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Nursing School

The Infant
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from class notes

The Infant


- 4 wks to 1 year – this is the time of the first major growth spurt (the 2nd is during puberty)

- these kids are susceptible to permanent effects of events (“If mom smacked him around when he’s a baby, it’ll really jack him up later in life”)

- there are basic needs to be met & certain tasks to accomplish & how these needs are met by others (mainly the mother figure) will determine how well the infant completes or achieves the tasks


- Erikson: 8 stages w/positive & negative aspects

            - “Trust vs Mistrust” 1st social achievement in acquiring trust & it lays a foundation for subsequent phases

                        - trust is built when mom meets needs; mistrust when needs are not met:

                                    - physiological needs: food, cleanliness, warmth, touch, stimulation

                                    - emotional needs: bonding, nurturing, love

                                    - physical needs: gross motor skills, exercises

                        1. Oral Phase – food intake is predominate, they eat almost constantly, will tolerate very                                    little frustration or delay in gratification

                                    - early gratification: meeting the need before it’s expressed

                                    - delayed gratification: failure to meet an expressed need

                                    - parents must find a balance between the two

                        - behavior during this phase is very egocentric

                        2. Grasping – reaching out to others & mom’s response to it – tactile stimulation is key in                                   trust – touch is key

                        3. Biting – biting controls pain during teething, brings about a sense of control


- Piaget­: 5 stages of Cognitive Development

            - The infant is in the Sensorimotor Phase: there are 6 stages ranging from birth – 2 years

                        1. Use of Reflexes – birth – 1 month (newborn period) – individuality & temperament are                                  expressed through reflexes such as sucking & rooting

                        2. Primary Circular Reactions – 1-4 months – more aware of objects, follow objects w/eyes                              & when distracted can later relocate object – environment is taken in by all senses

                        3. Secondary Circular Reactions – 4-8 months – behavior becomes more oriented to objects                            & events beyond his own body – ready to engage in play, vision & tactile senses are                              coordinated – beginning to develop object permanence & object is remembered even                                   though it’s beyond the range of perception – imitate sounds & gestures – engage in                            solitary play – develop separation anxiety around 6 months: closely related to                                              development of object permanence

                        4. Coordination of Secondary Scheme & it’s Application to New Situations – 9-12 months –                            they use previous behavioral achievements as the foundation for adding new                                           intellectual skills – increase in motor skills – start to crawl – realize object                                                   permanence & realize that removing the obstacle an item is behind will reveal the                                        object – begin to anticipate events


- Physical Development

- weight: doubles in 6 months, triples by 1 year; they gain 5-7 ozs/week, growing very rapidly, especially during the 1st 6 months

- height: increases 1 inch/month for 1st 6 months; by 1yr birth length increases by 50%

- Respiratory system: resps are still abdominal, usually about 30/minute

- Circulatory system: HR slows to 100/min w/irregular rhythm; the iron stores that were present in the first 5-6 months gradually decrease

- GI System: the majority of digestive processes are immature at birth & don’t begin to function until about 3 months; around 3 months they begin drooling d/t increased saliva production and a lack of cooridinated swallowing ability; peristalsis decreases throughout infancy so they have less bowel movements & are better able to utilize the food they eat; the stomach begins to enlarge to accommodate a larger quantity of food

- Renal system: structures remain immature until latter of 2nd year & urine is voided frequently & has a low specific gravity.


- Spiritual Development – Fowler’s 7 Stages

            - Infants are in 0 stage: Undifferentiated, no right/wrong, no beliefs, no convictions

            - beginnings of a faith relationship are established w/developments of a basic trust (usually through mother as she meets the needs of the child)


- Motor Development

- Gross – large muscles, each child grows differently – an older sibling may encourage motor skills at the expense of verbal skills

            -1st control is head control (d/t patterns of fetal circulation & head development/nourishment)

            - 16 wks can lift head/chest about 90 degrees above a surface & bear weight on forearms

            - 24 wks can raise chest & upper body off a surface

            - 28 wks bear weight on one hand while exploring w/other hand & reaching for an item

            - 16 wks ability to roll from back to side – some earlier

            - 20 wks rolls abdomen to back

            - 24 wks roll back to abdomen

            - Sit @ 7-8 months w/o support & w/spine straight

            - Crawl @ 9 months (some babies go right from sitting to walking but crawling is important in the development of muscles….possible psych disorder connection?)

