Pediatrics Ch 25- Growth & Development of the Newborn and Infant
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?
"The baby can sleep in your room in an infant crib, but not in an adult bed." Explanation: According to the 2016 recommendation by the American Academy of Pediatrics, infants should sleep in the same bedroom as the parents, but on a separate firm surface, such as a crib or bassinet, and never on a couch, armchair or adult bed, to decrease the risks of sleep-related deaths.
A new mother shows the nurse that her baby grasps her finger when she touches the baby's palm. How might the nurse respond to this information?
"This is a primitive reflex known as the palmar grasp." Feedback: 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. During the palmar grasp, the infant reflexively grasps when the palm is touched. The plantar grasp occurs when the infant reflexively grasps with the bottom of the foot when pressure is applied to the plantar surface. The root reflex occurs when the infant's cheek is stroked and the infant turns to that side, searching with mouth. The Moro reflex is displayed when with sudden extension of the head, the arms abduct and move upward and the hands form a "C."
The parent of a 6-month-old infant asks the nurse for advice about his son's thumb sucking. What would be the nurse's best response to this parent?
"Thumb sucking is a healthy self-comforting activity." Feedback: Thumb sucking is a healthy self-comforting activity. Infants who suck their thumbs or pacifiers often are better able to soothe themselves than those who do not. Studies have not shown that sucking either thumbs or pacifiers leads to the need for orthodontic braces unless the sucking continues well beyond the early school-age period. The infant who has become attached to thumb sucking should not have additional attention drawn to the issue, as that may prolong thumb sucking. Pacifiers should not be used to replace thumb sucking as this habit will also need to be discouraged as the child grows.
Which developmental milestone would the nurse expect an 11-month-old infant to have achieved?
Sitting independently Explanation: 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.
The nurse is teaching a new mother about the drastic growth and developmental changes her infant will experience in the first year of life. Which statement describes a developmental milestone occurring in infancy?
By 6 months of age, the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. Feedback: By 6 months of age, the infant's brain weighs half that of the adult brain; at age 12 months, the brain weighs 2.5 times what it did at birth. Most infants double their birth weight by 4 to 6 months of age and triple their birth weight by the time they are 1 year old. The head circumference increases rapidly during the first 6 months: the average increase is about 0.6 in (1.5 cm) per month. The heart doubles in size over the first year of life. As the cardiovascular system matures, the average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old.
The nurse is promoting a healthy diet to guide a mother when feeding her 2-week-old girl. Which is the most effective anticipatory guidance?
Discouraging the addition of fruit juice to the diet Feedback: Discouraging the addition of fruit juice to the child's diet is the most effective anticipatory guidance. Fruit juice can displace important nutrients from breast milk or formula. Cow's milk is likely to result in an allergic reaction. If breast milk is not available, infant formula may be substituted. Advising fluid intake per feeding of 5 or 6 ounces is too much for this neonate, but is typical for an infant 4 to 6 months of age. Advocating iron supplements with bottle-feeding is unnecessary so long as the formula is fortified with iron.
The infant weighs 6 lb 8 oz (2,950 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 12 months?
19 lb 8 oz (8825 g) Explanation: The average newborn weighs 7.5 lb (3400 g). The average newborn loses 10% of birth weight over the first week of life but regains it in about 10 to 14 days. Most infants double their birth weight by 4 to 6 months of age and triple their birth weight by the time they are 1 year old. If the newborn weighed 6 lb 8 oz (2,950 g) at birth and tripled that weight at 12 months, the infant should weigh 19 lb 8 oz (6.5 lb × 3 = 19.5 lb) or 8825 g.
The infant weighs 7 lb 4 oz (3,300 g) at birth. If the infant is following a normal pattern of growth, what would be the expected weight for this child at the age of 12 months?
21 lb 12 oz (9.9 kg) Explanation: The average weight of a newborn is 7.5 lb (3400 g). The infant gains about 30 g each day. By 1 year of age, the infant has tripled the birth weight and has grown 10 to 12 in (25 to 30 cm). 7.25 lb × 3 = 21.75 lb or 21 lb 12 oz (9.9 kg)
At which age would the nurse expect to find the beginning of object permanence?
6 months Feedback: Object permanence begins to develop between 4 and 7 months of age and is solidified by approximately age 8 months. By age 12 months, the infant knows he or she is separate from the parent or caregiver.
The nurse is assessing the respiratory system of a newborn. Which anatomic differences place the infant at risk for respiratory compromise? Select all that apply.
