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Peds- Chp 3: Health Promotion of Infants (2 Days to 1 Year)

Terms in this set (40)

General measurements of full-term newborn:
Head circumference
Averages between 33-35 cm (13 and 14 in).
General measurements of full-term newborn:
Crown to rump length
31-35 cm (12.5 to 14 in),
approximately equal to head circumference.
General measurements of full-term newborn:
Length
Head to heel length averages 48-53 cm (19 to 21 in).
General measurements of full-term newborn:
Weight
Averages 2,700 to 4,000 g (6 to 9 lb).
How much weight do newborns lose by how many days of age? Why is it lost?

When is it regained?
Newborns will lose up to 10% of their birth weight by 3 to 4 days of age.
Due to fluid shifts, loss of meconium, and limited intake, especially in infants who are breastfed.

The birth weight is usually regained by the tenth to fourteenth day of life, depending on the feeding method used.
Fontanels
●Posterior fontanel closes by 6 to 8 weeks of age.

●Anterior fontanel closes by 12 to 18 months of age.
Infant size: Height, Weight and Head circumference
Infant size is tracked using weight, height, and head
circumference measurements.

●Weight: Infants gain approximately 680 g (1.5 lb) per
month during the first 5 months of life.
The average weight of a 6 month old infant is 7.26 kg (16 lb).
Birth weight is at least doubled by the age of 5 months,
and tripled by the age of 12 months to an average of
9.75 kg (21.5 lb).

●Height: Infants grow approximately 2.5 cm (1 in) per
month the first 6 months of life.
Growth occurs in spurts after the age of 6 months, and the birth length increases by 50% by the age of 12 months.

●Head circumference: The circumference of infants'
heads increases approximately 2 cm (0.75 in) per month
during the first 3 months,
1 cm (0.4 in) per month from 4 to 6 months,
and then approximately 0.5 cm (0.2 in) per month during the second 6 months.
Dentition
●Six to eight teeth should erupt in infants' mouths by
the end of the first year of age.
The first teeth typically erupt between the ages of 6 and 10 months (average age 8 months).

●Some children show minimal indications of teething,
such as sucking or biting on their fingers or hard objects and drooling.
Others are irritable, have difficulty sleeping, have a mild fever, rub their ears, and have decreased appetite for solid foods.

●Teething pain can be eased using frozen teething rings
or an ice cube wrapped in a wash cloth and over-the-counter teething gels.
With topical anesthetic ointments, absorption rates vary in infants; therefore, parents should be advised to apply them correctly.
Acetaminophen (Tylenol) and/or ibuprofen (Advil) are
appropriate if irritability interferes with sleeping and feeding, but should not be used for more than 3 days.
Ibuprofen should be used only in infants over the age of
6 months.

●Clean infants' teeth using cool, wet washcloths.

●Bottles should not be given to infants when they are
falling asleep because prolonged exposure to milk or
juice can cause early childhood dental caries.
Cognitive Development: Piaget
Piaget: sensorimotor stage (birth to 24 months)
●Infants progress from reflexive to simple repetitive to
imitative activities.
●Separation, object permanence, and mental representation are the three important tasks accomplished in this stage.
◯Separation: Infants learn to separate themselves from
other objects in the environment.
◯Object permanence: The process by which infants learn that an object still exists when it is out of view.
This occurs at approximately 9 to 10 months of age.
◯Mental representation: The ability to recognize and
use symbols.
Language development
●Crying is the first form of verbal communication.
●Infants cry for 1 to 1½ hr each day up to 3 weeks of age
and build up to 2 to 4 hr by 6 weeks.
●Crying decreases by 12 weeks of age.
●Vocalizes with cooing noises by 3 to 4 months.
●Shows considerable interest in the environment by 3 months.
●Turns head to the sound of a rattle by 3 months.
●Laughs and squeals by 4 months.
●Makes single vowel sounds by 2 months.
●By 3 to 4 months the consonants are added.
●Begins speaking two-word phrases and progresses to
speaking three-word phrases.
●Says three to five words by the age of 1 year.
●Comprehends the word "no" by 9 to 10 months and
obeys single commands accompanied by gestures.
Psychosocial Development: Erikson
Erikson: trust vs. mistrust (birth to 1 year)
●Achieving this task is based on the quality of the caregiver-infant relationship and the care received by the infant.
●The infant begins to learn delayed gratification.
Failure to learn delayed gratification leads to mistrust.
●Trust is developed by meeting comfort, feeding, stimulation, and caring needs.
●Mistrust develops if needs are inadequately or
inconsistently met, or if needs are continuously met
before being vocalized by the infant.
Social development
●Social development is initially influenced by infants'
reflexive behaviors and includes attachment, separation,
recognition/anxiety, and stranger fear.
●Attachment is seen when infants begin to bond with
their parents. This development is seen within the first
month, but it actually begins before birth. The process
is enhanced when infants and parents are in good
health, have positive feeding experiences, and receive
adequate rest.
●Separation-individuation occurs during the first year
of life as infants first distinguish themselves and their
primary caregiver as separate individuals at the same
time that object permanence is developing.
●Separation anxiety begins around 4 to 8 months of
age. Infants will protest when separated from parents,
which can cause considerable anxiety for parents. By 11
to 12 months, infants are able to anticipate the mother's
imminent departure by watching her behaviors.
●Stranger fear becomes evident between 6 and 8 months
of age, when infants have the ability to discriminate
between familiar and unfamiliar people.
●Reactive attachment disorder results from maladaptive
or absent attachment between the infant and
primary caregiver and continues through childhood
and adulthood.
Body-image changes
●Infants discover that mouths are pleasure producers.
●Hands and feet are seen as objects of play.
●Infants discover that smiling causes others to react.
Motor Skills Development: 1 Month
Gross motor skills: Demonstrates head lag

