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
■ Separation-individuation occurs during the first year of life as infants first distinguish
themselves and their primary caregiver as separate individuals, and then develop
■ Separation anxiety begins around 4 to 8 months of age. Infants will protest when separated
from parents, which can cause considerable anxiety for parents.
■ Stranger fear becomes evident between 6 and 8 months of age, when infants are less likely to
■ Reactive attachment disorder results from maladaptive or absent attachment between the
infant and primary caregiver, and continues through childhood and adulthood.
■ 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 12 months); RV; Hib
■ 6 to 12 months - Seasonal influenza vaccination yearly (the trivalent inactivated influenza
vaccine (TIV) is available as an intramuscular injection)
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 4- to 7-day period, to observe for signs of
allergy or intolerance, which may 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 cooked, chopped, and unseasoned are appropriate by 9 months of age.
■ Appropriate finger foods include ripe bananas; toast strips; graham crackers; cheese cubes;
noodles; and peeled chunks of apples, pears, or peaches
◯ Birth to 3 months - colorful moving mobiles, music/sound boxes
◯ 3 to 6 months - noise-making objects and soft toys
◯ 6 to 9 months - teething toys and social interaction
◯ 9 to 12 months - large blocks, toys that pop apart, and push-and-pull toys
◯ Cloth books, puzzles with large pieces
◯ Large crayons and paper
◯ Push-and-pull toys, balls
◯ Educational television
◯ Videos for children
◯ Imitative and imaginative play
◯ Drawing, painting, riding a tricycle, swimming, jumping, and running
◯ Educational television and videos
● School-age children
◯ Games that can be played alone or with another person
◯ Team sports
◯ Musical instruments
◯ Arts and crafts
◯ Team sports
◯ School activities
◯ Reading and listening to music
◯ Peer interactions
Reye syndrome primarily affects the liver and brain, causing:
◯ Liver dysfunction
◯ Cerebral edema
● The cause of Reye syndrome is not understood.
● Peak incidence of Reye syndrome occurs when influenza is most common, typically January, February,
● Reye syndrome can be mistaken for other disorders, including encephalitis, meningitis, poisoning,
sudden infant death syndrome (SIDS), diabetes mellitus, and psychiatric illness.
● The prognosis for the client who has Reye syndrome is best with early recognition and treatment.
***◯ Recent viral illness or use of aspirin (Bayer Children's).
-◯ There is a potential association between using aspirin (salicylate) products for treating fevers
caused by viral infections and the development of Reye syndrome
Reye syndrome presents in clinical stages based on the severity of liver and neurologic findings.
☐ Profuse vomiting
☐ Loss of consciousness
-■ Liver biopsy
■ CSF analysis
☐ A lumbar puncture should be performed to collect CSF and rule out meningitis
◯ Maintain hydration while preventing cerebral edema.
◯ Monitor coagulation and prevent hemorrhage.
◯ Vitamin K
■ Improves synthesis of blood clotting factors in the liver
◯Osmotic diuretic - mannitol (Osmitrol)
■ To decrease cerebral swelling, administer as prescribed.
■ Nursing Considerations
☐ Monitor the client for increased ICP.
■ Most common during first 8 months of life
■ Sudden, brief, symmetric muscle contractions
■ Flexed head, extended arms with legs drawn up
■ Possible eyes rolling upward and inward
■ Possible loss of consciousness
■ Possible flushing, pallor or cyanosis
■ Possible cry or giggle before or after
◯ Partial (focal/local)
Simple partial seizures with motor signs
☐ Aversive seizure: eyes and head turn away from the side of focus, with or without loss of
☐ Rolandic seizure: tonic-clonic movements involving the face and most common
■ Simple partial seizure with sensory signs
☐ Tingling, numbness or pain in one area of the body then spreading to other parts, with
■ Complex partial seizures
☐ Altered behavior
☐ Inability to respond to the environment
☐ Impaired consciousness
☐ Confusion and unable to recall event
☐ Complex sensory aura: strange feeling in stomach that rises to the throat, auditory or visual
hallucinations, feelings of fear, distorted sense of time and self
Infants: bulging fontanel, separation of cranial sutures, irritability, increased sleeping,
high-pitched cry, poor feeding, setting-sun sign
X Children: nausea, headache, vomiting, blurred vision, increased sleeping, inability to
follow simple commands, seizures
X Late Signs: alterations in pupillary response, posturing (decorticate and decerebrate),
bradycardia, decreased motor response, decreased sensory response, Cheyne-Stokes
Z Decorticate (dysfunction of the cerebral cortex) - Demonstrates the arms, wrists, and
fingers flexed and bent inward onto the chest and the legs extended and adducted.
Z Decerebrate (dysfunction at the midbrain) - Demonstrates a backward arching of the
head and arms with legs rigidly extended and toes pointing downward