PEDS: Chapter 3 Growth and Development of the Newborn and Infant
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?
"That is great that he is recognizing objects and is able to name them. He is right on target for language skills." Recognizing the parents' excitement about their child's language skills while still letting them know that this is what the expected level is for language is a polite and accurate way to respond. The other responses do not give notice to the parents' pride and would likely make the parents feel defensive about their child's skill.
The nurse is assessing the oral cavity of a 4-month-old infant. Which finding is consistent with a child of this age?
No teeth Normally infants are not born with teeth. Occasionally there are one or more teeth at birth. These are termed natal teeth and are often associated with anomalies. The first primary teeth typically erupt between the ages of 6 and 8 months.
The best way for an infant's father to help his child complete the developmental task of the first year is to:
respond to her consistently. 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.
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 This primitive (not protective) reflex should be present at birth and disappear around age 4 months.
The nurse is reviewing the medical record of an infant who is being seen for the 12-month well-child visit. Which findings are normal for this infant? Select all that apply.
Heart rate 101 beats per minute Blood pressure 100/50 Respiratory rate 28/minute Temperature 99 degrees Farenheit The respiratory rate slows from an average of 30 to 60 breaths in the newborn to about 20 to 30 in the 12-month-old. 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. Blood pressure steadily increases over the first 12 months of life, from an average of 60/40 in the newborn to 100/50 in the 12-month-old. Page 65
An infant has been brought to the clinic for a well-child check. The infant is 12 months of age. The child's birth weight was 6 pounds, 7 ounces. What is the anticipated weight for the child at this visit?
19 pounds, 5 ounces Most infants double their birth weight by 4 months of age and triple their birth weight by the time they are 1 year old. Page 64
A 3-month-old still has a Moro reflex. Which statement is most true of this reflex?
Most 3-month-olds still have a Moro reflex. Typically, Moro (startle) reflexes last until 5 to 6 months and then fade.
The mother of an infant asks you when to begin brushing her son's teeth. Your best response would be:
as soon as the first tooth erupts. Toothbrushing should begin with the eruption of the first tooth.
The mother of a 6-week-old infant reports she doesn't know if her child recognizes her face yet. What response by the nurse is most appropriate?
"Since about 4 weeks of age your child has been able to recognize those who are around him often." At 1 month of age the infant can recognize by sight the people he or she knows best. Telling the child's mother that this will come with time is not correct as this developmental milestone has already occurred. Telling her not to worry minimizes her questions and concerns.
The nurse is assessing the sleeping practices of the parents of a 4-month-old girl who wakes repeatedly during the night. Which parent comment might reveal a cause for the night waking?
They put her to bed when she falls asleep. If the parents are keeping the child up until she falls asleep, they are not creating a bedtime routine for her. Infants need a transition to sleep at this age. 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.
Stacy is going to visit her son in the intensive care unit. She has been pumping breast milk and storing it in the fridge. Stacy is making her son's bottle for his feeding and goes to warm the breast milk. What option should the nurse give the mom to prepare the bottle?
"You can use the hot water tap to get warm water to warm the bottle." The nurse should recommend using warm water or a warm-water tap to place the bottle in before feeding. A microwave should never be used; it could create hot spots and burn the infant. The other choices are not recommended and can cause stomach discomfort. Page 85
Using knowledge of normal growth and development, what would be expected when observing a 12-week-old infant?
The infant smiles at significant others By 12 weeks of age the infant smiles at his mother and significant others. The other choices are seen in the infant who is about 20 weeks of age. Page 77
A staff nurse is talking about Piaget's theory with a nursing student. Infants are in the sensorimotor stage of cognitive development during which object permanence is mastered. An example of an infant displaying this ability is:
looking for a toy in her crib at the last place she saw it. Looking for the toy where it was last seen indicates object permanence. The infant knows the object still exists even though she cannot see it. All the rest of the infant's behaviors show use of her senses and motor activity but do not illustrate object permanence.
The nurse is teaching healthy eating habits to the parents of a 7-month-old girl. Which recommendation is the most valuable advice?
Serve new foods several times When introducing a new food to an infant, it may take multiple attempts before the child will accept it. Parents must demonstrate patience. Letting the child eat only the foods she prefers, forcing her to eat foods she does not want, or actively urging the child to eat new foods can negatively affect eating patterns.