Fine motor skills: Has a strong grasp reflex
Motor Skills Development: 2 months
Gross motor Skills: Lifts head off mattress when prone

Fine motor skills: Holds hands in an open position
Grasp reflex fading
Motor Skills Development: 3 months
Gross motor skills: Raises head and shoulders off mattress when prone
only slight head lag

Fine motor skills: no longer has a grasp reflex
Keeps hands loosely open
Motor Skills Development: 4 months
Gross motor skills: Rolls from back to side

Fine motor skills: Grasps objects with both hands
Motor Skills Development: 5 months
Gross motor skills: rolls from front to back

Fine motor skills: Uses palmar grasp dominantly
Motor Skills Development: 6 months
Gross motor skills: rolls from back to front

Fine motor skills: Holds bottle
Motor Skills Development: 7 months
Gross motor skills: Bears full weight on feet
sits, leaning forward on both hands

Fine motor skills: moves objects from hand to hand
Motor Skills Development: 8 months
Gross motor skills: sits unsupported

Fine motor skills: Begins using pincer grasp
Motor Skills Development: 9 months
Gross motor skills: Pulls to a standing position
Creeps on hands and knees instead of crawling

Fine motor skills: Has a crude pincer grasp
Dominant hand preference evident
Motor Skills Development: 10 months
Gross motor skills: Changes from a prone to a sitting position

Fine motor skills: Grasps rattle by its handle
Motor Skills Development: 11 months
Gross motor skills: Cruises or walks while holding onto something
Walks with one hand held

Fine motor skills: Places objects into a container
neat pincer grasp
Motor Skills Development: 12 months
Gross motor skills: sits down from a standing position without assistance

Fine motor skills: tries to build a two-block tower without success
Can turn pages in a book
Age Appropriate Activities
●Play should provide interpersonal contact and
educational stimulation.
●Infants have short attention spans and will not interact with other children during play (solitary play).

Appropriate toys and activities that stimulate the senses
and encourage development include the following.
◯Rattles
◯Soft stuffed toys
◯Teething toys
◯Nesting toys
◯Playing pat-a-cake
◯Playing with balls
◯Reading books
◯Mirrors
◯Brightly colored toys
◯Playing with blocks
Care of Newborn After discharge
●Newborn infants should be placed in an federally
approved car seat at a 45 degree angle to prevent
slumping and airway obstruction.
The car seat is placed rear facing in the rear seat of the vehicle and secured using the safety belt.
The shoulder harnesses are placed in the slots at or below the level of the infant's shoulders.
The harness should be snug and the retainer clip placed at the level of the infant's armpits.

●Instruct parents that their newborn will require a checkup by a provider within 72 hr of discharge. This is especially important for breastfed newborns to evaluate weight and hydration status.
Immunizations
The Centers for Disease Control and Prevention (CDC)
immunization recommendations for healthy infants less
than 12 months of age (http://www.cdc.gov) include:
●Birth: hepatitis B (Hep B)

●2 months: diphtheria and tetanus toxoids and
pertussis (DTaP), rotavirus vaccine (RV), inactivated
poliovirus (IPV), Haemophilus influenzae type B (Hib),
pneumococcal vaccine (PCV), and Hep B

●4 months: DTaP, RV, IPV, Hib, PCV

●6 months: DTaP, IPV (6 to 18 months), PCV, and Hep B (6
to 18 months); RV; Hib

●6 to 12 months: seasonal influenza vaccination yearly
(the trivalent inactivated influenza vaccine is available
as an intramuscular injection)
Nutrition: Feeding Alternatives
◯Breastfeeding provides a complete diet for infants
during the first 6 months.
◯Iron-fortified formula is an acceptable alternative to
breast milk. Cow's milk is not recommended.
◯It is recommended to begin vitamin D supplements
within the first few days of life to prevent rickets and
vitamin D deficiency.
◯Iron supplements are recommended for infants who are being exclusively breastfed after the age of 4 months.
◯Alternative sources of fluids, such as juice or water, are not needed during the first 4 months of life. Excessive intake of water could result in hyponatremia and water intoxication.
◯After the age of 6 months, 100% fruit juice should be
limited to 4 to 6 oz per day.
Solid foods
Solids are introduced around 4 to 6 months of age.

