ch1-3 infant

gross motor skills (month 7)

sits alone with some use of hands

gross motor skills (month 12)

sits from standing position; walks independently

Warning signs that may indicate problems with motor development include the following

- arms and legs are stiff or floppy - child cannot support head at 3 to 4 months of age - child reaches with one hand only - child cannot sit with assistance at 6 months of age - child does not crawl by 12 months of age - child cannot stand supported by 12 months of age

Newborns sleep _____ hours per day, often waking only to eat (24 hour day)

20

When does the Moro reflex disappear?

4 months

Object permanence begins to develop between ____ months of age and is solidified by approximately age 8 months

4-7

When do teeth erupt?

6-8 months

By 3 months, infants sleep _____ hours per night with 2 to 3 naps per day

7-8

By 12 months, infants sleep ______ hours per night along with 2 naps per day

8-12

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? A. 18 pounds B. 19 pounds, 5 ounces C. 20 pounds D. 21 pounds, 9 ounces

B. 19 pounds, 5 ounces

Is the following statement true or false? In 2008, the World Health Organization defined health solely as "an absence of disease or infirmity."

False. In 2008, the World Health Organization defined health as "a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity."

mortality vs morbidity

Mortality is death rate and morbidity is illness.

babinski reflex

Reflex in which a newborn fans out the toes when the sole of the foot is touched disappears around 12 months

sucking reflex

Reflex that causes a newborn to make sucking motions when a finger or nipple if placed in the mouth

What is the most common cause of hospitalization in 10-14 year olds?

mental disorders

rooting reflex

a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple

plantar and palmar grasp reflex

applying gentle pressure onto or by horizontally stroking the infant's palm/ sole of foot disappears at 9 month

gross motor skills (month 10)

pulls to stand, "cruises"

step reflex

baby appears to take steps or dance when held upright on a solid surface disappears at 4-8 weeks

gross motor skills (month 9)

crawls, abdomen off floor

fine motor development (month 8-10)

crude pincer grasp

What is the most common cause of hospitalization in 1-4 year olds?

diseases of the respiratory system

fine motor development (month 11)

neat pincer grasp; put objects into containers

gross motor skills (month 3)

raises 45 degrees in prone, slight head lag

gross motor skills (month 2)

raises head and chest, improving head control

fine motor development (month 8)

release an object at will

gross motor skills (month 5)

rolls from supine to prone and back, sits upright w/ support

fine motor development (month 7)

transfer objects from one hand to the other, crossing the midline, and bang objects on a hard surface

Maturation of the GU and Integumentary Systems of the Infant in First Year of Life

•Infants more susceptible to dehydration •Frequent urination with low specific gravity (not concentrated until glomeruli mature) •Lanugo and vernix may be seen in the newborns •Acrocyanosis is normal in the newborn and decreases over the first few months of life •Skin is relatively thinner than that of adults with peripheral capillaries more superficial

Assessing Growth and Development of a Premature Infant

•Subtract the number of weeks that the infant was premature from the infant's chronological age •Example- 32-week preemie (8 weeks early) subtract 2 months for developmental assessment

Promoting Safety for Infants

•Correct positioning and securing children in car seats •Use of current recommendations for infant furniture •Safety on the changing table and use of mobility devices for infants •Safety in the home using safety gates, outlet covers •Identify choking hazards (small toys, foods) •Water safety (bathrooms, buckets, and tubs)

Warning Signs Indicating Problems With Language Development in Infants

•Does not make sounds at 4 months of age •Does not laugh or squeal by 6 months of age •Does not babble by 8 months of age • infant does not use single words with meaning at 12 months of age (mama, dada) •The normal 12-month-old babbles expressively and uses two or three words with meaning

respiratory system of infant vs adult

•Nasal passages are narrower •Larynx is more funnel shaped •Trachea and chest wall are more compliant •Bronchi and bronchioles are shorter and narrower •Significantly fewer alveoli •Respiratory rates are fast and then decrease as the child matures

Special Considerations Related to Informed Consent

•Child not living with parent (biologic or adoptive) •Mature or emancipated minors •Parental consent after divorce •Consent for organ donation •Consent for medical experimentation •Psychiatric and reproductive health services (may be a different age of consent than for other health care services) •*In certain states, mature minors and emancipated minors may consent to their own health care.c

Is the following statement true or false? Fine motor skills develop in a cephalocaudal fashion (from the head to tail)

False. Fine motor skills develop in a proximodistal fashion (from the center to the periphery). Rationale: Gross motor skills develop in a cephalocaudal fashion (from the head to the tail).