The nasal passages are narrower The larynx is more funnel shaped There are significantly fewer alveoli. Feedback: In comparison with the adult, in the infant, the nasal passages are narrower, the trachea and chest wall are more compliant, the bronchi and bronchioles are shorter and narrower, the larynx is more funnel shaped, the tongue is larger, and there are significantly fewer alveoli. These anatomic differences place the infant at higher risk for respiratory compromise. The respiratory system does not reach adult levels of maturity until about 7 years of age.
The nurse is counseling the mother of a newborn who is concerned about her baby's constant crying. What teaching would be appropriate for this mother?
Reducing stimulation may decrease the length of crying. Feedback: Prolonged crying leads to increased stress among caregivers. Reducing stimulation may decrease the length of crying, and carrying the infant more may be helpful. Some infants respond to the motion of an infant swing or a car ride. Vibration, white noise, or swaddling may also help to decrease fussing in some infants. Parents should try one intervention at a time, taking care not to stimulate the infant excessively in the process of searching for solutions.
The nurse caring for newborns knows that infants exhibit phenomenal increases in their gross motor skills over the first 12 months of life. Which statements accurately describe the typical infant's achievement of these milestones? Select all that apply.
At 1 month, the infant lifts and turns the head to the side in the prone position At 7 months, the infant sits alone with some use of hands for support At 9 months, the infant crawls with the abdomen off the floor. At 12 months, the infant walks independently Feedback: At 1 month, the infant lifts and turns the head to the side in the prone position. At 7 months, the infant sits alone with some use of hands for support. At 9 months, the infant crawls with the abdomen off the floor. At 12 months, the infant walks independently. At 4 months, the infant lifts the head and looks around. At 10 months, the infant pulls to stand up.
The nurse is educating the mother of a newborn about feeding practices. The nurse correctly advises the mother that:
the newborn's stomach can hold between 0.5 oz and 1 oz. Explanation: The capacity of the normal newborn's stomach is between 0.5 oz and 1 oz. The recommended feeding plan is to use a demand schedule. Newborns may eat as often as 1.5 to 3 hours. Demand scheduled feedings are not associated with problems sleeping at night.
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." Explanation: 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.
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? Select all that apply.
"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." Explanation: 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 nurse is providing anticipatory guidance to the parent of a 2-month-old infant in relation to growth and development. Which statement from the parent demonstrates proper understanding?
"I can expect my infant to be able to raise the head up when on the stomach within the next month." Explanation: It is expected that a 3-month-old infant can raise the head to 45 degrees while laying on the stomach. Becoming clingy around strangers occurs in the infant around 6 to 8 months of age. The infant can begin to hold a rattle around 5 months of age. At 4 to 5 months, the infant will typically begin to laugh out loud.
The student nurse is reviewing the records of a pediatric client. Which statement about the client's progress indicates the need for further instruction?
"Maturation refers to the child's increases in body size." Explanation: 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.
The nurse comes into an infant's room on the pediatric floor. The nurse wants to try to feed the infant for the first time since her surgery. How does the nurse know what state the infant is in by what the mother says, and that it's fine to try and feed the infant?
"She has been a chatterbox and smiles just like her brother." Explanation: 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.
A new mother expresses concern to the nurse that her baby is crying and grunting when passing stool. What is the nurse's best response to this observation?
"This is normal behavior for infants unless the stool passed is hard and dry." Feedback: Due to the immaturity of the gastrointestinal system, newborns and young infants often grunt, strain, or cry while attempting to have a bowel movement. This is not of concern unless the stool is hard and dry. Stool color and texture may change depending on the foods that the infant is ingesting. Iron supplements may cause the stool to appear black or very dark green.
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?" Explanation: 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 information provided.
The parent of 1-week-old infant voices concerns about the infant's weight loss since birth. At birth the infant weighed 7 lb (3.2 kg); the infant currently weighs 6 lb 5 oz (2.9 kg). Which response by the nurse is most appropriate?
"Your infant's weight loss is within the expected range." Explanation: The normal newborn may lose up to 10% of birth weight. This infant has lost 9.1%. This degree of weight loss will likely not require hospitalization. Expressing to the parent that the infant may be hospitalized is rash and will most likely not occur.
The nurse is assessing a 1-year-old at the well-child annual visit and notes the child is meeting the growth parameters. After noting the birth weight was 8 pounds (3.6 kg) and length was 20 inches (50.8 cm) long, which measurements reflecting height/weight would the nurse expect to document for this visit?
