. The development of trust occurs when the infant has a need and that need is met consistently. Crying with a wet diaper without a change of the diaper leads to an unmet need. Playing peek-a boo and smiling are developmental tasks that indicate a normal healthy, happy baby. These would be attributed to Piaget theory. Page 967
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: A) should be pronounced and easy to elicit. B) is a protective reflex and retained for life. C) should have disappeared. D) is expected to appear within 1 month.
C This primitive (not protective) reflex should be present at birth and disappear around age 4 months. page 961
The infant weighs 6 lb 8 oz (2,912 g) at birth. If the infant is following a normal pattern of growth, what would be an expected weight for this child at the age of 4 months? A) 10 lb 8 oz (4760 g) B) 15 lb 4 oz (6920 g) C) 16 lb (7260 g) D) 13 lb (5900 g)
D The average newborn weighs 7.5 lb (3400 g). The average newborn looses 10% of birthweight over the first week of life but regains it in about 10 to 14 days. Most infants double their birth weight by 4 months of age and triple their birth weight by the time they are 1 year old. If the newborn weighed 6 lb 8 oz (2,912 g) at birth and doubled that weight at 4 months the infant should weigh 13 lb (6.5 lb × 2 = 13 lb). page 960
Fine Motor Skills: 5 months
Grasps rattle
Lanugo
Fine downy hair - covers the body of many newborns Darker-skinned races tend to have more present at birth than those with light skin
Fine Motor Skills: 10 months
Fine pincer grasp Puts objects into container and takes them out
Fine Motor Skills: 1 month
Fists mostly clenched Involuntary hand movements
Formula-fed infants' stools vs. breastfed infants' stools
Formula-fed: stools have the consistency of peanut butter Breastfed: usually looser in texture and appear seedy
Heredity influences growth & development by determining the child's potential, while environment contributes to...
the degree of achievement
A 3-month-old infant has a Moro reflex. Which statement is most true of this reflex? A) A Moro reflex normally lasts until 9 months. B) It is not important how long the reflex persists, only that it is present at birth. C) A Moro reflex present at 3 months of age requires referral for a neurologic exam. D) Most 3-month-old infants still have a Moro reflex.
D The Moro reflex is seen in the infant as a sudden extension of the head with the arms abducted and moving upward. In this position the hands for the letter "C". This reflex is present at birth and disappears around 4 months of age. This reflex is known as the startle reflex because the baby looks startled when this is seen. It is a normal reflex and there is no need for medical intervention. Page 962
What are some warning signs that may indicate problems with motor development?
Arms & legs are stiff or floppy Child cannot support head at 3-4 months Child reaches with one hand only Child cannot sit with assistance at 6 months Child does not crawl by 12 months Child cannot stand supported by 12 months
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? A) If the baby does not have any teeth come in by next month, the mother needs to bring him back for x-rays. B) A baby's first teeth should erupt by 8 to 10 months of age and are the two lower front teeth. C) Tooth eruption is often genetically based, with some families having babies with early tooth eruption, while others have late tooth eruption. D) Look for the baby to start running a fever and develop a stuffy nose and that will indicate his teeth are coming in.
C
Plantar grasp reflex
Infant reflexively grasps with bottom of foot when pressure is applied to plantar surface
The nurse at a family health clinic is teaching a group of parents about normal infant development. What patterns of communication should the nurse tell parents to expect from an infant at age 1? A) Uses multisyllabic babbling B) Understands "no" and other simple commands C) Squeals and makes pleasure sound D) Uses speech-like rhythm when talking with an adult
B At age 1, most babies understand the word "no" and other simple commands. Children at this age also learn one or two other words. Babies squeal, make pleasure sounds, and use multisyllabic babbling at age 6 months. Using speech-like rhythm when talking with an adult usually occurs between ages 9 to 12 months Page 972
A 12-month-old seen at a walk-in clinic weighed 8 pounds 4 ounces (3.75 kg) at birth. Weight now is 20 pounds 8 ounces (9.3 kg). The nurse determines: A) The child weighs more than expected for age. B) The child weighs less than expected for age. C) The child weighs the expected amount for age. D) The weight assessment is blatantly inaccurate.
