Chapter 23: Growth and Development of the Infant: 28 Days to 1 Year
After the nurse provides education to new parents about appropriate sleeping habits for infants, which statement by a parent would indicate to the nurse that teaching needs to reoccur?
"My husband gave the baby a special bear that I will place in the crib." The nurse should reinforce that stuffed animals, blankets, pillows, and soft mattresses are suffocation hazards for infants.
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.
A parent takes the 4-month-old infant to the health care provider. The parent asks what type of baby cereal to provide now that the infant is starting solid foods. How should the nurse respond?
"You should buy rice cereal." The rice cereal should be first. The infant should be monitored for food allergies by following the rice cereal with oats, barley, and wheat. Wheat has the highest allergy reaction in infants.
An infant is being introduced to drinking fluids from a cup. The nurse instructs the mother that fruit juice can now be added. Which of the following would the nurse suggest the mother try first? Select all that apply.
Apple White grape juice Juice is introduced when a cup is introduced to an infant. Usually 4-6 ounces of juice is recommended. Juices that have low-acidity like apple and white grape juice are appropriate. These juices may be diluted to half-strength with water. Orange, grapefruit and pineapple juice are to be avoided.
The nurse is assessing a 6-month-old infant in the clinic. Which characteristic represents normal language development for this age?
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 providing client education to the parent about bathing the infant. What would be important to instruct the parent?
Bath time provides an opportunity for play The work of children is play. Play provides a natural way for the infant to learn. In early infancy infants prefer their parents rather than toys. Parents can talk and sing to infants during feeding, bathing, and changing diapers. Infants do not need a daily bath as long as the diaper area is washed with diaper changes. Soap is actually drying to an infant's skin. Washing the hair with soap can help remove excess oil.
Which measures should receive priority in the care plan for an infant client who has sensitive skin?
Change diapers frequently The infant should be changed every 2-4 hours. It is best to use unscented wipes or clear water to clean the infant with each change. Baby power should never be used as it is an aspiration risk.
A mother calls the clinic every couple of weeks concerned that her infant is not developing appropriately. What would be an appropriate nursing diagnosis for the nurse to assign to this client?
Deficient knowledge related to normal infant growth and development The client is demonstrating deficient knowledge related to normal growth and development of her infant. The nurse should plan interventions that include teaching of expected outcomes of growth and development.
During an assessment, the nurse determines that a 3-month-old infant has a Moro reflex. What does this finding indicate to the nurse?
Most 3-month-old infants still have a Moro reflex. The Moro reflex will begin to at 4 months and disappear around age 6 months. A Moro reflex at age 9 months or 1 year indicates the need for a neurologic examination.
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 food 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.
A nurse is instructing the mother of a newborn about bathing and skin care. When discussing bathing, the nurse includes which of the following besides hygiene as an important reason for bathing?
Promoting parental bonding The parents can use bath time for bonding with their infant. This can be done with talking, cooing, and singing. Bath time should be paced and non-stressful.
The nurse observes a new mother bathing her 9-month-old baby. Which observation indicates that the experience is positive for both mother and infant?
The baby is moving the arms and hand and smiling. Bath time should be fun for an infant and can serve many functions. Especially during the second half of the first year, a child enjoys poking at soap bubbles on the surface of the water or playing with bath toys. Bath time also helps an infant learn different textures and sensations and provides an opportunity to exercise and kick as well as a good opportunity for a parent to touch and communicate with the child. Crying, screaming, reaching for the mother, and trying to avoid touching the water indicates that the bath experience is not positive for the baby or the mother.
The nurse is conducting a physical examination of a 8-month-old infant. 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 between 4 and 7 months, the palmar grasp reflex by between 3 and 6 months, and the Babinski reflex (fanning of toes when sole of foot stroked) between 12 and 24 months. Retaining these primitive reflexes may indicate a neurologic abnormality. The anterior fontanel (fontanelle), which remains open for brain growth, closes between 12 and 18 months of age.
An infant who is 4 months old continues to be seen at doctor visits for illness prevention. What would be the next scheduled appointment that this infant should attend to be evaluated?
The next visit would be at 6 months. The routine schedule for newborn visits within the first year of life is at 1 week, and then at 1, 2, 4, 6, 9, and 12 months of age. The above infant should be seen at 6 months of age for follow-up care and instructions.
A home visit nurse is providing health promotion on safety to a family of a 1-week-old infant. Which of the following statements by the parents indicates the need for further teaching?