24 pounds (10.8 kg) and 30 inches (75 cm) Explanation: By 1 year of age, the infant should have tripled his or her birth weight and grown 10 to 12 inches (25 to 30 cm). If this infant was 8 pounds (3.6 kg) at birth, at 1 year, this child should weigh 24 pounds (8 x 3 = 24) and grown to 30 to 32 inches (20 + 10 to 12 = 30 to 32 inches). Most of the growing occurs during the first 6 months with the infant's birth weight doubling and height increasing about 6 inches (15 cm). Growth slows slightly during the second 6 months but is still rapid.
The nurse is performing a health assessment of a 3-month-old African-American boy. For what condition should this infant be monitored based on his race?
Lactose intolerance Feedback: Many dietary practices are affected by culture, both in the types of food eaten and in the approach to progression of infant feeding. Some ethnic groups tend to be lactose intolerant (particularly blacks, Native Americans, and Asians); therefore, alternative sources of calcium must be offered. Jaundice, iron deficiency, and GERD are not seen at a significantly higher rate in African-American infants.
The nurse is assessing the newborn. Which would the nurse assess to be an abnormal finding?
Natal teeth noted in the mouth that are loose Explanation: The presence of 1 or 2 teeth at birth (natal teeth) is a finding that may be benign or may point to other congenital abnormalities. The neck should be short, thick and mobile. The gluteal folds should be symmetrical. It is normal for the newborn to startle to loud sounds.
Which activity will the nurse encourage new parents to complete in order to assist their infant in accomplishing Erikson's developmental task for the first year of life?
Respond promptly when the infant cries. Explanation: The developmental task of the infant year, according to Erikson, is to gain a sense of trust. This can be accomplished by promptly meeting the infant's needs during the first year of life. If the infant does not learn to trust, mistrust will develop. Praising will help meet the future developmental tasks of the child. Reading books and appropriately enunciating words will aid in the infant's language development.
The nurse is assessing a 4-month-old boy during a scheduled visit. Which findings might suggest a developmental problem?
The child does not vocally respond to voices. Feedback: The fact that the child does not vocally respond to voices might suggest a developmental problem. At 4 to 5 months of age, most children are making simple vowel sounds, laughing aloud, doing raspberries, and vocalizing in response to voices. The child is too young to babble, squeal, yell, or say dada or mama.
The nurse is examining a 10-month-old boy who was born 10 weeks early. Which finding is cause for concern?
The child's head circumference is 49.53 cm. Feedback: The child's head size is large for his adjusted age (7.5 months), which would be cause for concern. The average head circumference of the full-term newborn is 35 cm (13.5 in). Head circumference increases about 10 cm from birth to 1 year (Levine, 2019). Birth weight doubles by about 4 months of age. Plantar grasp reflex does not disappear until 9 months adjusted age. Primary teeth may not erupt until 8 months adjusted age.
The nurse is completing a developmental assessment on a 6-month-old infant. Which findings indicate the need for additional follow-up? Select all that apply.
The infant does not pay attention to noises behind him. The infant has frequent episodes of crossed eyes. The infant seems disinterested in the surrounding environment. Explanation: Warning signs that may indicate problems with sensory development include the following: 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. Language development at this stage of development does not include stringing together 2-word sentences.
The nurse in a community clinic is assessing a 2-month-old infant. The parent asks if the infant is developing normally. The nurse refers to which finding as suggestive of normal development in infants from birth to 2 months of age?
The infant raises head and chest while on stomach. Explanation: Infants have gained some neck control and can independently raise head and chest by 2 months of age. Transferring objects from one hand to another is expected at 7 months of age. Laughing aloud and responding to his or her name is expected between 4 to 5 months of age. Sitting in the tripod position is not expected until 6 months of age.
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. Explanation: 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.
A new mother reports that she is exhausted and that the little sleep she gets is determined by her baby. Which suggestion should the nurse prioritize to help the mother establish healthy sleeping patterns in her infant?
Use the crib for sleeping only, not for play activities. Explanation: A consistent bedtime routine is usually helpful in establishing healthy sleeping patterns and in preventing sleep problems. Using the crib for sleeping only helps the child associate the bed with sleep. Depriving the baby of sleep during the afternoon or evening will make the baby over-tired and less able to establish a healthy sleeping pattern. While letting a baby cry for a while is acceptable, this does not promote consistency in the baby's sleeping pattern.