B Birth weight should triple by 12 months. The child should weigh near 24 pounds 12 ounces (11.25 kg). The child is underweight for age. page 960
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? A) "Breastfeeding will become painful when the child gets more teeth, so the infant needs to eat solid foods." B) "By this age the child becomes interested in trying new skills." C) "Milk will not fully provide the child's needs for iron, which is found in solid foods." D) "The extrusion reflex must be developed and feeding solid foods will help the child to develop this reflex."
C At about 4 to 6 months of age, the infant's milk consumption alone is not likely to be sufficient to meet caloric, protein, mineral, and vitamin needs. In particular, the infant's iron supply becomes low, and supplements of iron-rich foods are needed. It is also around 4 to 6 months when the infant is able to swallow solids effectively and has the necessary enzymes necessary to digest them. It is true that the child becomes interested in new skills, but this is not the primary rationale for introducing solids. Few parents will understand the "extrusion reflex" so using that term is not effective in teaching. The nurse should, however, describe the reflex to the parents. Breastfeeding does not become painful when the child develops teeth. Many mothers nurse for long after their infants develop teeth. Page 980
A nurse is educating a client being discharged with her newborn baby. What is the highest priority item that must be included in the teaching plan? A) Give warm bottles of formula to the baby. B) Lock all cabinets that contain cleaning supplies. C) Keep all pots and pans in lower cabinets. D) Restrain the baby in a car seat.
D The client should restrain the baby in a car seat when driving. Infants are especially vulnerable to injuries resulting from falls from changing tables or being unrestrained in automobiles. Locking the cabinets and giving warm bottles of formula to the baby are secondary teachings. Page 976
How do fine motor skills develop?
In a proximodistal fashion (from the center to the periphery) In other words, the infant first bats with the hold hand, eventually progressing to gross grasping, before being capable of fine fingertip grasping.
Gross Motor Skills: 1 month
Lifts and turns head to side in prone position Head lag when pulled to sit Rounded back in sitting
Paiget: Sensorimotor (birth to 2 years)
Substage 1: use of reflexes (birth to 1 month) Substage 2: primary circular reactions (1 to 4 months) Substage 3: secondary circular reactions (4 to 8 months) Substage 4: coordination of secondary schemes (8 to 12 months) Infant uses senses and motor skills to learn about the world. Reflexive sucking brings the pleasure of ingesting nutrition. Infant begins to gain control over reflexes and recognizes familiar objects, odors, and sounds. Thumb sucking may occur by chance; then the infant repeats it on purpose to bring pleasure. Imitation begins. Object permanence begins. Infant shows affect. Infant repeats actions to achieve wanted results (e.g., shakes rattle to hear the noise it makes). The infant's actions are purposeful but the infant does not always have an end goal in mind. Infants coordinate previously learned schemes with previously learned behaviors. They may grasp and shake a rattle intentionally or crawl across the room to reach a desired toy. Infant can anticipate events. Object permanence is fully present at about 8 months of age. The infant begins to associate symbols with events (e.g., waving goodbye means someone is leaving).
Gross Motor Skills: 6 months
Tripod sits
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? A) The development of a 10-week-old B) The growth of a 5-month-old C) The growth of a 2-month-old D) The development of a 3-month-old
D The infant was born 8 weeks early. Two months are subtracted from the present age of 5 months. Both growth and development should be assessed using 3-month norms. Page 960
The nurse is educating the mother of a 6-month-old boy about the symptoms for teething. Which symptom would the nurse identify? A) Frequent loose stools B) Increased biting and sucking C) Choosing soft foods over hard foods D) Running a mild fever or vomiting
B 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. page 985
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? A) Sitting ability and the age of first tooth eruption are correlated. B) Most infants do not sit steadily until 8 months; this infant is normal. C) Most infants sit steadily at 3 months; this infant is slightly delayed. D) Most infants sit steadily at 4 months; this infant is normal.
B At 3 months of age the infant should be able to raise the head about 45 degrees when in the prone position. The infant does yet have the developmental skills for sitting. Most infants are unable to sit steadily until 8 months of age. Gross motor skill development does not correlate with tooth eruption. The nurse should reassure the parent that this infant is on tract developmentally. Page 968
The student nurse is reviewing the records of a pediatric client. Which statement about the client's progress indicates the need for further instruction? A) "Development refers to the increase in skills the child demonstrates as they grow and age." B) "Maturation refers to the child's increases in body size." C) "Both growth and development are influenced by heredity." D) "Increases in body size are referred to as growth."
