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What factors influence growth and development? What is the most important factor?
- Nutrition: most important factor
- Health Status
- Parent Attitudes
- Client Rearing Philosophies
What age encompasses infancy?
1mo - 1yr
Describe how an infants weight, height, head circumference, and fontanels change within the first year
- Posterior fontanel closes by 6-8 wks, anterior fontanel closes by 12-18 mo
- Weight should be doubled by 6 mo, triples by 1 yr with a weight gain of 5-7 oz per ounce
- Height increase by 50% by 1 yr
- Infants head circumference increases 0.6 in per month for first 6 mo, then 0.5 until 1 yr
Physically, what should an infant accomplish by the time it is 12 mo old?
- Head and chest circ equal by 1 yr
- 6-8 teeth
- Post fontanel closed and ant font closing
- Babinski reflex may last up to 2 yrs
At what age does teething begin? What supportive measures can be used during this time?
- 6-8 teeth by 1 yr with first teeth at 6-10 mo
- Use cold teething rings
- Rinse with cold wash cloth
- Acetaminophen or Ibuprofen (>6 mo old) should not be used for more than 3 days
- Do not prop bottles
How does the neurological system adapt during the first year?
- Brain grows rapidly, 2.5x weight by 12 mo
- Primitive reflexes diminish by 4 mo (moro, tonic neck, rooting, grasps)
How does the Respiratory system adapt during the first year?
- Size of resp tract increases
- Vulnerable to respiratory difficulties
- Elastic trachea
- Eustachian tubes are short and horizontal, putting infants at risk for otitis media
How does the cardiovascular system adapt within the first year?
- Shunt close
- Heart doubles in size and weight by 1 yr
- Heart rate slows and BP rises
How does the immune system adapt within the first year?
- Passive immunity for 3-4 mo
- Begins production of immunoglobulins
- Has approx 4% of adult levels by 1 yr
- Max protection not avail until early childhood
- Due to short RBC lifespan, physiologic anemia occurs at 2-3 mo of age
How do the gastrointestinal system and the liver adapt within the first year?
- Stomach capacity increases to 200 ml by 12 mo
- Enzymes for digestion increase (Vit K shot at birth prevents hemorrhage due to lack of clotting enzymes in gut)
- Fat digestion by 4-5 mo
- Complex carbs at 4-6 mo
- The Liver is the most immature of all systems
- Liver has a decreased capacity for gluconeogenesis, formation of plasma proteins and ketones, and storage of vitamins
Why are body fluids important for the infant (include renal function)?
- Infants have increased extracellular fluids (40% of body) which predisposes them to rapid dehydration
- Renal system has low glomerular filtration rate, putting the infant at risk for f/e imbalances
- Should have 6-10 wet diapers a day
What is the formula to calculate fluid resuscitation for the infant?
- 100 ml/kg/hr up to 10 kg
- For each kg over 10, add 50 ml/kg up to 20 kg
What are some motor milestones of the infant by month?
- 1 mo: demonstrates head lag and has grasp reflex
- 2 mo: lifts head off mattress when prone, holds hands in open position
- 3 mo:Lifts head, hands open position, hold rattle by will not reach
- 4 mo: rolls from back to side, places objects in mouth, plays by putting blanket over face
- 5 mo: Rolls from stomach to back voluntary palmar grasp
- 6 mo: rolls from back to belly, holds bottle
- 7 mo: bears full weight on feet, sits leaning forward on hands, transfers objects from one hand to the other
- 8 mo: sits unsupported, begins crude pincer grasp
- 9 mo: pulls self into standing position, creeps on hands and knees, has crude pincer grasp
- 10 mo: pincer grasp, moves from prone to sitting
- 11 mo: walks holding onto something, placed objects in container, neat pincer grasp
- 12 mo: sits from standing position, tries to build 2 block tower w/o success
What Piaget stage is the infant in?
- Sensorimotor stage (birth to 24 mo) progresses from reflexes to simple repetitive to imitative activities
- Ability to differentiate self from others (separation)
- Develops object permanence by 9mo
- Mental representation of symbols
What are some cognitive milestones for the infant?