Is the following statement true or false? A child who is highly reactive and reacts to new experiences by withdrawing in frustration is classified as having a "slow to warm up" temperament.

False. A child who is highly reactive and reacts to new experiences by withdrawing in frustration is classified as having a "difficult ("challenging or highly reactive") temperament. Rationale: Children with a "slow to warm up" temperament may initially complain, may react to new experiences with mild but passive resistance and may need more time to warm up. "Easy" children more readily adapt to new experiences.

The nurse is assessing a 6-month-old infant in the clinic. Which characteristic represents normal language development for this age? A. Cooing B. Laughing out loud C. Babbling D. Producing noises when spoken to

C. Babbling Cooing begins in the first 4 weeks of life, productions of noises when spoken to and laughing out loud are seen later than 6 months of age. Infants begin to babble around 6 months of age.

The nurse is examining a 6-month-old girl who was born 8 weeks early. Which finding is cause for concern? A. The child measures 21 in (53 cm) in length. B. The child exhibits palmar grasp reflex. C. Head size has increased 5 in (12 cm) since birth. D. The child weighs 10 lb 2 oz (4.6 kg).

C. Head size has increased 5 in (12 cm) since birth. The child's head size is large for his adjusted age of 4 months, which would be cause for concern. Normal growth would be 3.6 in (9 cm). At 10 lb, 2 oz (12 cm), the child is the right weight for a 4-month-old adjusted age. Palmar grasp reflex disappears between 4 and 6 months adjusted age, so this would not be a concern yet. The child is of average weight for a 4-month-old adjusted age.

maturation of the CV system of the infant in 1st year of life

•Heart doubles in size in the first year •Average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1 year old •Blood pressure steadily increases, from an average of 60/40 in the newborn to 100/50 in the 12 month old •Peripheral capillaries are closer to the surface of the skin, making the newborn and young infant more susceptible to heat loss •Thermoregulation becomes more effective

Exceptions to Recommended Breastfeeding

•Infants with galactosemia •Maternal use of illicit drugs and a few prescription medications •Maternal untreated active tuberculosis •Maternal HIV infection in developed countries

Promoting Healthy Eating Habits

•Newborns and young infants feed "on demand" •Family models acceptable eating behaviors •Infants can require exposure to new foods up to 20 times before accepting the food •Introduce a new food and wait 3 to 5 days before introducing a different food to observe for any allergies •The child will decide how much to eat---the parent provides the food •Introduce the cup early (~6 months) to start •Solid food should be soft and mashed until teeth erupt

Maturation of the GI System of the Infant in First Year of Life

•Tongue is larger relative to oral cavity size; it must be able to latch onto the nipple for the infant to feed •Stomach capacity increases as the infant grows •First primary teeth erupt between the ages of 6 and 8 months (incisors)à Teeth emerge in a predictable pattern •Consistency and frequency of stools change over the first year of life based on intake (breast or bottle) and age

gross motor skills (month 8)

sits unsupported

The postpartum nurse observes new mothers as they put their newborns in the bassinet to sleep. Which actions by the new mothers require further instruction from the nurse? Select all that apply. A. A mother places her newborn on its side after falling asleep B. A mother states all of her children like sleeping on their abdomen and this newborn likes it too C. A mother places the baby comforter her grandmother made over the newborn's body D. A mother tells her husband to be sure to place the newborn on his back when putting the baby in the bassinet E. A mother states her baby looks too warm, so she is moving the bassinet in front of the air conditioner to cool him off

A, B, C, E Newborns and infants should be on their backs when sleeping in order to help prevent sudden infant death syndrome (SIDS). a firm mattress without pillows or comforters should also be used. The baby's bed should be placed away from air conditioner vents, open windows, and open heaters.

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 mostappropriate? A. "What does his stool look like?" B. "Grunting is normal with infant stool formation." C. "Is he in pain?" D. "We will need to collect a stool specimen for analysis."

A. "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 information provided.

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. A push-pull toy C. Pots and pans from the kitchen cupboard D. Brightly colored stacking toy

A. A yellow rubber duck for the bath Rationale: 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.

The nurse is preparing a list of abilities of 10-month-olds to use in teaching a parenting group. Which ability should appear at this age? A. Cruises around furniture B. Uses two or three words with meaning C. Feeds self with spoon (but spills) D. Sits from standing position

A. Cruises around furniture At 10 months, this ability appears and is practiced often in preparation for later independent walking. All the rest of the skills take an additional 2 months to develop and appear around age 1 year.