The nurse is caring for a 5-week-old infant who is spitting up "all the time." This is the mother's first child. What should be the priority nursing intervention?
Observe the mother while she feeds and burps her infant. Assessing the mother's feeding and burping technique is the first nursing action needed. The mother may be overfeeding or inadequately burping the child. Recommending smaller and more frequent feedings would be determined by the assessment. Assuring the mother that some spitting up is normal and describing the capacity of the infant's stomach is helpful information but not the priority.
An infant is breastfed. When assessing her stools, which findings would be typical?
Breastfed infants are less likely to be constipated than bottle-fed infants. The stools of breastfed infants tend to be yellow and looser than those of bottle-fed babies.
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." Page 86
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 yellow rubber duck for the bath 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 73
At what age would it be okay to introduce carrots to an infant's diet?
Solid food can be introduced at 4 to 6 months of age. Solid food may be introduced at 4 to 6 months of age. The infant must be ready to handle spoon-feeding. The first food should be rice cereal. Rice cereal is bland and usually does not cause an allergic reaction.
When preforming neurological reflexes on the infant, which primitive reflex will be present longest?
Babinski Primitive reflexes are subcortical and involve a whole-body response. Selected primitive reflexes present at birth include Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski. Except for the Babinski, which disappears around 1 year of age, these primitive reflexes diminish over the first few months of life, giving way to protective reflexes.
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?
Lower central gumline The lower central incisors are usually the first to appear, followed by the upper central incisors.
What feeding practice used by the parents of an 8-month-old should the nurse discourage?
Placing all liquids given the child in a "no spill" sippy cup. No-spill sippy cups promote sucking rather than teach cup drinking. Reserve these for times when avoiding spills is a must. The other feeding practices are age appropriate and safe. Soft table and finger foods promote accepting new textures and self-feeding. Reoffering rejected food allows the child to accept it when ready. Including the infant at the family table provides for modeling of eating behaviors and socialization. Page 86
Place these primitive protective reflexes of infancy in the order in which they will disappear as the child matures.
Step Root Moro Plantar Babinski Page 71
When teaching an infant's mother about bathing her, it would be important to instruct her that:
bath time provides an opportunity for play. 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.
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?
The infant displays an asymmetric tonic neck reflex (fencing reflex). 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.
The nurse is reviewing topics to be discussed with caregivers related to caring for infants. Which statement would be the most appropriate statement for the nurse to make to this group of caregivers?
The infant sleeps 10-12 hours at night and take 2-3 naps during the day Most infants sleep 10-12 hours at night and take 2-3 naps. By being put to bed while awake and allowed to fall asleep, the infant learns good sleeping habits. The infant should be dressed in the same amount of clothing the adult finds comfortable. Hard-soled shoes are not needed by infants and may hamper the development of the foot.
The mother of a 1-month-old infant voices concern about her baby's respirations. She states they are rapid and irregular. Which information should the nurse provide?
The respirations of a 1-month-old infant are normally irregular and periodically pause. The normal respiratory rate for a 1-month-old infant is 30 to 60 breaths per minute. By 1 year of age the rate will be 20 to 30 breaths per minute. The respiratory patterns of the 1-month-old infant are irregular. There may normally be periodic pauses in the rhythm.
The nurse goes in to check on a new mother to see how breast-feeding is going with her new son. The nurse observes the infant is on the mother's lap with the blanket unwrapped, and the mother is washing his face, and gently stroking the baby. The mother has had trouble breastfeeding the last few times. What is the appropriate response from the nurse?
"You are doing a wonderful job attempting to waken the baby." The nurse should be emotionally supportive to the new mom. The mom's techniques are commonly used in breastfed infants who are sleeping. The encouragement from the nurse will support the mom through this learning period. The other responses do not emotionally support the mom or contribute to a positive learning environment.
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?
Urging the baby's mother to take time for herself away from the child 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.
Which developmental milestone would the nurse expect an 11-month-old infant to have achieved?
Sitting independently Infants typically sit independently, without support, by age 8 months. Walking independently may be accomplished as late as age 15 months and still be within the normal range. Few infants walk independently by age 11 months. Building a tower of three or four blocks is a milestone of an 18-month-old. Turning a doorknob is a milestone of a 24-month-old.
