PrepU Q's Chapter 3: Growth and Development of the Newborn and Infant

A parent asks the nurse what symptoms to expect with normal teething in the infant. How should the nurse respond?

Answer: The infant's gumline will be tender. Explanation: Infants experience discomfort as the tooth emerges through the periodontal membrane and from inflammation. When teething, some infants become irritable, have excessive drooling, and like to bite on hard surfaces. To relieve discomfort, the parent can apply ice to the gums or use an over-the-counter topical anesthetic for infants. Some infants will refuse to eat or have poor sleeping due to the pain in the gums. There is not a definitive time frame for this to occur, and it does not happen in all infants. Fever, diarrhea, and vomiting are signs of illness, not teething.

The nurse is assessing the oral cavity of a 4-month-old infant. Which finding is consistent with a child of this age?

Correct response: no teeth Explanation: 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 nurse is assessing the 18-month-old infant. The nurse notes the anterior fontanel (fontanelle) has closed. What initial action by the nurse is indicated?

Correct answer: Document the findings as normal. Explanation: The anterior fontanel (fontanelle) most often closes between 12 and 24 months of age. The closure of the fontanel (fontanelle) at 18 months of age does not signal any health issues for the infant.

A nurse is educating a client being discharged with her newborn baby. What is the highest priority item that must be included in the teaching plan?

Correct answer: Restrain the baby in a car seat. Explanation: The client should restrain the baby in a car seat when driving. Infants are especially vulnerable to injuries resulting from falls from changing tables or being unrestrained in automobiles. Locking the cabinets and giving warm bottles of formula to the baby are secondary teachings.

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?

Correct answer: The infant will most likely present with developmental skills consistent with a 6-month-old infant. Explanation: When assessing the growth and development of a premature infant, the nurse will use the infant's adjusted age to determine expected outcomes. To determine adjusted age, the nurse subtracts the number of weeks that the infant was premature from the infant's chronological age. The infant who was born at 32 weeks' gestation was 8 weeks (or 2 months) premature. To determine the adjusted age, the nurse subtracts 2 months from the chronological age of 8 months: 6 months.

The nurse is assessing an infant at the 6-month well-baby check-up. The nurse notes that at birth the baby weighed 8 lb (3600 g) and was 20 in (50.8 cm) in length. Which finding is consistent with the normal infant growth and development?

Correct answer: weight of 16 lb (7300 g) and length of 26 in (66.0 cm) Explanation: The average newborn weighs 7.5 lb (3400 kg) at birth. Most infants double their birth weight at 4 to 5 months and will triple by the time they are 1 year old. If this infant was 8 lb (3600 kg) at birth, then it is most likely now 16 lb (7300 g). The average newborn is 20 in (50 cm) long at birth. They grow more quickly in length over the first 6 months, than during the second 6 months. By 12 months of age, the infant's length has increase by 50%. At 1 year, this infant will most likely be 30 in (76.2 cm) in length; however, since most of the growth occurs in the first 6 months, it is possible for the infant to grow an additional 6 in (15 cm) during that time.

The infant weighs 7 lb 4 oz (3,300 g) at birth. If the infant is following a normal pattern of growth, what would be the expected weight for this child at the age of 12 months?

Correct response: 21 lb 12 oz (9.9 kg) Explanation: The average weight of a newborn is 7.5 lb (3400 g). The infant gains about 30 g each day. By 1 year of age, the infant has tripled the birth weight and has grown 10 to 12 in (25 to 30 cm). 7.25 lb × 3 = 21.75 lb or 21 lb 12 oz (9.9 kg)

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:

Correct response: looking for a toy in her crib at the last place she saw it. Explanation: 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 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?

Correct response: lower central gumline Explanation: The lower central incisors are usually the first to appear, followed by the upper central incisors.

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?

Correct answer: a rear-facing 5-point harness restraint Explanation: 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 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?

Correct response: "Delays are normal when a child is premature." Explanation: When infants are born prematurely delays may be noted. When assessing the growth and development of a premature infant, use the infant's adjusted age to determine expected outcomes. To determine adjusted age, subtract the number of weeks that the infant was premature from the infant's chronological age. Plot growth parameters and assess developmental milestones based on adjusted age. Delays will not necessarily be resolved by the age of 6 months.