The nurse enters a client's room to find the new mother crying softly. The client states, "I had my heart set on breastfeeding but my infant was born with a cleft lip. My dreams of breastfeeding are destroyed." Which response by the nurse is appropriate? A. "I am so sorry your infant has a cleft lip. Bottle feeding will be easiest for you and your infant." B. "You may still breastfeed your infant. I will show you appropriate techniques to use." C. "You can use a supplemental nursing system to get a similar experience." D. "You should speak with a lactation consultant before making a decision on which feeding method to use."

B. "You may still breastfeed your infant. I will show you appropriate techniques to use." The nurse should be therapeutic and reassure the mother that breastfeeding may still be an option. Infants with cleft lips may still successfully breastfeed once appropriate techniques are learned and implemented. A supplemental nursing system is used to provide supplemental milk to breastfeeding babies. Telling the client to speak with a lactation consultant does not address the client's current concern.

moro reflex

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 form 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.

gross motor skills (month 1)

lifts, turns head when prone, head lag

What is the most common cause of hospitalization in 15-19 year olds?

pregnancy/childbirth (1) and mental disorders (2)

gross motor skills (month 6)

tripod sits

fine motor development (month 12)

try to build towers of two blocks

fine motor development (month 5)

voluntarily grasp objects; palmar -> pincer

average measurements of infants at 6 months

weight: 16 lbs length: 25-27 in head circumference: 16.5-17.5 in

average measurements of infants at 12 months

weight: 23 lb length: 28-30 in head circumference: 17.7-18.7 in

average measurements of infants at birth

weight: 7.5 lbs length: 19-21 in head circumference: 13-14 in

causes of death in children from ages 5 to 9

•Accidents (unintentional injuries) •Cancer •Developmental, genetic conditions present at birth

causes of death in children from ages 10 to 14

•Accidents (unintentional injuries) •Cancer •Suicide

Is the following statement true or false? The nurse researcher would measure the number of cases of asthma in children in an inner-city population to determine mortality.

False. The nurse researcher would measure the number of cases of asthma in children in an inner-city population to determine morbidity. Rationale: Researching the number of deaths due to a specific cause over a specific period would assess mortality.

causes of death in children from ages 1 to 4

•Accidents (unintentional injuries) •Developmental, genetic conditions present at birth •Homicide

causes of death in children from ages 15 to 19

•Accidents (unintentional injuries) •Suicide •Homicide

Injury Prevention (newborn)

•Aspiration of foreign objects and food -> hot dog •Suffocation •Motor vehicle injuries -> infants should be rear facing to protect the head and neck in the event of an accident •Falls •Poisoning •Burns •Drowning

Common Developmental Concerns in Infancy

•Colic •Spitting up •Thumb sucking, pacifiers, security items •Teething

causes of death in children from ages 0 to 1 years

•Developmental, genetic conditions present at birth •Premature birth •SIDS

The nurse is assessing a 12-week-old infant in the clinic at a well-baby visit. Which assessment finding does the nurse predict to assess in this healthy infant? A. Able to sit up and roll over B. Smiles at significant others C. Grasps objects and brings them to the mouth D. Bears weight on legs when held in standing position

B. Smiles at significant others By 12 weeks of age the infant smiles at his or her mother and significant others. The other choices are seen in the infant who is about 20 weeks of age.

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. talk to the infant at a special time each day. C. respond to the infant consistently. D. keep the infant stimulated with many toys.

C. respond to the infant consistently. 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.

A client who is breastfeeding asks the nurse if she can give the newborn a pacifier. Which nursing response is most appropriate? A. "I know a lot of people who breastfed and also gave their newborns a pacifier." B. "This decision should be made by you and your partner based on your personal preferences." C. "I will request the lactation consultant come talk to you about pacifier usage while breastfeeding." D. "It is recommended to wait until breastfeeding is well-established before introducing a pacifier."

D. "It is recommended to wait until breastfeeding is well-established before introducing a pacifier." It is recommended to wait to introduce a pacifier once breastfeeding is well-established, which can take about 1 month. This is to limit nipple confusion and promote an adequate milk supply. Stating other people have done this does not provide education to the client, nor does it address this specific client's situation. While the decision is up to the newborn's parents, this response does not address the client's concern. Requesting a lactation consultant come does not address the client at this moment. The nurse can provide education now, and also request the consultant for follow-up information.

The mother of an infant questions the nurse about her baby's teething. The nurse provides client education. Which statement by the mother indicates understanding of the information provided? A. "My baby will most likely have his upper middle teeth come in first." B. "My baby's first tooth will likely appear between 5 and 6 months." C. "By 1 year my baby should have about three teeth." D. "The first teeth that will likely appear are the lower incisors."