A new mother reports that she is exhausted and that the little sleep she gets is determined by her baby's daytime naps and the few hours the baby sleeps during the night. The nurse discusses with this mother the importance of helping the infant establish healthy sleeping patterns. What would be most helpful for this mother to do to encourage healthy sleeping patterns?
Use the crib for sleeping only, not for play activities. 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.
A teen mom asks the discharge nurse if it is okay to sleep in bed with her baby. She says her mom always did it with her siblings and it seemed okay. How should the nurse respond?
"Bed sharing has positive effects on babies, let me get you information." The nurse should enforce that bed sharing is sometimes a positive experience if the parents are safe and responsible. When done properly, the effect can be positive on infant nutrition and physiology. The other responses do not promote safety or educate the teen.
The infant weighs 6 lbs., 8 oz. (2.95 kg) 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 four months?
13 lbs. (5.9 kg) Most infants double their birthweight by 4 months of age and triple their birth weight by the time they are 1 year old.
What is the correct amount of wet diapers a mature infant should have each day?
An infant should have 6 to 8 wet diapers/day. 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.
What is the best awake state for infant interaction?
Eyes wide and bright The best time for a family to interact with an infant is when the infant is in the quiet or active alert stage. Examples of this are minimal body activity, regular respirations, face with shiny look, eyes wide and bright, and paying attention to stimuli.
A 2-month-old boy has inconsolable crying, is gassy, and constantly draws his legs up. It has been determined that the boy has colic. What is the best intervention to treat colic?
He needs to try a different formula to assess for sensitivity. Colic peaks between 3 weeks and 6 months of age. Treatment is a restful, soothing environment. Changing an infant's formula or having a breastfeeding mom decrease her intake of gassy foods may alleviate the symptoms.
The mother of a 3-month-old is concerned because her daughter does not yet sit by herself. Which statement best reflects average sitting ability?
Most babies do not sit steadily until 8 months; she is normal. Many infants sit steadily by 8 months of age.
The student nurse is caring for a 2 1/2-week-old in the newborn intensive care unit. Which term is most accurate when discussing this client?
Newborn A more accurate term for this child would be newborn rather than infant because the newborn or neonatal period of infancy is defined as the period from birth until 28 days of age. Infancy is the period of time up to 1 year old. Child and baby don't refer to the client's age accurately.
In working with an infant, the nurse recognizes what as a characteristic of the infant?
The child grows and develops skills more rapidly than at any other time in their life. The infant grows and develops skills more rapidly than she ever will again. The toddler insists she can do things one minute and then becomes dependent the next minute. The preschool age child soaks in information and asks "why" and "how" over and over. The school-age child has a longer attention span and can become absorbed in a craft or activity for several hours. Page 64
A father asks you what symptoms he can expect with normal teething in his infant. What would you tell him?
The child's gumline will be tender. Normal teething creates tender gumlines but does not include an elevated temperature or constipation.
The father of a 6-week-old infant voices concerns about his son's stooling. He further shares that his son grunts and cries when having a bowel movement. What response by the nurse is most appropriate?
"What does his stool look like?" Grunting, crying and straining during bowel movements by infants and newborns is normal. This is due to the immaturity of the gastrointestinal system. The most important thing to do initially is to determine the appearance of the stool. The grunts and cries are not of concern unless the stool is dry and hard, so asking about the characteristics is the initial response. 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.
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. 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.
Anticipatory guidance for an infant for the 4th month should include the fact that she probably will:
be able to turn over onto the back. Infants typically turn over front to back at 4 months, enlarging the area of the house that needs to be childproofed.
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 one-half and 1 ounce. The capacity of the normal newborn's stomach is between one-half and one ounce. 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.
The student nurse is reviewing the records of a pediatric client. Which statement about the client's progress indicates the need for further instruction?
"Maturation refers to the child's increases in body size." Growth 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 64
A parent who is feeding his child formula prepared at home using evaporated milk is concerned about whether the child is receiving all necessary nutrients. What would it be important for this parent to add to his child's diet to supplement the formula?
