NUR101 - Chp. 23 - Growth & Development of the Infant

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?

"I can expect my infant to be able to raise the head up when on the stomach within the next month." ** It is expected that a 3-month-old infant can raise the head to 45 degrees while laying on the stomach.

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.

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 milk, 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.

A client who is breastfeeding asks the nurse if she can give the newborn a pacifier. Which nursing response is most appropriate?

"It is recommended to wait until breastfeeding is well-established before introducing a pacifier."

The parent of a 2-month-old infant tells the nurse, "I am worried because my infant is not able to sit independently." Which response by the nurse is appropriate?

"That is not unusual because most infants do not sit by themselves until about 8 months."

When the nurse discharges a new mom and infant, the nurses notices that the car seat is in the front seat of the car. What is the appropriate response for the nurse to make regarding the car seat?

"Let me go over car seat safety with you, so you can install your car seat properly."

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 is the best response by the nurse?

"Milk will not fully provide the infant's needs for iron, which is found in solid foods." ** Around 4 - 6 months when the infant is able to swallow solids effectively and has the necessary enzymes to digest them.

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 oatmeal 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.

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 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."

A nurse on a home visit is providing safety tips 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.

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.

A nurse in a pediatrician's office is educating a parent of a 2-month-old infant about developmental milestones. Drag words from the choices below to fill in each blank in the following sentence. The parent requires further education when the parent states BLANK, BLANK, and BLANK.

- "At 6 months, my baby should be able to feed themselves.", - "My infant should be able to sit on their own by 3 months.". - "I will be able to play games like peek-a-boo with my infant when they are 4 months old."

A nurse is preparing to administer vaccines to a 4-month-old infant. Which vaccines will the nurse administer? Select all that apply.

- Haemophilus B - Inactivated poliomyelitis - Diphtheria, tetanus, and pertussis - Pneumococcal

The infant weighs 7 lb 4 oz (3300 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?

21 lb 12 oz (9.9 kg) ** By 1 year of age, the infant has tripled the birth weight and has grown 10 to 12 in (25 to 30 cm).

In working with infants, the nurse would expect the posterior fontanel to be closed in an infant who is which age?

3 months

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?

6 - 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.

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).

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.

Rooting Reflex

Automatic oral action that newborn babies make to find & latch onto a nipple or source of food for feeding; triggered by stimulating the baby's cheek or mouth area.

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 nurse should plan interventions that include teaching of expected outcomes of growth and development.

Pedodontists

Dentists who specialize in the care & tx of children's teeth.

Personal-Social Development: 32 weeks

Dislikes diaper & clothing change; Afraid of strangers; Fear of separating from mother.

Personal-Social Development: 40 weeks - 1 year

Does things to attract attention' Tries to follow when being read to; Imitates parents; Looks for objects not in sight.

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.

Object Permanence

Just because the object cannot be seen does not mean it is gone.

Personal-Social Development: 24 weeks

Likes to be picked up; Knows family from strangers; Plays Peek-a-Boo; Knows likes & dislikes; Fear of strangers.

Physical Development: 28 Weeks

Lower lateral incisors are followed in the next month by upper central incisors.

When does the posterior fontanel close? Anterior fontanel?

Posterior Fontanel - by the second or third month of life. Anterior Fontanel - between the 12th & 18th months.

Physical Development: 10-12 Weeks

Posterior fontanel closes.

Deciduous (Primary) Teeth

Primary teeth; first ones are usually the lower central incisors - usually erupt between 6 & 8 months of age.

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.

Secondary Circular Reactions

Realizes actions bring pleasure; 24 weeks

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.

Personal-Social Development: 16 weeks

Responds to stimulus; Sees bottle, squeals, & laughs; Aware of new environment & shows interest.

Babinski Reflex

Response to stroking the sole of the foot with a blunt object; causes the big toe to extend & the other toes to fan out.

Which milestone would the nurse expect an infant to accomplish by 8 months of age?

Sitting w/o 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.

Personal-Social Development: 20 weeks

Smiles at self in mirror; Cries when limits are set or when objects are taken away.

The nurse is conducting a physical examination of an 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.

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.

A nurse is collecting weight on a 6-month-old infant. The weight was 14 lbs 3 oz. The mother states that the infant's birth weight was 8 lbs 8 oz. What is the nurse's assessment of this data?

The weight is too little for age. ** By 6 months of age the infant should double its birth weight. The nurse may need to further assess the infant's health status and nutritional status.

Extrusion (Protrusion) Reflex

Thrust the tongue forward as if to suck to take food; has the effect of pushing solid food out of the infant's mouth.

A nurse is reviewing the health records of several 4-month-old infants who were seen in the pediatric office today. Which infant behavior will require referral for further evaluation of growth and development?

Unable to support their head. ** An infant at 4 months of age who cannot support their head should be referred for evaluation. A 4-month-old infant should be able to reach for objects of interest and should be able to roll from a prone to a supine position.

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.

Pincer Grasp

Using thumb & index finger; 32 weeks old.