D. "The first teeth that will likely appear are the lower incisors."

A mother of a 10-month-old states to the nurse, "I brush my child's teeth every day with flavored kids' toothpaste." Which is the mostappropriate response by the nurse? A. "Toothpaste plays an important role in overall oral health." B. "That is great, infants typically hate toothpaste." C. "Drinking water is really all you need to do to rinse your child's mouth." D. "Toothpaste is not necessary; it is the scrubbing that is required."

D. "Toothpaste is not necessary; it is the scrubbing that is required." Toothpaste for infants is not required. The important health technique is the removing of plaque, and that is accomplished through scrubbing of the teeth.

The nurse is teaching healthy eating habits to the parents of a 7-month-old girl. Which recommendation is the most valuable advice? A. Let the child eat only the foods she prefers B. Actively urge the child to eat new foods C. Provide small portions that must be eaten D. Serve new foods several times

D. Serve new foods several times Rationale: 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.

At what age would it be okay to introduce carrots to an infant's diet? A. Solid food can be introduced whenever the child seems ready. B. Solid food can be introduced after 9 months of age. C. Solid food can be introduced at 7 to 9 months of age. D. Solid food can be introduced at 4 to 6 months of age.

D. Solid food can be introduced at 4 to 6 months of age. The tongue extrusion reflex is present until the infant is 4 to 6 months of age. After this reflex disappears 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.

Is the following statement true or false? The role of the family is limited to providing physical care to the child.

False. Rationale: Parents (or those acting in the parental role) impart the rules and expected behaviors of society through teaching and discipline techniques as well as caring for the physical and emotional needs of the growing child.

A parent sets rules for a child and expects the child to follow them without asking questions or complaining. What style of parenting is this parent displaying? a. Authoritarian b. Authoritative c. Permissive d. Rejecting-neglecting

a. Authoritarian. A parent setting rules for a child and expecting the child to follow them without asking questions or complaining is displaying an authoritarian parenting style. Rationale: An authoritative (democratic) parent shows respect for the child's opinions, but has ultimate authority over the child. A permissive (laissez-faire) parent has little control over the child and a rejecting-neglecting parent is indifferent or uninvolved in parenting the child.

Which of the following figures influenced the evolution of pediatric nursing by establishing the Henry Street Settlement House to provide medical and other services to the poor? a. Abraham Jacobi b. Lillian Wald c. Lina Rogers d. Florence Nightingale

b. Lillian Wald established the Henry Street Settlement House in NYC to provide medical and other services to the poor. Rationale: Abraham Jacobi was awarded the first pediatric professorship for a physician. Lina Rogers was the first full-time school nurse in a public school. Florence Nightingale was a pioneer of nursing who was instrumental in founding nursing as a profession and reforming hospital sanitation methods.

Early Warning Signs Indicating Problems With Hearing or Vision in Infants

•Does not respond to loud noises •Does not start to make sounds or babble by 4 months of age •Does not turn to locate sound at age 4 months •Crosses eyes most of the time at age 6 months •Does not track (follow) an interesting article •Does not try to study an object in the visual field

The nurse is assessing developmental milestones for a 7-month-old premature infant born at 28 weeks' gestation. What would be the adjusted age upon which the nurse would base the assessment? a. 2 months b. 3 months c. 4 months d. 5 months

c. 4 months. The nurse assessing developmental milestones for a 7-month-old premature infant born at 28 weeks' gestation would adjust the age to 4 months. Rationale: The infant was born 12 weeks early (3 months); therefore, the nurse would subtract 3 months from the chronological age of 7 months to obtain an adjusted age of 4 months. Healthy growth would be demonstrated if the infant were the size of a 4 month old and achieved the developmental milestones of a 4 month old.

When caring for an adolescent, in which case must the nurse share information with the parents no matter which state the care is provided in? a. Pregnancy counseling b. Depression c. Contraception d. Tuberculosis

d. Tuberculosis. Rationale: Pregnancy, contraception, and mental illness treatment are provided in many states to adolescents without parental involvement. However, care for communicable diseases such as tuberculosis would require parental consent and notification.

What is the most common cause of hospitalization in 5-9 year olds?

diseases of the respiratory system, but not as much as 1-4 year olds

Most infants ____________ their birth weight by 4 months of age and ________ their birth weight by the time they are 1 year old.

double; triple

asymmetric tonic neck

known as the "fencing reflex" because of the characteristic position of the infant's arms and head, which resembles that of a classically trained fencer

gross motor skills (month 4)

lifts head and looks around, rolls from prone to supine