"We will position our infant on his side for sleeping." Infants should be placed on their backs for sleeping to reduce the risk of SIDS. All other choices are safe infant practices.
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 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 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.
Anticipatory guidance for an infant for the 4th month should include the fact that the infant will be able to achieve which developmental milestone?
be able to turn over onto the back At four months of age, the infant is able to lift the head and look around. The infant can roll from prone to supine. When being pulled up, the head leads. The 4-month-old infant can make simple vowel sounds, laugh aloud, and vocalize in response to voices. A fear of strangers does not occur until the child is older; a 4-month-old infant has not developed emotionally to have "moody" periods and is dependent on parental care.
A parent calls the clinic nurse asking for recommendations on comfort measures for the infant who is teething. What recommendation(s) will the nurse make? Select all that apply.
teething rings topical oral anesthetic The nurse should recommend teething rings that can be refrigerated and use of a topical oral anesthetic. If used, parents should apply the anesthetic correctly to the gums, avoiding the lips, as these products cause numbing. Occasionally, oral acetaminophen or ibuprofen may be given to relieve pain acetaminophen dosed by the health care provider. All other items create a choking hazard for the infant.
Marcy asks the nurse if her 9-month-old son is drinking the recommended amount of breast milk or formula every day. What would the appropriate response be?
"He needs 7 ounces every 6 hours." This response is correct because the recommended amount of milk/breast-milk for an infant 7 to 11 months old is 6 to 8 ounces every 6 to 8 hours. This should be around 32 ounces a day. The other responses do not meet the recommended daily allowance.
The caregiver of 7-month-old twins tells the nurse that she has noticed that both of her children enjoy playing with a toy by moving the object back and forth between their hands over and over again. Which statement made by the nurse most accurately explains this behavior?
"This is one of the ways that infants develop their fine motor skills." Transferring objects is one of the manifestations of fine motor skills development, which is not fully mastered by this early age. References to nerve endings do not address the parent's query.
The nurse is preparing to assess an 8 month-old child during a clinic visit. Which action would be the most appropriate for the nurse when beginning the assessment?
Approach the infant calmly while the parent holds the infant on their lap Stranger anxiety occurs around 8 months and manifests as fear and withdraw from anyone the child is not familiar with, such as the nurse or an assistant. The nurse would avoid stranger anxiety and have a more cooperative infant to assess when allowing the parents to hold the child on their lap. The nurse or an assistant holding the child, even when wrapped in a blanket or wrap, or asking the parents to undress the child and lie them on the exam table, will likely result in the child reaching for the parent and wanting to be held.
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. 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; never microwave formula as it could burn the infant.
The nurse is assessing Julie, a 3-month-old infant. Which developmental milestone would the nurse expect?
Julie can hold her head erect and steady. When an infant matures and grows they move through different developmental milestones. A 3-month-old rolls over from back to side and holds the head erect and steady and begins to replace the reflex grasp with voluntary grasping. Grasping a toy at will occurs at about 6- to 7-months of age. Sitting without support occurs around 6 months. Playing pat-a-cake is characteristic of an 8- to 9-month-old.
The nurse is concerned that a 9-month-old baby is gaining too much weight. What should the nurse instruct the parents to help control the baby's weight gain?
Provide whole-grain cereal for one feeding. A way to prevent obesity is to add a source of fiber such as whole-grain cereal to the infant's diet. This prolongs the stomach-emptying time and helps reduce food intake. Nonfat milk should not be given because it contains little essential fatty acids and will not ensure cell growth. The baby should not be given refined sugars such as diluted gelatin or pudding because this will encourage weight gain.
Which milestone would the nurse expect an infant to accomplish by 8 months of age?
Sitting without support Physical development of infants occurs in a cephalocaudal fashion. That means they must learn to control and lift their heads first. This is followed by the ability to turn over. Once this occurs the remainder of development occurs quickly. Most infants are able to sit unsupported by 8 months. They are able to creep at 9 months and pull to a standing position by 10 months. At 12 months the infant is able to sit from a standing position and is learning to walk.
The nurse is visiting a mother who has a 3-month-old infant. Which anticipatory guidance information should the nurse provide to the mother at this time?
The child should be able to turn over onto the back at age 4 months. Infants typically turn over from the front to back at age 4 months. Fear of strangers will not occur until 7 months. The nurse has no way of knowing the infant's temperament to determine that the child will be moody or when the child will expect things to be done a certain way.
In observing an infant who is 6 months of age, which fine motor skill would the infant have most recently attained?
The infant can hold a bottle. By the age of 24 weeks, the infant holds a bottle fairly well.