The parent of an infant asks the nurse when to begin brushing the infant's teeth. What would be the nurse's best response?
as soon as the first tooth erupts Explanation: 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.
Which activity is most beneficial in the development of the newborn?
being sung to by his mother Explanation: 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.
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 Explanation: 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 assesses a 4-month-old child during a well-child visit (above). Which assessment finding should the nurse report to the primary health care provider?
not smiling or tracking faces Explanation: Preterm infants should be assessed developmentally based on their corrected age. For a 2-month-old infant, corrected waking at night, spitting up, and not rolling over are all normal findings. Not smiling or tracking faces are concerning findings that could indicate problems with vision. This requires follow-up by the health care provider.
The best way for an infant's parent to help the child complete the developmental task of the first year is to:
respond to the infant consistently. Explanation: 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.
The nurse conducting a 6-month well-baby check-up assesses for the presence/absence of the asymmetric tonic neck reflex. At this age the reflex:
should have disappeared. Explanation: This primitive (not protective) reflex should be present at birth and disappear around age 4 months.
A 12-month-old seen at a walk-in clinic weighed 8 pounds 4 ounces (3750 g) at birth. Weight now is 20 pounds 8 ounces (9300 g). The nurse determines:
the child weighs less than expected for age. Explanation: Birth weight should triple by 12 months. The child should weigh near 24 pounds 12 ounces (11250 g). The child is underweight for age.
A 5-month-old infant being assessed was born at 32 weeks. The nurse doing the well-child check-up should compare the baby to what norms?
the development of a 3-month-old Explanation: 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.
The nurse is assessing an infant at the 6-month well-baby check-up. The nurse notes that at birth the baby weighed 8 lb (3600 g) and was 20 in (50.8 cm) in length. Which finding is consistent with the normal infant growth and development?
weight of 16 lb (7300 g) and length of 26 in (66.0 cm) Explanation: The average newborn weighs 7.5 lb (3400 kg) at birth. Most infants double their birth weight at 4 to 5 months and will triple by the time they are 1 year old. If this infant was 8 lb (3600 kg) at birth, then it is most likely now 16 lb (7300 g). The average newborn is 20 in (50 cm) long at birth. They grow more quickly in length over the first 6 months, than during the second 6 months. By 12 months of age, the infant's length has increase by 50%. At 1 year, this infant will most likely be 30 in (76.2 cm) in length; however, since most of the growth occurs in the first 6 months, it is possible for the infant to grow an additional 6 in (15 cm) during that time.
The nurse is caring for a 7-month-old girl during a well-child visit. Which intervention is most appropriate for this child?
Discussing the type of sippy cup to use Feedback: The cup may be introduced at 6 to 8 months of age. Old-fashioned sippy cups are preferred compared to the new style. The nurse would not advise about increased caloric needs as caloric needs drop at this age. Transition to table meat will not take place until age 10 to 12 months. Tongue extrusion reflex has disappeared at age 4 to 6 months.
The nurse is assessing the 18-month-old infant. The nurse notes the anterior fontanel (fontanelle) has closed. What initial action by the nurse is indicated?
Document the findings as normal. Explanation: The anterior fontanel (fontanelle) most often closes between 12 and 24 months of age. The closure of the fontanel (fontanelle) at 18 months of age does not signal any health issues for the infant.
The nurse is reviewing the medical record of an infant who is being seen for the 12-month well-child visit. Which finding(s) is normal for this infant? Select all that apply.
infant walks independently heart rate 101 beats/min respiratory rate 28 breaths/min Explanation: The respiratory rate slows from an average of 30 to 60 breaths/min in the newborn to about 20 to 30 breaths/min in the 12-month-old infant. As the cardiovascular system matures, the average pulse rate decreases from 120 to 140 beats/min in the newborn to about 100 beats/min in the 12-month-old infant. Walking independently often occurs at 12 months of age. Head lag should not be present in a 12-month-old infant (usually not present by 4 months of age). A temperature of 100.6°F (38.1°C) is abnormal and could indicate an infection.
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?
"Does he move a toy back and forth from one hand to the other when you give it to him?" Explanation: 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.
The nurse is educating the parents of a newborn prior to discharge home. The parents demonstrate teaching was successful when making which statement(s)? Select all that apply.