B Growth refers to an increase in physical size. Development is the sequential process by which infants and children gain various skills and functions. Heredity influences growth and development by determining the child's potential, while environment contributes to the degree of achievement. Maturation refers to an increase in functionality of various body systems or developmental skills. Page 960
A newborn requires skin care that includes bathing. Besides hygiene, what is another reason for bathing the newborn? A) Bathing helps moisten the skin. B) Bathing is a great time to apply lotion. C) Bathing can prevent infection. D) Bathing is a time for bonding with the parents.
D 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. Page 975
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? A) "You are doing a wonderful job attempting to wake the baby." B) "Maybe you should watch the breastfeeding video again." C) "That is not how you get him to eat." D) "You will never get him to eat all unwrapped like that."
A 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 other responses do not emotionally support the mom or contribute to a positive learning environment. Page 987
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? A) "It is too soon to determine a milk intolerance." B) "Your baby's stomach is small and can only hold about 1/2 to 1 ounce at birth." C) "You need to make certain to burp him more frequently." D) "Babies do not each much."
B 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. Page 965
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? A) The child has a regular, scheduled bedtime. B) They put her to bed when she falls asleep. C) They sing to her before she goes to sleep. D) If she is safe, they lie her down and leave.
B 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. If the parents are singing to her before she goes to bed, if she has a regular, scheduled bedtime, and if they check on her safety when she wakes at night, then lie her down and leave, they are using good sleep practices. Page 983
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? A) Document the findings as normal. B) Review the birth records of the infant to see if there were any other anomalies. C) Measure the infant's head circumference. D) Notify the infant's physician.
A 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. Page 961
A breast-feeding 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? A) At 6 months, you need to quit breast-feeding because he is not getting enough iron or Vitamin C and D and that should help him transition to solids better. B) The first food offered to an infant is iron-enriched rice cereal and can be started now. Additionally, the infant needs to receive Vitamin D and iron. C) If you give him one or two bottles of juice each day, he should get all the vitamins he needs. You can begin fruits and cereal in 1 month. D) You can begin feeding the infant fruits and vegetables now followed by iron-enriched cereal to ensure that he gets enough iron.
B Breast-feeding is the best method for feeding infants, according The Academy of Pediatrics Committee on Nutrition. However, by 4 to 6 months of age, breast-fed infants need supplements of iron and vitamin D. Solids are introduced at the same age and begins with iron-fortified rice cereal. The infant may also have diluted fruit juice in small portions.
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: A) shaking a rattle to enjoy the sound. B) looking for a toy in her crib at the last place she saw it. C) pushing a spoon from her high chair tray to the floor. D) smiling at herself in the mirror.
B 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. All the rest of the infant's behaviors show use of her senses and motor activity but do not illustrate object permanence. Page 967
When performing neurological reflexes on the infant, which primitive reflex will be present longest? A) Rooting B) Babinski C) Step D) Moro
B 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. page 961
The best way for an infant's parent to help the child complete the developmental task of the first year is to: A) expose the infant to many caregivers to help the infant learn variability. B) respond to the infant consistently. C) talk to the infant at a special time each day. D) keep the infant stimulated with many toys.
B The developmental task of an infant is gaining a sense of trust. The infant develops this sense from the caretakers who respond to the child's needs, such as feeding, changing diapers, being held. It is a continuous process. A sense of trust is difficult to learn if things are constantly changing. Consistently responding to an infant's needs helps to build a sense of trust. An infant is too young to have variability in caretakers. This causes mistrust. The parents or caretakers do not need a special time to talk to the infant each day. It should be done with each interaction. Providing too much stimulus before the infant develops gross motor skills causes frustration from the child and not enjoyment. Page 967
A mother takes her 4-month-old to the doctor for a visit. She asks the nurse what type of baby cereal she should buy now that her child is starting solid foods. How should the nurse respond? A) "You should buy barley cereal." B) "You should buy rice cereal." C) "You should buy wheat cereal." D) "You should buy oat cereal."