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?

Correct response: "Does he move a toy back and forth from one hand to the other when you give it to him?" Explanation: Transferring an object from one hand to the other is expected at 7 months of age, so this would be expected of an 8-month-old. The other options are not expected until later months, so questioning the parents about these skills would not help in determining if he was at the motor skill developmental level that should be expected.

The nurse is providing anticipatory guidance to the parent of a 2-month-old infant in relation to growth and development. Which statement from the parent demonstrates proper understanding?

Correct response: "I can expect my infant to be able to raise the head up when on the stomach within the next month." Explanation: It is expected that a 3-month-old infant can raise the head to 45 degrees while laying on the stomach. At 4 to 5 months, the infant will typically begin to laugh out loud. The infant can begin to hold a rattle around 5 months of age. Becoming clingy around strangers occurs in the infant around 6 to 8 months of age.

During a well-baby visit the mother of a 3-month-old infant tells the nurse that she does not understand why her baby continues to spit out food during feeding of solid foods. What is the best response by the nurse?

Correct response: "Infants still have a tongue protrusion reflex until 4 to 6 months so they can't help but push out the solid food." Explanation: Introducing solid food with a spoon prior to 4 to 6 months of age will result in extrusion of the tongue. The parent may think that the infant does not want the food and is spitting it out intentionally, but the extrusion reflex is still present.

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?

Correct response: "The baby can sleep in your room in an infant crib, but not in an adult bed." Explanation: According to the 2016 recommendation by the American Academy of Pediatrics, infants should sleep in the same bedroom as the parents, but on a separate firm surface, such as a crib or bassinet, and never on a couch, armchair or adult bed, to decrease the risks of sleep-related deaths.

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?

Correct response: "What does his stool look like?" Explanation: Grunting, crying and straining during bowel movements by infants and newborns is normal. This is due to the immaturity of the gastrointestinal system. The most important thing to do initially is to determine the appearance of the stool. The grunts and cries are not of concern unless the stool is dry and hard, so asking about the characteristics is the initial response. Simply indicating this is normal without having additional information is not the appropriate response. There is no need for a stool specimen based upon the information provided.

A parent asks the nurse if the 2-month-old infant can have bananas yet. The nurse would respond and educate the parent on the nutrition stages of infants by which response?

Correct response: "You can try bananas 2 or 3 months from now." Explanation: The nurse will educate the parent to wait 2 to 3 months, because solid foods are not recommended for infants at 2 months of age. The age of 4 to 6 months is when it is recommended to introduce solid foods. In 1 month, the infant will be only 3 month of age. The other responses will not help the parent determine the appropriate answer.

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?

Correct response: "You may be right, since infants can sense their mother's smell as early as 7 days old." Explanation: The sense of smell develops rapidly: the 7-day-old infant can differentiate the smell of his or her mother's breast milk from that of another woman and will preferentially turn toward the mother's smell.

The nurse is assessing a 1-year-old at the well-child annual visit and notes the child is meeting the growth parameters. After noting the birth weight was 8 pounds (3.6 kg) and length was 20 inches (50.8 cm) long, which measurements reflecting height/weight would the nurse expect to document for this visit?

Correct response: 24 pounds (10.8 kg) and 30 inches (75 cm) Explanation: By 1 year of age, the infant should have tripled his or her birth weight and grown 10 to 12 inches (25 to 30 cm). If this infant was 8 pounds (3.6 kg) at birth, at 1 year, this child should weigh 24 pounds (8 x 3 = 24) and grown to 30 to 32 inches (20 + 10 to 12 = 30 to 32 inches). Most of the growing occurs during the first 6 months with the infant's birth weight doubling and height increasing about 6 inches (15 cm). Growth slows slightly during the second 6 months but is still rapid.

What is the correct amount of wet diapers a mature infant should produce each day?

Correct response: An infant should have 6 to 8 wet diapers/day. Explanation: Urination occurs in the first 24 hours of life. A normal amount of urine is 200 to 300 ml/day as the infant matures. This amount is equal to 6 to 8 wet diapers/day. The infant should have an intake of between 140 to 160 ml/kg/day to be well hydrated and nourished. This amount of intake will produce the 6 to 8 diapers/day.