"I will not be concerned if my newborn has stools that begin to have a yellowish color to them." "I understand it is normal for newborns to lose 5% to 10% of their bodyweight after birth." "My newborn can see up-close things, like our faces, better than things at a distance." Explanation: Newborn stools will become yellowish in color after the first few days of life. Newborns typically lose 5% to 10% of their birthweight the first few days of life, and begin to gain weight after this period. Newborns have better up-close vision and begin to recognize human faces during their newborn stage. Most infants will not sleep through the night until about 3 months of age. There is no evidence that rice cereal keeps a newborn from waking and the practice of feeding rice cereal to newborns is discouraged by physicians as the newborn needs formula or breast milk specifically.
A mother is concerned about her infant's spitting up. Which suggestion would be most appropriate?
"Keep the baby sitting up for about 30 minutes afterward." Feedback: Keeping the baby upright for 30 minutes after the feeding, burping the baby at least two or three times during feedings, and feeding smaller amounts on a more frequent basis may help to decrease spitting up. Positioning the infant in an infant seat compresses the stomach and is not recommended.
The nurse is providing anticipatory guidance to a mother of a 5-month-old boy about introducing solid foods. Which statement by the mother indicates that effective teaching has occurred?
"The cereal should be a fairly thin consistency at first." Feedback: Iron-fortified rice cereal mixed with a small amount of formula or breast milk to a fairly thin consistency is typically the first solid food used. As the infant gets older, a thicker consistency is appropriate. Strained, pureed, or mashed meats may be introduced at 10 to 12 months of age. A cup is typically introduced at 6 to 8 months of age regardless of what or how much solid food is being consumed.
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?
27.5 in (70 cm) Explanation: 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.
The nurse is assessing the infants in the nursery for the six stages of consciousness. The nurse becomes concerned when assessing which infants? Select all that apply.
An infant rapidly moves from deep sleep to crying An infant moves from active alert state to drowsiness An infant frequently skips the quiet alert state during the six stages of consciousness. Feedback: The nurse becomes concerned if the infant does not move slowly through six states of consciousness, which begin with deep sleep. The infant should then progress as follows: light sleep, drowsiness, quiet alert state, active alert state, and finally crying. States are not normally skipped.
What is the correct amount of wet diapers a mature infant should produce each day?
An infant should have 6 to 8 wet diapers/day. Explanation: 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.
The nurse is teaching a new mother the proper techniques for breastfeeding her newborn. Which is a recommended guideline that should be implemented?
Bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola. Feedback: Before each breastfeeding session, mothers should wash their hands, but it is not necessary to wash the breast in most cases. The mother should then stroke the nipple against the baby's cheek to stimulate opening of the mouth and bring the baby's wide-open mouth to the breast to form a seal around all of the nipple and areola. When the infant is finished feeding, the mother can break the suction by inserting her finger into the baby's mouth.
A 6-month-old girl weighs 14.7 lb during a scheduled check-up. Her birth weight was 8 lb. What is the priority nursing intervention?
Discussing the child's feeding patterns Feedback: Assessing the current feeding pattern and daily intake is the priority intervention. Talking about solid food consumption may not be appropriate for this child yet. Discouraging daily fruit juice intake or increasing the number of breastfeedings may not be necessary until the situation is assessed.
The nurse is providing discharge teaching regarding formula preparation for a new mother. Which guideline would the nurse include in the teaching plan?
Do not add cereal to the formula in the bottle or sweeten the formula with honey. Feedback: Proper formula preparation includes the following: wash nipples and bottles in hot soapy water and rinse well or run nipples and bottles through the dishwasher; store tightly covered ready-to-feed formula can after opening in refrigerator for up to 48 hours; after mixing concentrate or powdered formula, store tightly covered in refrigerator for up to 48 hours; do not reheat and reuse partially used bottles; throw away the unused portion after each feeding; do not add cereal to the formula in the bottle; do not sweeten formula with honey; warm formula by placing bottle in a container of hot water; and do not microwave formula.
The nurse is educating a first-time mother who has a 1-week-old boy. Which is the most accurate anticipatory guidance?
Explaining that the stomach holds less than 1 ounce Feedback: Explaining that the child's stomach holds less than 1 ounce gives the mother a reason for frequent, small feedings and is the most helpful and accurate anticipatory guidance. Telling that the step reflex persists until the child walks and informing that fontanels will close by 6 months are inaccurate. The step reflex disappears at about 2 months and fontanels close between 12 and 18 months. Neonatal teeth are highly unusual and need no explanation unless they occur.