Physical Development: Birth - 4 Weeks

Weight gain of 5-7 oz per week; Height gain of 1 inch per month the first 6 months; Head circumference increases 0.5" per month; Moro, Babinski, rooting & tonic neck reflexes present.

Seborrhea

Yellow crusty patches of lesions on the scalp; causes "cradle cap"; regular shampooing is important for prevention.

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.

Tonic Neck Reflex

Involuntary, primal response when the baby lies on the back & turns their head to one side, causing the arm on that side to stretch out & the other arm to bend at the elbow.

Early Childhood Caries (Formerly referred to as Baby Bottle Syndrome or Nursing Bottle Caries)

Erosion of the enamel of the deciduous teeth due to the sugar from formula or sweetened juice coating the infant's teeth for long durations.

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.

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.

Personal-Social Development: 10-12 weeks

Aware of new environment, less crying, smiles at significant others.

When do the first deciduous teeth erupt?

Between 6 & 8 months.

The nurse assesses a 4-month-old child during a well-child visit (above). Which assessment finding should the nurse report to the primary health care provider?

Not smiling or tracking faces. ** Preterm infants should be assessed developmentally based on their corrected age. For a 2-month-old infant, corrected waking at night, spitting up, and not rolling over are all normal findings. Not smiling or tracking faces are concerning findings that could indicate problems with vision. This requires follow-up by the health care provider.

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.

Personal-Social Development: 6 weeks

Smiling in response to familiar stimuli; less flexion noted.

Physical Development: 6 Weeks

Tears appear

Primary Circular Reactions

Explores objects by touching or putting in mouth; infant unaware actions are what bring pleasure; 6 weeks old.

Physical Development: 40 Weeks - 1 Year

Birth weight tripled; has six teeth; Babinski reflex disappears; Anterior fontanel closes between now & 18 months.

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.

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 juice - White grape juice ** 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 infant weighs 6 lb 8 oz (2,950 g) 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 12 months?

19 lb 8 oz (8825 g) ** Most infants double their birth weight by 4 to 6 months of age and triple their birth weight by the time they are 1 year old.

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?

6 month mark. ** 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.

A nurse is teaching first-time parents about bathing their infant. The nurse instructs the parents to wait until which day to give the baby a tub bath?

7-10 days after birth. ** To prevent the spread of infection and promote healing, an infant can be submerged in water and receive a tub bath after the umbilical cord stump has fallen off, which usually around 7-10 days after birth.

A 6-month-old infant weighs 14.7 lb (6.7 kg) during a scheduled check-up. The infant's birth weight was 8 lb (3630 g). What is the priority nursing intervention?

Discussing feeding patterns. ** On average an infant's weight doubles by the age of 4 to 6 months and triples by the age of 12 months, so an infant born with a weight of 8 lb (3630 g) should weigh about 16 lb (7.3 kg) by 6 months of age. Assessing the current feeding pattern and daily intake is the priority intervention to try to determine a cause for this lower weight.

When does an infant's birth weight double? Triple?

Double - during the first 6 months. Triple - By 1 yr 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.

Physical Development: 24 Weeks

Birth weight doubles; weight gain slows to 3-5 oz per wk; height slows to 0.5" per month; teething begins with lower central incisors.

Personal-Social Development: 28 weeks

Imitates simple acts; Responds to no; Shows preferences & dislikes for food.

Moro Reflex

Involuntary response that infants have to sudden stimulation or disruption of body balance; splaying arms & legs & then bringing their arms in front of their body.

The nurse working in the child clinic observes infant Max. He is 8 months old. What type of activity should the nurse be observing?

Max is on the floor picking up blocks from a bucket. ** An infant 8 months old would be able to reach and grasp and pick up objects.

Physical Development: 20 Weeks

May show signs of teething.

The nurse in a community clinic is caring for a 6-month-old infant and parent. Which nursing intervention is priority?

Monitoring the infant's weight and height. ** Monitoring the infant's weight and height is the priority intervention. Ongoing assessments of growth are important so that too-rapid or inadequate growth can be identified early. With early identification, the cause can be diagnosed and the potential for further appropriate growth maximized.

Physical Development: 16 Weeks

Moro, rooting, & tonic neck reflexes disappear; drooling begins.

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 fade at 4 to 5 months and disappear around age 6 months. A Moro reflex at age 9 months or 1 year indicates the need for a neurologic examination.

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.

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?

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 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 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.

Personal-Social Development: Birth - 4 weeks

Some smiling begins; Erikson's stage of Trust vs Mistrust.

Fontanel

Space between the bones of the skull in an infant or fetus, where ossification is not complete/sutures not fully formed. ** Main one is between the frontal & parietal bones.

What does the acronym SIDS stand for?

Sudden Infant Death Syndrome ** Often happens during sleep.

Physical Development: 32 Weeks

Teething continues

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 around age 4 months.

A 12-month-old seen at a walk-in clinic weighed 8 pounds 4 ounces (3750 g) at birth. Weight now is 20 pounds 8 ounces (9300 g). The nurse determines:

The child weighs less than expected for age. ** Birth weight should triple by 12 months.