Iron Infants who are fed home-prepared formulas (based on evaporated milk) need supplemental vitamin C and iron. Evaporated milk has adequate amounts of vitamin D, which is unaffected by heat used in the preparation of formula. Calcium and vitamin E would not be concerns in this infant's formula.
A nurse is preparing discharge teaching for a client being discharged with her newborn baby. What is the highest priority item that must be included in the teaching plan?
Restrain the baby in a car seat. The client should restrain the baby in a car seat when driving. Infants are especially vulnerable to injuries resulting from falling off changing tables or being unrestrained in automobiles. Locking the cabinets and giving warm bottles of formula to the baby are secondary teachings.
The student nurse is reviewing the chart of a newborn. The document indicates the newborn is in the quiet alert state. Which is the best description of this sleep phase?
The newborn's eyes are open and no body movements are noted. 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 65
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?
Understands "no" and other simple commands 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.
The nurse pulls the 5-month-old to sitting position from supine and notes head lag. The nurse's response is to:
refer the infant for developmental and/or neurologic evaluation. 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 72
The mother of a 11-month-old has come to the clinic with concerns. She reports to the nurse that her baby's "soft spot in the front" is now gone. The nurse assesses the infant and notes the fontanel has closed. What response by the nurse is most appropriate?
"The soft spot or fontanel has closed." The anterior fontanel traditionally closes between 12 and 18 months. In some infants this may close sooner. This does not indicate there is any abnormality in the development of the infant.
Which developmental task, according to Erikson, should an infant accomplish during the infant year?
Trust The developmental task of the infant year, according to Erikson, is to gain a sense of trust or knowing how to love.
The caregiver of an infant tells the nurse that her dentist told her not to let the child go to bed with a bottle of milk. The caregiver states she doesn't understand the reason for this since her baby seems to enjoy the bottle. The most appropriate response to this caregiver would be:
"Bottles given at bedtime can cause erosion of the enamel on the teeth." The sugar from formula or sweetened juice coats the infant's teeth for long periods and causes erosion of the enamel on the deciduous teeth. While giving water in a bottle at bedtime is acceptable and a pacifier will satisfy the sucking need, the most appropriate response is to warn of possible enamel erosion. Giving a bottle at bedtime is not a factor that leads to obesity
The nurse is evaluating if nutrition counseling for new mothers has been effective. Which comments by the mothers indicate the need for more instruction? Select all that apply.
"It is much healthier if I puree my own baby food and add a very small amount of salt to make it taste better." "No-spill sippy cups are a good way to limit the amount of juice that comes into contact with the baby's teeth." Either home-made pureed or pre-packaged baby food is acceptable, but neither should have any spices added to it. No-spill sippy cups actually allow juice to be in constant contact with the teeth because they are much like bottles in that the child must suck on them to get a drink.
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 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 performing an assessment on a 8-month-old infant. The infant's medical history notes that he was born at 32 weeks' gestation. The infant is progressing normally. At what adjusted age should the nurse expect the infant's developmental accomplishments?
The infant will most likely present with developmental skills consistent with a 6-month-old infant. When assessing the growth and development of a premature infant, the nurse will use the infant's adjusted age to determine expected outcomes. To determine adjusted age, the nurse subtracts the number of weeks that the infant was premature from the infant's chronological age. 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 making a home visit and observes the 7-month-old pulling the family dog's hair and ears. Which parenting skill does the nurse determine is most effective?
The parent tells the child "no" with a stern voice and pulls the child's hand away from the dog 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.
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. 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. Page 74
Which milestone would you expect an infant to accomplish by 8 months of age?
Sitting without support Most babies sit steadily at 8 months, creep at 9 months, and pull to standing at 10 months.
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?
"She has been a chatterbox and smiles just like her brother." 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.
The infant measures 21 ½ inches (54.6 cm) at birth. If the infant is following a normal pattern of growth, what would be an expected height for this child at the age of six months?
27 ½ inches (69.9 cm) Most infants double their birth weight by 4 months of age and triple their birth weight by the time they are 1 year old. By 12 months of age, the infant's length has increased by 50 percent
Debbie asks her nurse what she thinks about giving her baby a pacifier. Debbie is struggling with this issue and is very teary-eyed about making a decision. How should the nurse respond to Debbie?