The nurse in a community clinic is caring for a 6-month-old boy and his mother. Which intervention is priority to promote adequate growth?
Monitoring the child's weight and height Feedback: Monitoring the child's weight and height is the priority intervention to promote adequate growth. Encouraging a more frequent feeding schedule, assessing the child's current feeding pattern, and recommending higher-calorie solid foods are interventions when the nursing diagnosis is that nutrition level does not meet body requirements.
The nurse is providing anticipatory guidance to a mother to help promote healthy sleep for her 3-week-old baby. Which recommended guideline might be included in the teaching plan?
Place the baby on his or her back when sleeping. Feedback: Sudden infant death syndrome (SIDS) has been associated with prone positioning of newborns and infants, so the infant should be placed to sleep on the back. The baby should sleep on a firm mattress without pillows or comforters. The baby's bed should be placed away from air conditioner vents, open windows, and open heaters. By 4 months of age, night waking may occur, but the infant should be capable of sleeping through the night and does not require a night feeding.
Which reflex, if found in a 4-month-old infant, would cause the nurse to be concerned?
Step Feedback: Appropriate appearance and disappearance of primitive reflexes, along with the development of protective reflexes, indicates a healthy neurologic system. The step reflex is a primitive reflex that appears at birth and disappears at 4 to 8 weeks of age. The plantar grasp reflex is a primitive reflex that appears at birth and disappears at about the age of 9 months. The Babinski reflex is a primitive reflex that appears at birth and disappears around the age of 12 months. The neck righting reflex is a protective reflex that appears around the age of 4 to 6 months and persists.
The nurse is caring for a 4-week-old girl and her mother. Which is the most appropriate subject for anticipatory guidance?
Telling how and when to introduce rice cereal Feedback: Telling the mother how to introduce rice cereal is the most appropriate subject for anticipatory guidance. Since this mother is already breast- or bottle-feeding her baby, educating her about these subjects would not inform her about what to expect in the next phase of development.
The nurse is assessing the neurological status of a 10-month-old infant. Which finding(s) does the nurse determine to be abnormal when performing this assessment? Select all that apply.
The infant turns to the right side, searching with mouth, when the right side of the cheek is stroked. The infant demonstrates reflexive sucking when nipple or finger is placed in infant's mouth. The infant reflexively grasps when the nurse touches the palm. With sudden extension of the infant's head, the arms abduct and move upward and the hands form a "C". Explanation: The primitive reflexes (root, suck, palmar grasp, moro) should be absent by 10 months of age. A positive Babinski sign normally persists until 12 months of age so the presence of this sign would be considered a normal finding in the 10-month-old.
A new mother tells the nurse that she is having difficulty breastfeeding her baby. When observing the mother, which actions prompt the nurse to provide teaching about proper breastfeeding techniques? Select all that apply.
The mother carefully washes her breasts prior to feeding the infant The mother feeds the infant every hour The mother supplements feedings with water. Feedback: The mother should wash her hands prior to breastfeeding the infant. There is no need to wash the breasts in most circumstances. The best time to feed the infant is on demand rather than hourly, and there is no need to supplement breastfeeding with water. The "C" position and stroking the nipple against the infant's face promote effective breastfeeding.
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. Explanation: 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.
The neonatal nurse assesses newborns for iron deficiency anemia. Which newborn is at highest risk for this disorder?
A premature newborn Feedback: 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, placing them at increased risk for iron deficiency anemia compared with term infants. An infant having jaundice, having been born to a mother with diabetes, or having been born postterm does not significantly place the infant at risk for iron deficiency anemia.
The nurse is assessing a 12-month-old boy with an English-speaking father and a Spanish-speaking mother. The boy does not say mama or dada yet. What is the priority intervention?
Asking the mother if the child uses Spanish words Feedback: Infants in bilingual families may use some words from each language. Therefore, the priority intervention in this situation would be to ask the mother if the child uses Spanish words. There is not enough evidence to warrant performing a developmental evaluation or referring the child to a developmental specialist. Encouraging the parents to speak English to the child is unnecessary if the child is progressing with Spanish first.
The nurse is assessing the developmental milestones of an infant. The infant was born 8 weeks ago and was 4 weeks premature. The nurse anticipates that the infant will be meeting milestones for what age of child? Record your answer in weeks.
4 weeks Feedback: To determine adjusted age, subtract the number of weeks that the infant was premature (4 weeks) from the infant's chronologic age (8 weeks).
