Transcript Fertilization

CHAPTER 16
The Infant
MILESTONES

Describes general patterns of achievement at
various stages
Often referred to as norms
 Nurse must understand normal range for milestone
achievement

Establishment of sleep-wake cycle
 Social smile
 Drinking from cup
 Separation anxiety

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3
AVERAGE VITAL SIGNS OF THE INFANT
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ERICKSON’S DEVELOPMENTAL TASK

Trust vs Mistrust

Getting needs met

Tolerating frustration in small amounts

Recognizing mother as distinct from others and self
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SENSES
TOUCH
HEARING
VISION
TASTE
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TOUCH

It is the most highly developed sense.

Mostly at the lips, tongue, ears, and forehead.

Very comfortable with touch.
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HEARING


Ordinary sounds are heard well before 10 days of
life.
Response is either cry, eye movement, cessation
of activity or startle reaction
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HEARING
BAER done at birth
 Ability to hear correlates with ability to
enunciate words
 Ask for history of otitis media or aids
 Referral for fluid in ears
 Repeat hearing test
 Speech therapy

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VISION
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Pupils dilate to light
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Bright lights are unpleasant

Follow objects in line of vision
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TASTE


Bitter and sour fluids are resisted while sweet
are accepted.
SMELL

Only evidence in search for nipple as he smells breast
milk.
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ORAL STAGE
•
Sucking brings comfort and relief from tension
•
Important to hold infant during feedings
•
Allow sufficient time for infant to suck
•
Infants on IV fluid/nutrition need additional
attention and a pacifier to ensure the need for
sucking is satisfied
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MOTOR DEVELOPMENT

Grasp reflex disappears around 3 months of age


Touch palm of hand of infant and flexion occurs.
Prehension occurs around 5 to 6 months of age
Grasp objects between fingers and opposing thumb
 Can hold drinking cup


Parachute reflex appears around 7 to 9 months as
a protective arm mechanism


When infant is suddenly thrusted downward when prone
Pincer grasp well-established by 1 year of age

Coordination of index finger and thumb
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FINE MOTOR DEVELOPMENT
IN INFANCY
6-month-old
12-month-old
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REFLEXES

Swallowing

Gagging

Sucking

Grasp

Tonic Neck
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THE DEVELOPMENT OF LOCOMOTION,
PREHENSION, AND PERCEPTION
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THE DEVELOPMENT OF LOCOMOTION,
PREHENSION, AND PERCEPTION (CONT.)
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Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
SOCIAL DEVELOPMENT
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SITTING UP
Age 2 months
Age 6 months
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AMBULATION
13 month old
Nine to 12-months
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SPEECH MILESTONES

1-2 months – coos

2-6 months- laughs and squeals


8-9 months – babbles, mamma and dada as
sounds
10-12 months – mamma/dada specific
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EMOTIONAL DEVELOPMENT
 Consistency
must be established to develop
trust, which is vital to the development of a
healthy personality.
 Pick
up when crying
 When
infant shows readiness to learn a task,
parents should provide encouragement
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EMOTIONAL DEVELOPMENT


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
Emotions are instable- changes from crying to
laughter.
His affection for love from his family is apparent.
10 months – begins to express anger, sadness,
pleasure, jealousy, and affection.
12 months- above emotions are distinguishable.
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NEED FOR CONSTANT CARE AND GUIDANCE




A crying baby needs to be soothed
Each time the parents attend to the baby needs,
will help the baby at later months to develop
trust when not met immediately.
You will never spoil a child by holding them too
much
The newborn expresses his emotion through cry,
for hunger, pain or discomfort.
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DEVELOPMENT AND CARE

Important to note that no two infants are the same

Physical patterns cannot be separated from social
patterns

Abrupt changes do not take place with each new
month of life
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COPING WITH AN IRRITABLE OR
LETHARGIC INFANT



Whether irritable or
lethargic, many of the
same interventions can
be used
An irritable baby cries
and may be difficult to
soothe
A lethargic baby may
“shut down” and sleep in
order to avoid an
excessively stimulating
(loud or noisy)
environment



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
Shield infant’s eyes from
bright light
Sit quietly with infant;
don’t talk or sing
Eliminate as much noise
as possible
Talk in a soft voice
Swaddle snugly
Change infant’s position
slowly
Provide nonnutritive
sucking
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COLIC

Periods of unexplained
irritability and crying in an
otherwise healthy and
well-fed infant
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Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
DEVELOPING POSITIVE SLEEP PATTERNS

Newborns sleep in 4-hour intervals

By 4 to 6 months, can be up to 8 hours
Position infants on their backs on a firm mattress
 Infants rely on parent to soothe them back to sleep if
awakened during the night