"It is a personal decision, let me give you a pamphlet from the AAP." The nurse would not give a biased opinion and would offer Debbie literature on which to base her own decision making. The other choices offer personal views or are not supportive in educating Debbie.
The nurse is documenting the relationship between a postpartum mother and her infant. Which observation would demonstrate attachment?
"The mom is talking to the infant while breast-feeding the infant." The nurse would document attachment when she observes eye-to-eye contact between infant and mother, and the mother holding the infant close and talking softly with the infant. The attachment relationship occurs with eye-to eye contact, communication, and physical contact. The other choices display none of these characteristics between infant and mother.
Infant development is best described by which statement?
Development proceeds cephalocaudally. Growth and development both proceed from head to toe, or in a cephalocaudal sequence.
The nurse is assessing the 10-month-old infant. The nurse notes the anterior fontanel has closed. What initial action by the nurse is indicated?
Document the findings as normal. The anterior fontanel most often closes between 12 and 18 months of age. It may normally close as early as 9 months of age. The closure of the fontanel at 10 months of age, while somewhat early, does not signal any health issues for the infant.
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:
The child weighs less than expected for age. 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.
What action shows an example of Erik Erikson's developmental task for the infant?
The infant cries and the caregiver picks the child up. Erikson's 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.
The nurse is examining an 8-month-old girl for appropriate development during a regular check-up. Which observation points to a developmental risk?
Uses only the left hand to grasp Favoring one hand over the other may be a warning sign that proper motor development is not occurring in the other arm or hand. Grasping small objects with the entire hand is common at 8 months and precedes the pincer grasp, which is used about 2 months later. Crawling with stomach down and being unable to pull to standing are abilities that may not occur for another 4 to 8 weeks
A nurse is talking to and making facial expressions at a 9-month-old baby girl during a routine office visit. What is the most advanced milestone of language development that the nurse should expect to see in this child?
The infant says "da-da" when looking at her father By 9 months, an infant usually speaks a first word: "da-da" or "ba-ba." The other answers refer to earlier milestones in language development. In response to a nodding, smiling face, or a friendly tone of voice, a 3-month-old infant will squeal with pleasure or laugh out loud. By 4 months, infants are very "talkative," cooing, babbling, and gurgling when spoken to. At 6 months, infants learn the art of imitating. They may imitate a parent's cough, for example, or say "Oh!" as a way of attracting attention.
The infant weighs 7 lbs. 4 oz. (3.3 kg) 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 lbs. 12 oz. (9.9 kg) By one year of age, the infant has tripled his or her birth weight and has grown 10 to 12 inches.
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?" 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 mother of a newborn reports she does not think her baby likes his formula since he spits up after only taking a small amount. Which response by the nurse is most appropriate?
"Your baby's stomach is small and can only hold about 1/2 to 1 ounce at birth." At the time of birth an infant's stomach can only hold 1/2 to 1 ounce. This will gradually increase. 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.
A 9-month-old has been brought to the clinic for a well-child visit. The mother reports her son was born 6 weeks prematurely. During the data collection, the child's mother reports her son seems to be a few months "behind" what she recalls from her older children. What is the best response by the nurse?
"Delays are normal when a child is premature." When infants are born prematurely delays may be noted. When assessing the growth and development of a premature infant, use the infant's adjusted age to determine expected outcomes. 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
A frustrated mother comes to a 9-month well-baby check-up because her son is refusing all of the solid food she gives him. When talking with this mother, the nurse discovers that she has struggled all her life with a weight problem. She attributes this problem to being forced to eat all of the food she was served as a child, even when she was full. Because she doesn't want to cause the same problem in her child, she tells the nurse that each time her son pushes food away with his tongue she believes that he doesn't want it. Which statement would be most appropriate for the nurse to say to this mother?
"The baby needs to learn how to move the food to the back of the mouth for swallowing, so catch the food and offer it again until the baby learns this." The infant knows only one way to take food: namely to thrust the tongue forward as if to suck. This is called the extrusion (protrusion) reflex and has the effect of pushing solid food out of the infant's mouth. The process of transferring food from the front of the mouth to the throat for swallowing is a complicated skill that must be learned. If the food is pushed out, the caregiver must catch it and offer it again. The baby soon learns to manipulate the tongue and comes to enjoy this novel way of eating.