B The rice cereal should be first. The infant should be monitored for food allergies by following the rice cereal with oats, barley, and wheat. Wheat has the highest allergy reaction in infants. Page 982
The nurse is providing client education to the parent about bathing the infant. What would be important to instruct the parent? A) Infants need a daily bath B) Bath time provides an opportunity for play C) Never use soap on an infant's hair D) Soap lubricates and oils an infant's skin
B The work of children is play. Play provides a natural way for the infant to learn. In early infancy infants prefer their parents rather than toys. Parents can talk and sing to infants during feeding, bathing, and changing diapers. Infants do not need a daily bath as long as the diaper area is washed with diaper changes. Soap is actually drying to an infant's skin. Washing the hair with soap can help remove excess oil. Page 975
What is the correct amount of wet diapers a mature infant should produce each day? A) An infant should have 9 to 10 wet diapers/day. B) An infant should have 6 to 8 wet diapers/day. C) An infant should have 3 to 5 wet diapers/day. D) An infant should have 1 to 2 wet diapers/day.
B Urination occurs in the first 24 hours of life. A normal amount of urine is 200 to 300 ml/day as the infant matures. This amount is equal to 6 to 8 wet diapers/day.The infant should have an intake of between 140 to 160 ml/kg/day to be well hydrated and nourished. This amount of intake will produce the 6 to 8 diapers/day. Page 978
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? A) "Recognition of this type begins around 8 weeks of age." B) "Don't worry. He knows you are his mother." C) "Since about 4 weeks of age your child has been able to recognize those who are around him often." D) "Recognition of faces and voices will come with time."
C
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? A) The infant will likely show the skills of an infant with the adjusted age of 7 month. B) By 8 months of age, the child's skill level will vary greatly and cannot be predicted. C) The infant will most likely present with developmental skills consistent with a 6-month-old infant. D) The infant can be expected to display developmental skills consistent with a 8-month-old infant.
C 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. The infant who was born at 32 weeks' gestation was 8 weeks or 2 months premature. To determine the adjusted age, the nurse subtracts 2 months from the chronological age of 8 months: 6 months. Page 960
Erikson: Trust vs. Mistrust (birth to 1 year)
Caregivers respond to the infant's basic needs by feeding, changing diapers, cleaning, touching, holding, and talking to the infant. This creates a sense of trust in the infant. As the nervous system matures, infants realize they are separate beings from their caregivers. Over time the infant learns to tolerate small amounts of frustration and trusts that although gratification may be delayed, it will eventually be provided.
What information would the nurse include when teaching the parents of an infant about colic? A) Symptoms will decrease if the infant is laid on the back after feedings. B) Formula intake should be doubled to keep the infant from losing weight. C) The infant will need future follow-up for a "nervous" bowel. D) Colic symptoms will probably fade at 3 months of age.
D Colic is defined as unconsolable crying that lasts 3 hours or longer per day and which it has no physical cause. Colic symptoms typically fade around 3 months of age. This is an age when infants are better able to console themselves. Colic can be very stressful for parents and lead to sleep deprivation. Many infants need to be carried at all times to reduce crying. Some do well with non-nutritive sucking and other need white noise or motion to help them soothe. Because colic has no physical cause telling the parents about follow up for "nervous stomach" is not necessary. The infant should be placed in a position of comfort to reduce the crying. Every infant has one's own position which helps, not just placing the infant on the back. Doubling up the formula will not help colic and may cause more problems, because it can cause abdominal pain and increased weight gain. Page 984
A parent asks the nurse if her 2-month-old could have bananas yet. The nurse would respond and educate the parent on the nutrition stages of infants by which of these responses? A) "Sure, if you feel she is ready to have bananas." B) "When did you feed your other child bananas? C) "In one month you can try bananas if you think she is ready." D) "In two months you can try bananas if you think she is ready."
D The nurse should choose this response because no solid foods are recommended for infants until 3 months of age. The age of 4 to 6 months is the age recommended to introduce solid foods. The other responses are the incorrect age or are letting the parent decide the appropriate answer. Page 981
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? A) "Maybe she just knows your voice better than your mother's." B) "I'm not sure a 4-week-old infant can tell their mother from another woman's smell." C) "Babies really can't tell the difference between people at that age." D) "You may be right since infants can sense their mother's smell as early as 7 days old."
D 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. Page 970