Assist infant to learn self-soothing behaviors – placing pacifier
in crib
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Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
IMMUNIZATIONS

Stress repeatedly importance of immunizations and
timing of administration

Delays can lead to increased risk of serious illness
or even death
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ILLNESS PREVENTION: PHYSICAL
EXAMINATION

Physical examination in the clinic setting at least
five times in the first year
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
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
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Hearing and vision
Screening tests administered as required
Growth grids and developmental screening
Immunizations
Nutritional counseling
Provide appropriate education and/or explanations to
the parents
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BREASTFEEDING AND BOTTLE FEEDING

Human milk is best for infants younger than 6
months

Formulas that are cow’s milk based and ironfortified are recommended by the AAP

Whole cow’s milk not given until after 1 year of age
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SAFE BOTTLE FEEDING
Check expiration date on container
 Follow instructions on how to mix, store, and give
formula to infant
 Always use clean containers to mix/store formula
 Do not heat bottle in microwave
 Do not save formula that is left from a feeding; can
lead to diarrhea

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ABSOLUTE CONTRAINDICATIONS TO
BREASTFEEDING
Galactosemia
 Phenylketonuria
 HIV-positive mother
 Chemotherapy
 Radioactive isotope therapy
 Illicit drug use
 Active untreated tuberculosis

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NUTRITION COUNSELING

Solid food can slowly be added beginning around 6
months of age
The tongue extrusion reflex has completely disappeared
 GI tract is mature enough to digest food


Between 4 and 6 months, sucking is more mature,
and munching or an up-and-down
chewing/chomping motion ensues
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ADDING SOLID FOODS

Do not introduce new food if infant is ill, as adverse
effects such as allergic reactions may not be
appropriately identified

Rice cereal is recommended as first food

Do not mix cereal or baby food with formula

Introduce one food at a time in small amounts
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NURSING TIP
Do not introduce new food if infant is ill, as
adverse effects such as allergic reaction may not
be appropriately identified
 Introduce one food at a time in small amounts
and continue for several days before introducing
new food
 Delay introduction of foods known to cause
allergic responses, such as orange juice, fish,
nuts, strawberries, chocolate and egg whites
 Do not start with mixed veggies
 Do not feed from jar

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NURSING TIP

New solid foods should be introduced before the
milk feeding to encourage the infant to try the new
experience

As solid food intake increases, the amount of
formula or milk should decrease to avoid
overfeeding
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RECOMMENDED FAT INTAKE DURING INFANCY
Infants require almost three times more calories
per kilogram of weight than adults
 By age 6 months, the digestive tract has the ability
to digest fats present in food
 A well-balanced diet provides appropriate fat and
cholesterol intake
 A low-fat diet should not be given to infants under
2 years of age
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WEANING

Signs of readiness include
Infant eagerly looks forward to new tastes and textures
found on the spoon
 May not want to be held close during feedings
 May start to “bite” the nipple as teeth erupt
 Imitates parents/siblings


Should be gradual, start with daytime then progress
to nighttime
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ORGANIC AND NATURAL FOODS

Do not contain any additives
Strict guidelines/regulations on soil, fertilizers,
herbicides/pesticides
 If animal, no drugs or hormones are used prior to
processing


Nutritive value has not been shown by evidencebased research to be superior to nonorganic foods

Stress importance of reading food labels
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INFANT SAFETY

Car safety


Fall prevention



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
Rear-facing for infants younger than 1 year or 22 lb
Never leave an infant unattended on a flat surface
Crib rails should be raised and securely locked
Protect from stairways and pools
Keep car seat on floor.
Toy safety



Should be appropriate for stage of development
No small or removable parts that can be easily swallowed
A child’s response to a toy may indicate readiness to learn
new skills
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SUMMARY OF MAJOR DEVELOPMENTAL
CHANGES IN THE FIRST YEAR




Weight doubles by 6
months of age and
triples by 1 year of age
Head and chest
circumference are
equal by 1 year of age
Maternal iron stores
decrease by age 6
months
Depth perception
begins to develop at
age 9 months




Infants older than 4
months can voluntarily
roll over
By age 1 year, infants
can take some
independent steps
Primitive reflexes are
replaced by voluntary
movements
Tooth eruption begins
at age 6 months, when
“biting” activities begin
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• Birth to One year
– Mobiles
– Safety mirrors
– Rattles
– Stacking toys
– Simple pop ups picture books
– Musical toys
– Squeeze toys
– Infant swing
– Teething toys
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RED FLAG IN INFANT
DEVELOPMENT


Unable to sit alone by 9 months.
Unable to transfer objects from hand to hand by
1 year.

Abnormal pincer grip or grasp by age 15 months.

Unable to walk alone by 18 months
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Failure to speak recognizable words by 2 years.
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