Chapter 25: Growth and Development of the Newborn and Infant

What is the earliest age at which an infant is able to sit steadily alone?

8 months (pg. 932, Table 25.3)

What is the most appropriate activity to recommend to parents to promote sensorimotor stimulation for a 1-year-old?

Play with push-pull toys.

The nurse is assessing a 1-year-old infant in the pediatric office. What finding should the nurse report to the physician immediately?

Respiratory rate of 60 breaths per minute Respirations of a 1-year-old infant should be 20 to 40 breaths/minute. Increased respiratory rate can lead to distress and should be reported immediately. Pulse rate of 100 to 140 beats/minute is normal.

A parent is concerned because her infant has a diaper rash. What is the best action the nurse would advise the parent to implement?

Apply a protective ointment on the area.

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 (pg. 924).

A mother is discussing her 10-month-old boy with the nurse. Which comment indicates a *need for teaching*?

"He loves being in his walker and 'zips' around the house." Walkers are safety hazards and not recommended by the American Academy of Pediatrics. They cause falls plus promote the ability to reach items on surfaces otherwise inaccessible. The other comments are age appropriate and acceptable practice (pg. 942).

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 (pg. 933).

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 (pg. 933).

The nurse is aware that the 7-month-old can signal feeding readiness by:

- Pulling spoon toward mouth - Manipulating finger foods

The nurse is assessing development in a 9-month-old infant. What would the nurse expect to observe?

-Imitating sounds such as da-da -Creeping along the floor

At what age does an infants birth weight triple?

1 year

What is the earliest age at which the infant should be able to walk independently?

12 to 15 months (pg. 932, Table 25.3)

The parent of a 3-month-old infant asks the nurse, "At what age do infants usually begin drinking from a cup?" What is the nurses most accurate response?

5 months

A parent brings a 6-month-old infant to the pediatric clinic for her well-baby examination. Her birth weight was 8 pounds, 2 ounces. What will the nurse weighing the infant today would expect her weight to be?

At least 16 pounds

A new mother is voicing concern she is breastfeeding her newborn too frequently. How often does the nurse instruct this mother she should expect her newborn to feed?

Every 2 to 3 hours

At which age would the nurse expect to find the beginning of object permanence? A)1 month B)6 months C)9 months D)12 months

B) 6 months

The mother of an infant born prematurely tells the nurse, The baby is irritable. She cries during diaper changes and feedings. Can you make some suggestions about what I should do to soothe her? What is the most appropriate recommendation to help this parent?

Cover the baby snugly when you hold him. Swaddle to infant in a light blanket with extremities flexed and hands near the face.

A mother is concerned because her 10-month-old is lethargic. What is the best action the nurse can advise this mother to implement?

Handle the infant slowly and gently. Some infants respond to stimulating environments by shutting down. Move and handle infants slowly and gently.

What is an abnormal finding in an evaluation of growth and development for a 6-month-old infant?

Head lag present Warning signs that may indicate problems with motor development - child cannot support head at 3 to 4 months of age (pg. 932).

What statement made by a parent indicates correct understanding of infant feeding?

I give the baby any new foods before he takes his bottle. New solid foods should be introduced before formula or breast milk to encourage the infant to try new foods.

Which statement indicates the mother of an 8-month-old understands infant sleep patterns?

I put the pacifier in the crib so that she can find it when she wakes up. The parent should assist the infant to develop self-soothing behaviors so that the infant can get back to sleep on her own.

The nurse discusses child-proofing the home for safety with the mother of a 9-month-old. Which statement made by the mother would indicate an *unsafe behavior*?

In the car, she rides in a front-facing car seat.

A mother calls the pediatricians office because her infant is colicky. What is the most helpful measure the nurse can suggest to the mother?

Rock the fussy infant slowly and gently.

Piaget

Sensorimotor stage - infant uses senses and motor skills to learn about the world. Sucking for nutrition and comfort / pleasure. Imitation and repeated actions to get what they want - shake rattle. *Object permanence* - I left this toy here and I'll expect it to be there when I get back (8 months).

Parents of a 6-month-old infant ask the nurse why it is necessary to offer iron-rich formula to their child. What is the correct response?

The infant has exhausted maternal iron stores.

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

The infant's gumline will be tender. 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 (pg. 951).

A new mother reports that she is exhausted and that the little sleep she gets is determined by her baby. Which suggestion should the nurse prioritize to help the mother establish healthy sleeping patterns in her infant?

Use the crib for sleeping only, not for play activities. 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 (pg. 941).

The nurse observes a 10-month-old infant using her index finger and thumb to pick up pieces of cereal. What does this behavior indicate the infant has developed?

The pincer grasp

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. The respiratory patterns of the 1-month-old infant are irregular. There may normally be periodic pauses in the rhythm (pg. 925).

How might the nurse demonstrate the parachute reflex with an infant?

Thrusting the infant downward into the crib

Erikson

Trust vs. Mistrust - respond to infant's basic needs creates a sense of trust, from birth to 1 yr. Eventually, can tolerate small amounts of frustration and delayed gratification.

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 (pg. 931).

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 The first primary teeth typically erupt between the ages of 6 and 8 months (pg. 929).

What will the nurse advise a parent to do when introducing solid foods?

Introduce each new food 4 to 7 days apart. The introduction of one new food every 3 to 5 days is recommended. This allows for identification of food allergies. No salt, sugar, or other seasoning should be added to these first foods (pg. 948).

What would the nurse expect a 4-month-old to be able to accomplish?

Lift head and shoulders (pg. 932, Table 25.3)

The nurse is talking with a parent about tooth eruption. What teeth will the nurse explain are the first deciduous teeth to erupt?

Lower central incisors The lower central incisors are usually the first to appear, followed by the upper central incisors. The average 12-month-old has four to eight teeth (pg. 929).

When does the posterior fontanelle close?

2 to 3 months It closes within 8 to 12 weeks after birth to allow growth of the brain (pg. 443).

The nurse is assessing the infants in the nursery for the six stages of consciousness. The nurse becomes concerned when assessing which infants? Select all that apply. A) An infant rapidly moves from deep sleep to crying B)An infant moves from active alert state to drowsiness C)An infant progresses slowly from deep sleep to light sleep D)An infant frequently skips the quiet alert state during the six stages of consciousness E) An infant ends the stages of consciousness with crying

A) An infant rapidly moves from deep sleep to crying B) An infant moves from active alert state to drowsiness D) An infant frequently skips the quiet alert state during the six stages of consciousness

Milestones

A) At 1 month the infant lifts and turns the head to the side in the prone position. D) At 7 months the infant sits alone with some use of hands for support. E) At 9 months the infant crawls with the abdomen off the floor. F) At 12 months the infant walks independently.