During the first visit to the pediatrician's practice the nurse is performing an admission interview and assessment of a 4-week-old infant. The mother states, "I am sure my baby girl knows my smell because she is much more settled in my arms rather than my mother's arms when she is upset." What is an appropriate response by the nurse?
"You may be right, since infants can sense their mother's smell as early as 7 days old." Explanation: 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.
A mother asks the nurse where the microwave is so that she can warm up breast milk to feed her baby. What is the best response by the nurse?
"You should warm the milk under warm water instead." Explanation: A microwave can heat unevenly and cause burns and therefore should never be used to heat breast milk or formula for an infant. In addition, it can change the immune properties of the breast milk.
The nurse is providing anticipatory guidance to the mother of a 9-month-old girl during a well-baby visit. Which topic would be most appropriate?
Advising how to create a toddler-safe home Feedback: The most appropriate topic for this mother would be advising her on how to create a toddler-safe home. The child will very soon be pulling herself up to standing and cruising the house. This will give her access to areas yet unexplored. Warning about small objects left on the floor, telling about safety procedures during baths, and cautioning about using baby walkers would no longer be anticipatory guidance as the child has passed these stages.
The nurse observes an infant interacting with his parents. What are normal social behavioral developments for this age group? Select all that apply.
Around 2 months, the infant exhibits a first real smile Around 3 months, the infant smiles widely and gurgles when interacting with the caregiver Around 3 months, the infant will mimic the parent's facial movements, such as sticking out the tongue Separation anxiety may also start in the last few months of infancy. Feedback: The infant exhibits a first real smile at age 2 months. By about 3 months of age, the infant will start an interaction with a caregiver by smiling widely and possibly gurgling. The 3- to 4-month-old will also mimic the parent's facial movements, such as widening the eyes and sticking out the tongue. Separation anxiety may also start in the last few months of infancy. Around the age of 8 months, the infant may develop stranger anxiety. At 6 to 8 months of age, the infant may enjoy socially interactive games such as patty-cake and peek-a-boo.
What information would the nurse include when teaching the parents of an infant about colic?
Colic symptoms will probably fade at 3 months of age. Explanation: Colic is defined as inconsolable 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 others 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 his or her own position that helps; don't just place the infant on his or her back. Doubling up the formula will not help colic and may actually cause more problems because it can cause abdominal pain and increased weight gain.
The parents of a 5-month-old child are concerned that the child has a slightly flat spot on one side of the back of the head. The child sleeps on their back with the head tilted to one side. What will the nurse recommend? Select all that apply.
Encourage "tummy time" when awake. Limit car seat use when not in car. Encourage tilting head to the other side when sleeping and resting. Explanation: The child is showing signs of mild plagiocephaly (flattening of the back of the head) from the sleep position on one side of the head. The sleep position should still be on the back, but parents should be encouraged to limit pressure on that part of the head during awake times, by limiting time in the car seat and varying positions. The parents should provide plenty of "tummy time" for the child. They should also try to get the child to tilt the head to the other side, often achieved through positioning in the opposite direction in the crib.
An infant is breastfed. When assessing the stools, which findings would be typical?
Less constipation than bottle-fed infants Explanation: 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.
The parent of a 3-month-old infant is concerned because the infant does not yet sit by oneself. Which statement best reflects average sitting ability?
Most infants do not sit steadily until 8 months; this infant is normal. Explanation: 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.
At the 6-month-old well-child visit, the parent is concerned that the child is unsteady and often falls over when sitting. What will the nurse advise the parent about this?
The child's stability will progress to independent sitting over the upcoming months. Explanation: It is a normal finding for the 6-month-old child to be shaky and fall over when learning to sit and for the child to often only sit with a "tripod" sit supported by the hands. No further assessment or support is needed.
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. Explanation: 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.
The nurse is teaching a new mother about the development of sensory skills in her newborn. What would alert the mother to a sensory deficit in her child?
The newborn does not respond to a loud noise. Feedback: Though hearing should be fully developed at birth, the other senses continue to develop as the infant matures. The newborn should respond to noises. Sight, smell, taste, and touch all continue to develop after birth. The newborn's eyes wander and occasionally cross, and the newborn is nearsighted, preferring to view objects at a distance of 8 to 15 in. Holding, stroking, rocking, and cuddling calm infants when they are upset and make them more alert when they are drowsy.