The nurse is assessing a 6-month-old infant in the clinic. Which characteristic represents normal language development for this age?

Correct response: Babbling Explanation: 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.

What information would the nurse include when teaching the parents of an infant about colic?

Correct response: Colic symptoms will probably fade at 3 months of age. Explanation: Colic is defined as inconsolable crying that lasts 3 hours or longer per day and which it has no physical cause. Colic symptoms typically fade around 3 months of age. This is an age when infants are better able to console themselves. Colic can be very stressful for parents and lead to sleep deprivation. Many infants need to be carried at all times to reduce crying. Some do well with non-nutritive sucking and others need white noise or motion to help them soothe. Because colic has no physical cause, telling the parents about follow up for "nervous stomach" is not necessary. The infant should be placed in a position of comfort to reduce the crying. Every infant has his or her own position that helps; don't just place the infant on his or her back. Doubling up the formula will not help colic and may actually cause more problems because it can cause abdominal pain and increased weight gain.

An infant is breastfed. When assessing the stools, which findings would be typical?

Correct response: Less constipation than bottle-fed infants Explanation: The first stool of the infant is meconium. It is the result of digestion of amniotic fluid and it is black-green color and sticky. Following that, in 1 to 2 days the infant's stools change to a yellowish-tan color. The stools of breastfed infants tend to be yellow-tan. They are looser in texture and appear "seedy." The stool of a bottle-fed baby has the consistency of peanut butter. The stools of breastfed babies generally have no odor since all milk is digested. Some babies will have a bowel movement with every feeding but it is small. Bottle-fed babies have less stools each day but they are larger and more likely to have an associated odor.

The parent of a 3-month-old infant is concerned because the infant does not yet sit by oneself. Which statement best reflects average sitting ability?

Correct response: Most infants do not sit steadily until 8 months; this infant is normal. Explanation: At 3 months of age the infant should be able to raise the head about 45 degrees when in the prone position. The infant does yet have the developmental skills for sitting. Most infants are unable to sit steadily until 8 months of age. Gross motor skill development does not correlate with tooth eruption. The nurse should reassure the parent that this infant is on tract developmentally.

Which activity will the nurse encourage new parents to complete in order to assist their infant in accomplishing Erikson's developmental task for the first year of life?

Correct response: Respond promptly when the infant cries. Explanation: The developmental task of the infant year, according to Erikson, is to gain a sense of trust. This can be accomplished by promptly meeting the infant's needs during the first year of life. If the infant does not learn to trust, mistrust will develop. Praising will help meet the future developmental tasks of the child. Reading books and appropriately enunciating words will aid in the infant's language development. The 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.

Which developmental milestone would the nurse expect an 11-month-old infant to have achieved?

Correct response: Sitting independently Explanation: Infants typically sit independently, without support, by age 8 months. Walking independently may be accomplished as late as age 15 months and still be within the normal range. Few infants walk independently by age 11 months. Building a tower of three or four blocks is a milestone of an 18-month-old. Turning a doorknob is a milestone of a 24-month-old.

The nurse in a community clinic is assessing a 2-month-old infant. The parent asks if the infant is developing normally. The nurse refers to which finding as suggestive of normal development in infants from birth to 2 months of age?

Correct response: The infant raises head and chest while on stomach. Explanation: Infants have gained some neck control and can independently raise head and chest by 2 months of age. Laughing aloud and responding to his or her name is expected between 4 to 5 months of age. Sitting in the tripod position is not expected until 6 months of age. Transferring objects from one hand to another is expected at 7 months of age.

Anticipatory guidance for an infant for the 4th month should include the fact that the infant will be able to achieve which developmental milestone?

Correct response: be able to turn over onto the back Explanation: 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.

The nurse is educating the mother of a 6-month-old boy about the symptoms for teething. Which symptom would the nurse identify?

Correct response: increased biting and sucking Explanation: The nurse would advise the mother to watch for increased biting and sucking. Mild fever, vomiting, and diarrhea are signs of infection. The child would more likely seek out hard foods or objects to bite on.