◯Indicators for readiness include interest in solid foods, voluntary control of the head and trunk, and disappearance of the extrusion reflex.
◯Iron-fortified cereal is typically introduced first due
to its high iron content.
◯New foods should be introduced one at a time, over
a 5- to 7-day period, to observe for signs of allergy
or intolerance, which might include fussiness, rash,
vomiting, diarrhea, and constipation.
◯Vegetables or fruits are started first between 6 and
8 months of age. After both have been introduced,
meats may be added.
◯Citrus fruits, meat, and eggs are not started until
after 6 months of age.
◯Breast milk/formula should be decreased as intake of
solid foods increases, but should remain the primary
source of nutrition through the first year.
◯Table foods that are well-cooked, chopped, and
unseasoned are appropriate by 1 year of age.
◯Appropriate finger foods include ripe bananas, toast
strips, graham crackers, cheese cubes, noodles,
firmly-cooked vegetables, and raw pieces of fruit
(except grapes).
Nutrition: Weaning
Weaning can be accomplished when infants show signs
of readiness and are able to drink from a cup (sometime
in the second 6 months).

◯Gradually replace one bottle or breastfeeding at a time
with breast milk or formula in a cup with handles.
◯Bedtime feedings are the last to be stopped.
Sleep and Rest
●Nocturnal sleep pattern is established by 3 to 4 months
of age.
●Infants sleep 14 to 15 hr daily and 9 to 11 hr at night
around the age of 4 months.
●Infants sleep through the night and take one to two
naps during the day by the age of 12 months.
Injury Prevention: Aspiration of foreign objects
●Hold the infant for feedings; do not prop bottles.
●Small objects that can become lodged in the throat
(grapes, coins, candy) should be avoided.
●Age-appropriate toys should be provided.
●Clothing should be checked for safety hazards
(loose buttons).
Injury Prevention: Bodily harm
●Sharp objects should be kept out of reach.
●Anchor heavy objects and furniture so they cannot be
overturned on top of the infant.
●Infants should not be left unattended with any
animals present.
Injury Prevention: Burns
●Avoid warming formula in a microwave; check temperature of liquid before feeding.
●The temperature of bath water should be checked.
●Hot water thermostats should be set at or below 49° C (120° F).
●Working smoke detectors should be kept in the home.
●Handles of pots and pans should be kept turned to the
back of stoves.
●Sunscreen should be used when infants are exposed
to the sun.
●Electrical outlets should be covered.
Injury Prevention: Drowning
●Infants should not be left unattended in bathtubs or
around water sources such as toilets, cleaning buckets,
or drainage areas.
●Secure fencing around swimming pools.
●Close bathroom doors.
Injury Prevention: Falls
●Crib mattresses should be kept in the lowest position
possible with the rails all the way up.
●Restraints should be used in infant seats.
●Infant seats should be placed on the ground or floor
if used outside of the car, and they should not be left
unattended or on elevated surfaces.
●Place safety gates at the top and bottom of stairs.
Injury Prevention: Poisoning
●Exposure to lead paint should be avoided.
●Toxins and plants should be kept out of reach.
●Safety locks should be kept on cabinets that contain
cleaners and other household chemicals.
●The phone number for a poison control center should be
kept near the phone.
●Medications should be kept in childproof containers,
away from the reach of infants.
●A working carbon monoxide detector should be kept in
the home.
Injury Prevention: Motor-vehicle injuries
●Infant-only and convertible infant-toddler car seats
are available.
●Infants and toddlers remain in a rear-facing car seat
until the age of 2 years or the height recommended by
the manufacturer.
●The safest area for infants and children is the backseat
of the car.
●Do not place rear-facing car seats in the front seat of
vehicles with passenger airbags.
●Infants should not be left in parked cars
Injury Prevention: Suffocation
●Plastic bags should be avoided.
●Balloons should be kept away from infants.
●Crib mattresses should fit snugly.
●Crib slats should be no farther apart than 6 cm (2.375 in).
●Crib mobiles and/or crib gyms should be removed by
4 to 5 months of age.
●Pillows should be kept out of the crib.
●Infants should be placed on their backs for sleep.
●Toys with small parts should be kept out of reach.
●Drawstrings should be removed from jackets and
other clothing.
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