A mother of a 9-month-old 18-pound (8.2 kg) infant asks the nurse about choosing the best car seat. What should the nurse recommend?
a rear-facing 5-point harness restraint An infant until 2 years of age should be in a rear-facing car seat. The 5-point harness seat is made for children up to 40 pounds (18 kilograms) and the booster seat for children from 40 to 80 pounds (18 to 36 kilograms).
A 6-month-old girl weighs 14.7 pounds (6.7 kg) during a scheduled check-up. Her birth weight was 8 pounds (3600 g). What is the priority nursing intervention?
discussing the child's feeding patterns 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 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.
A nurse is providing health promotion education to a family of an infant at the family birth center. The nurse knows the parents need more education when they state which response?
"I will switch to whole milk when my infant is around 6 months of age." An infant can be introduced to whole milk at about 1 year of age. At this stage infants' intestinal tracts should be mature enough for whole mile, and they will be less likely to have allergic reactions. Soft food, a drinking cup, and introducing foods one at a time are all correctly stated for developmental age.
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." 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 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?
"The first teeth that will likely appear are the lower incisors." Teeth will begin erupting between 6 and 8 months. Traditionally, the first teeth to erupt will be the lower incisors, followed by the upper incisors. By the age of 12 months, the infant will have between 4 and 8 teeth, if progressing normally.
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." 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."
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 most appropriate response by the nurse?
"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 English-speaking nurse is assessing a 12-month-old child with an English-speaking father and a Spanish-speaking mother. The child does not use words like "drink" "dog" or "ball." What is the nurse's priority intervention?
Asking the mother if the child uses Spanish words for those items 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 only one language to the child is unnecessary if the child is progressing with both.
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. 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.
The nurse is teaching a parenting class to a group of first-time mothers. She recommends which of the following as positive caregiver-infant interactions? Select all that apply.
Mother offers adequate types and amounts of food for the infant. Mother holds the infant in an appropriate position while feeding. Mother burps the baby during and after feeding. Mother provides age-appropriate toys for the infant. The mother should talk to the infant, which provides for bonding and stimulation of the developing infant. The other choices are all correct.
A new mother asks the nurse when toothbrushing should begin for the baby. Which response is the most appropriate for the nurse to make at this time?
Now Toothbrushing can begin even before teeth erupt by rubbing a soft washcloth over the gum pads. This eliminates plaque and reduces the presence of bacteria, creating a clean environment for the arrival of first teeth. Dental care should begin before the age of 12 months, before solid food is eaten, and before the first tooth appears.
The nurse is visiting a mother who has a 3-month-old infant who has been hospitalized for cardiac problems. Which nursing diagnosis should the nurse use to guide care for this family at this time?
Risk for impaired parenting related to hospitalization of infant The diagnosis appropriate for the family whose infant has been hospitalized would be risk for impaired parenting related to hospitalization. There is no evidence to suggest that the mother is not adjusting to parenthood. There is no information about the infant's feeding schedule. There is no information to suggest the mother has a knowledge deficit regarding normal infant growth and development.
A new mother asks the nurse what she should look for when the baby starts to teethe. What should the nurse explain to the mother?
The child's gum line will be tender. Gums are sore and tender before a new tooth breaks the surface. As soon as the tooth is through, the tenderness passes. A high temperature is not a normal expectation with teething and should be reported to the health care provider. The child may resist chewing because of the sore gum; however, it may not last for 2 days. Playing may or may not be affected. Constipation is not an expectation with teething.
In working with infants, the nurse would expect the posterior fontanel to be closed in an infant who is which age?
3 months The posterior fontanel is usually closed by the second or third month of life.
At which age would the nurse expect to find the beginning of object permanence?
6 months 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 providing anticipatory guidance to the parent of a 9-month-old infant during a well-baby visit. Which topic would be most appropriate?
Advising how to create a toddler-safe home The most appropriate topic for this parent would be advising on how to create a toddler-safe home. The infant will very soon be pulling oneself up to standing and cruising the house. This will give the infant access to areas yet unexplored. Warning about leaving small objects on the floor, telling about safety procedures during baths, and cautioning about using baby walkers would no longer be anticipatory guidance as the infant has passed these stages.
A nurse is conducting a class for new mothers about infants and nutrition. One of the women asks, "What is the best nutrition for my 3-month-old infant?" Which response by the nurse would be most appropriate?