- 2 mo: social smile in response to stimuli
- 6 mo: object permanence beginning
- 7 mo: increased stranger anxiety (plays peek a boo)
- 10 mo: object permanence is developed
- 12 mo: searches for object even if it has not been hidden, but only searches where object was last seen; recognize they are distinct from parents
How does the sensory system adapt during the first year?
- Eye growth is rapid and acuity improves
- Preference for high contrast colors, such as black and white
- Uncoordinated eye movements after 4-6 mo needs eval (binocularity by 4mo)
- Hearing is relatively acute, even at birth
- With myelinization, hearing response becomes more specialized
What are some sensory milestones for the infant?
- 1 mo: able to fixate on moving objects
- 3 mo: follows objects to 180 degrees (located sound by turning head and looking in same directions)
- 7 mo: can fixate eyes on very small objects
How does language develop for the infant?
- Can understand more than they can express
- By age 1, can comprehend "no" and say 3-5 words
- Siblings can enhance development
What are some language milestones for the infant?
- 2mo: vocalizes; coos
- 3 mo: squeals to show pleasure
- 4 mo: laughs out loud
- 6 mo: imitates sounds; babbles one syllable
- 7 mo: babbles 2 syllable sounds
- 10: says mama, dada with meaning
- 12 mo: says 3-5 words besides mama or dada
Describe what Freudian stage and stag of Erikson the infant is in
- Erickson: Trust vs Mistrust
- Freud: Oral Stage
- Parent-infant attachments begin in utero (reactive attachment disorder is most commonly diagnosed by age 5)
What play activities appeal to the infant?
- Involves sensorimotor skills and is a major socializing agent
- bright colored toys
- nesting cups
- *Solitary play
Describe separation anxiety and stranger anxiety
- Separation anxiety: begins4-8 mo, by 12 mo they can anticipate parent leaving and will protest
- Stranger anxiety: increases around 7 mo (lack of stranger anxiety may indicate FTT)
What are the different infant temperaments?
- Difficult child: respond best to structured routine
- High Distractable child: responds to soothing measures
- High Activity Child: provide opportunities for increased gross motor activities
- Slow to warm up child: needs additional time to adjust to new situations
- Easy Child: sometimes easy to forget their needs
- *child rearing practices related to temperment
What is an infant's sleep pattern like?
- sleep/wake styles are established by 3-4 mo and need to learn self regulation behaviors
- Encourage bed time rituals early and place awake infant in their own crib
- Infants who learn to fall asleep on their own have longer periods of sleep than those whose parents put them to sleep
What is the concept of graduated extinction?
- Used to develop independent sleeping pattern
- When babies cry in crib, wait and then comfort them and then leave. This process will need to be repeated in order to promote independent sleeping habits
Describe the necessary nutrition for a newborn
- Breast milk provides complete nutrition for the first 6mo
- Formula should be iron fortified if being formula fed, iron supplements can be given to all after 6 mo
- Solid foods can be introduced starting at 4-6 mo and should be introduced 5-7 days apart to assess for allergies
- Cow's milk, eggs, wheat, peanuts/butter, citrus & honey should not be given until 1 yr
What are common safety concerns for the infant?
- Aspiration of foreign objects
- *Constant supervision, vigilance, and awareness are essential to prevent injuries & death
What vaccines are given during the first year of life (vaccine schedule)?
- Birth: HepB
- 2 mo: Hep B, Rotavirus, DTap, HiB, pneumococcal, Inactivated polio virus
- 4 mo: Rotavirus, DTap, HiB, pneumococcal, Inactivated polio virus
- 6 mo: Hep B, Rotavirus, DTap, HiB, pneumococcal, Inactivated polio virus and Flu vaccine (dead)
- 12 mo:pneumococcal, HiB,
Who creates the vaccine recommendations?
- Advisory Committee on Immunization Practices (ACIP)
- Center for Disease Control & Prevention (CDC)
- Committee on Infectious diseases of the American Academy of Pediatrics (AAP)
What is VAERS and what is VIS?
- VAERS is the vaccine adverse event reporting system where any adverse effects can be reported
- VIS is a vaccine information statement that every parent needs to be given so that they can give informed consent