I. Physical growth and development A.

Growth parameters >The best indicator of good overall health in an infant is steadily increasing size >Growth and development is monitored by plotting measurement in a standardized growth chart, from birth to 3 years, and from 3 to 18 years

Length: A. From 0 to 6 months an infant grows 1 inch per month (2.5 cm) B. average 6 month old infant is 25.5 inches C. average 12 month old is 29 inches Birth length increases by 50 % by 12 months Weight: A. from 0 to 5 month old, child gains 1.5 lbs per month

B. weight doubles by 5 months C. average 6 month weight is 16 lbs D. birth weight triples by 12 months E. average 12 month weight is 21.5 lbs > chest circumference is normally about 1 inch less than HC; it is measured at level of the nipples >Fontanel changes A. anterior: diamond shape; closes at 12 & 18 months B. posterior: triangular, closes by 2 months

NUTRITION . Breast milk is the most desirable complete food source for the first 6 months . Commercially prepared iron-fortified formula is an acceptable alternative . Formula intake varies per infant but averages 4 oz 6 x a day for 1 month; 4.2 oz 5 x a day at 6 months when solid foods are introduced . Solid foods are not recommended before 4- 6 months

. Breast milk or formula is the primary source of nutrition for 6 to 12 months, although solid foods should be added . Infant cereals are usually the infants initial solid foods; easy to digest, contains iron, and rarely causes allergic reaction . Additional foods include other cereals, fruits and meat . Finger foods are introduced at 8-9 months

. Weaning from breast or bottle to a cup should be gradual. The infants desire to imitate (between 8-9) increases success of weaning . Honey should be discouraged because it may be a source of infant botulism SLEEP PATTERRNS < sleep patterns vary < during 1st month, most infants sleep when not eating

< between 3 and 4 months, most infants sleep between 9-11 hours at night < by 12 month, most infants take morning and afternoon naps < bedtime rituals should begin in infancy to prepare the infant for sleep and prevent future sleep problems

DENTAL HEALTH Fluoride supplements are needed for exclusively breast- fed infants, those receiving ready to feed formula and where local water is inadequately fluorinated Primary tooth eruption begins by 6 months Teeth should be cleaned with damp cloth Breast and bottle feeding should be discouraged during sleep to prevent dental carries that result from prolonged contact with milk

II. Cognitive development Overview ( Piaget) > In the sensorimotor stage, between birth and 18 months, intellect develops and the infant gains knowledge of the environment through senses. Development progresses from reflexive activity to purposeful acts in 5 substages:

A. Substage 1 ( birth 1 month): use of reflexescharacterized by innate and predictable survival reflexes ( such as sucking and grasp) B. substage 2 ( 1- 4 months) primary circular reactions- marked by stereotyped repetition and the focus on his/ her own body as center of interest C. substage 3 (4-8 months) secondary circular reactions- acquired adaptation and shifting of attention to objects and environment

D. substage 4 (8- 12 months) coordination of secondary schemes- consolidation of and coordination of schemes ( searching for hidden) E. substage 5 ( 12- 18 months) tertiary circular reactions- interest in creativity, and discovery through active experimentation; stage completed when infant achieves sense of permanence An emerging body image parallels sensorimotor development

LANGUAGE Crying is the first means of communication Cooing begins between 1 and 2 months Babbling, laughing, and consonant sounds begin between 3 and 4 months Imitative sound at 6 months Combined syllables (ma-ma) at 8 months Understands no-no by 9 months Infant says mama and dada in correct context by 10 months Infant can say 4 and 10 words in correct context by 12

III. Psychosocial development A. Overview ( Erikson) Erikson terms the crisis faced by the infant trust vs mistrust The sense of trust developed in the 1st year forms the foundation for all future psychosocial tasks.

In this stage, developing a sense of trust in caregivers and environment is the central focus. The quality of caregiver- child relationship is a crucial factor in the development of trust Consistent delay in needs gratification develops sense of uncertainty, leading to mistrust

B. Fears > infant exhibits startle or Moro reflex in response to loud noises, falling, and sudden movements in the environment > stranger anxiety typically begins in age 6 months > caregiverss cuddling and warmth can ease fears >commonly seeks comfort from a security object during times of stress or uncertainties

C. Socialization Attachment to significant others begins at birth and very evident after 6 months Age 2 months: social smile Age 3 months: familiar faces Age 4 months: social interaction Age 5 months: smiles at mirror image Age 6 months: begins to fear strangers Age 8 months: consistent stranger anxiety Age 12 months: shows emotions (jealousy, etc)

D. Play and toys Play is the work of children It reflects the development and awareness of environment From age 1 month to 1 year, play is solitary The infant develops sensory and motor skills by manipulating toys and other objects Toys stimulate psychological development Offers diversion Means of communication and feelings

Infant toys should be safe and appropriate: No sharp parts and objects No small or detachable parts Examples of age appropriate toys: 1 to 3 months: mobile,, music box, rattle, etc 4 to 6 months: squeeze toys, busy boxes,, play gym 7 to 9 months: cloth- textured toys, splashing bath toys, large blocks and balls 10 to 12 months: books with large pictures

E. Discipline spoiling an infant with too much attention is difficult; meeting the needs is precedence to discipline Has no ability to accept delayed gratification. Learning to wait progresses after infancy discipline action is fruitless in infancy Effective measures include negative voice, stern eye contact, time- out Corporal punishment is not recommended

IV. Motor development Gross motor: Infant can turn head side to side from prone position unless if the surface is very soft which may lead to suffocation About 3 months, head lag is almost not exhibited 5 months, rolls from front to back 7 months, sits leaning forward 8 months, sits unsupported 9 months, pulls up to stand

10 months, infant cruises 12 months, walks holding someones hand Fine motor: 1 month, strong grasp 3 months, infants grasp reflex fades and can actively hold rattle 5 months, can grasp voluntarily 7 months, can make hand- to- hand transfer

9 months, develop pincer grasp 12 months, attempt to build 2 tower block Related safety concerns: Falling off beds and stairs Aspiration, poisoning Suffocation caused by inadvertently covering of nose and mouth, or strangulation Burns from hot liquids Motor vehicle accident

Nursing interventions: Instruct parents to maintain safe environment (out of reach) Alert parents of age- related potential injury sources and accident prevention strategies Encourage parents to avoid repetitive negative expressions for the sake of safety and to stress positive behaviour such as playing with suitable toys

V. Psychosexual development Overview ( Freud) The oral stage of development extends from birth to 18 months Infant sucks for enjoyment as well as nourishment and gains gratification by swallowing, chewing, and biting In this stage, infant meets the world orally by crying, tasting, eating, and early vocalizing

Biting is interpreted as a way to get hold on the environment and gain greater sense of control Grasping and touching are used to explore variations in the environment VI. Illness and hospitalization Young infants respond to pain by crying and facial expression Older infants respond with a generalized body responses and deliberately withdraws from stimulated area.

Reactions to hospitalization: Infants under age 3 months tolerate short term hospitalization if with nurturing person to meet needs consistently Separation anxiety due to stranger anxiety between 4 and 6 months

Nursing considerations: Spend time with parents within sight of infant so you are seen safe person Allow parents to give care as much as possible Provide sensorimotor stimulation Provide physical comfort and safety: Keep baby warm and dry Meet hunger needs consistently; keep cribb side rails up

Cognitive interventions: Provide variety off stimulating toys Provide language development Psychosocial and emotional interventions: Maintain relationship with parents Maintain consistent staffing Promote sense of security (cuddle, holding gently talking)