"Human milk is the best nutrition for your child" Human milk provides optimal nutritional support for a newborn and has recognized prebiotic and anti-inflammatory effects that enhance biological wellness for the child. Ingestion of human milk is known to aid the newborn's immature immune system. Breastfeeding is the feeding method most encouraged by health care providers today, resulting from the nutritional composition of the milk, the additional immunity it provides the infant in the form of antibodies, and the fact that it has the most easily digestible form of protein. Human milk is readily available, inexpensive, and encourages bonding between the mother and infant. The AAP (2005a) recommends breastfeeding exclusively (no supplemental formulas or baby foods) for approximately the first 6 months and supports continuing breastfeeding after foods are introduced to serve as the child's milk source for the entire first year as long as it is mutually desired by the infant and the mother. Parents should not offer low-iron milks (e.g., cow, goat, soy) to their child until the child is at least 12 months old. Cow's or goat's milk can contribute to anemia because both are deficient in iron. Infants should also never receive low-fat or nonfat milk because these milks do not have the fat, calories, or iron needed to support the rapid growth and development that occurs at this age.
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. 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 nurse is providing health promotion education to a family of an 11-month-old infant who is eating "finger foods." The nurse knows the parents understand the risk of infant choking when they state which response below?
"I can feed our baby Cheerios." Cheerios are a good choice for finger-foods to promote finger-grasp fine motor coordination and self-feeding. Ten to 12 months is a good age to promote self-eating as infants move into mostly solid foods. Popcorn, raisins, and lollipops are choking hazard foods for infants at this age.
The nurse is reinforcing teaching with a group of caregivers related to the nutritional needs of the infant. One caregiver asks why the 6-month-old infant needs to have solid foods when breast milk is such a good source of nutrition. What would be the best response by the nurse?
"Milk will not fully provide the child's needs for iron, which is found in solid foods." At about 4 to 6 months of age, the infant's milk consumption alone is not likely to be sufficient to meet caloric, protein, mineral, and vitamin needs. In particular, the infant's iron supply becomes low, and supplements of iron-rich foods are needed. It is also around 4 to 6 months when the infant is able to swallow solids effectively and has the necessary enzymes necessary to digest them. It is true that the child becomes interested in new skills, but this is not the primary rationale for introducing solids. Few parents will understand the "extrusion reflex" so using that term is not effective in teaching. The nurse should, however, describe the reflex to the parents. Breastfeeding does not become painful when the child develops teeth. Many mothers nurse for long after their infants develop teeth.
The mother of a 3-month-old infant expresses concern that her infant's head is misshapen. Which would be the most appropriate question by the nurse?
"Do you use "tummy time" with the infant?" The appropriate question would be for the nurse to assess whether the mother is placing the infant in the prone position during supervised period of time. This allows for the infant to increase head and neck muscle strength and development of rolling over. It also aids in evening out misshapen or flat heads.
A 3-month-old infant has a Moro reflex. Which statement is most true of this reflex?
Infant may retain the Moro reflex at 3 month old; it fades between 2 and 4 months. 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 known as the "startle reflex" because the infant looks startled when this reaction is seen. This reflex is present at birth; it begins to fade at 2 months of age and disappears by 4 months. It is a normal reflex for some 3-month-old infants; thus, there is no need for medical intervention.
If the infant is following a normal pattern of dentition, the child would most likely have how many teeth by the age of 14 months?
Six to 12 teeth The central incisors erupt between 6 and 12 months of age and lateral incisors erupt between 9 and 13 months. The other lateral incisors erupt between 10 and 16 months, so by age 14 months the infant could have up to 12 teeth.
Estimating illness in an infant is difficult. To help an infant's parents do this, which of the following would you instruct them to use?
Use her interest in eating as a good gauge. A healthy infant eats well, voids adequately, and gains weight.
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.
A new mother asks for advice from the nurse about bathing her infant. Which of the following should the nurse tell her?
Be sure to wash the infant's face, hands, and diaper area daily Except in very hot weather, an infant does not need a bath every day. If a parent is tired and would not enjoy bath time or if some days are just too rushed, a complete bath can be omitted, with only the infant's face, hands, and diaper area washed. Some infants do need their head and scalp washed frequently (every day or every other day) to prevent seborrhea, a scaly scalp condition often called cradle cap. If seborrhea lesions do develop, they adhere to the scalp in yellow, crusty patches. The skin beneath them may be slightly erythematous. The patches can be softened by oiling the scalp with mineral oil or petroleum jelly and leaving it on overnight. The crusts can then be removed by shampooing the hair the next morning. A soft toothbrush or fine-toothed comb can be used to help remove them.
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. 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.