            - Locomotion – 36 wks pull to standing position

            - 1 yr walk w/1 hand held

            - 15 months walk w/o help

- Fine – small muscles

            - 4 wks hand in fisted position, needs to be opened to clean…

            - 16 wks hands open & reach for object but miss d/t vision/tactile coordination just beginning

            - 28 wks palmar grasp – pick up object w/whole hand

            - 28 wks transfer objects from hand to hand

            - 40 wks pincer grasp, thumb & forefinger grip, ready for finger foods


- Language

            - begins before child can speak in words… CRYING!

            - 4 months coo & babble

            - 1 yr 2-3 words (mom, dad, bye)

            - receptive language develops earlier than expressive language (they understand much much more than they can articulate)


- Social – not very social, don’t initiate interactions


- Attachment – separation anxiety @ 6 months & again @ 15 months, develop stranger anxiety/fear at about 9 months


-Play – engage in solitary play; play helps w/ intellectual skills, motor skills, social skills, bonding, imagination growth…


- Nutritional Needs – 1st 6 months often breast & bottle feeding

            - Weaning – bottle feeding 1 yr, breast feeding no set time limit but nutritional value of breast milk ends when child is eating solid foods

- Only put WATER in a baby’s bottle at bedtime (other drinks can rot teeth & pool in Eustachian tubes)

            - 2-3 months tsp of rice cereal (less allergies & easy digestion), may add juice to diet (usually apple juice diluted, no citrus juices)


            - 2nd 6 months solid foods are introduced, GI system is more mature, head control is more developed, start to get teeth, swallow more effectively, extrustion reflex is gone (tongue doesn’t push food right back out… babies often spit foods out d/t the new sensation of solids)

            - 1 yr need 1000 k/day

            - at 6 months introduce fruits

            - only introduce 1 new food at a time, 1 every 4-7 days in case of allergic reactions

            - NO HONEY TO INFANTS d/t botulism toxin

            - yellow veggies are introduced before green – easier to digest

            - then introduce meats

            - educate parents about making their own “baby food”


- Sleep/Rest

            - 12/22 hours a day, varies greatly among children

            - 20/30% REM

            - about 4 months may start to sleep through the night

            - 1-2 naps/day


-Health Maintenance

- Immunizations – mandated by state law, still need parental consent

            - 1st is Hep B, 3 doses: 0-2 days, 1-2 months, 6-18 months

            - Diptheria – 6 doses, then tetnus booster q 10 yrs

            - H Flu – 4 doses

            - MMR – 2 doses

            - Chicken Pox – 1 dose

            - Meningococcal – preferred dose at 11-12, or at 18 if not before

            - Pneumococcal – 5 doses

            - Flu – yearly after 6 months of age unless immunosuppressed (HIV, cancer…)

            - Hep A – 2 doses, 1 yr & 18 months, relatively new mandate


- Well-Baby Doctor Visits – to assess baby’s reaching of milestones, physical/neuro assessment, hearing screening, at 6 months check Hgb, do health teaching to mom/dad


-Safety Concerns – child proof the home, make sure toys are safe, be careful around steps, pooling water, water temperature, electrical outlets, blinds at windows, pets, ALWAYS know where the child is & monitor his behavior

            - Motor Vehicle safety – child must be in carseat until 1 yr or 20 pounds in the back seat, in the middle, facing the rear. At 1 year/20 pounds, child can face forward.


- Common Health Concerns­

            - Paroxysmal Abdominal Pain – colic, gas pains, usually start around 1 month, last until about 4 months, baby screams, usually same time every day, give myelecon, use air reducing bottles, rock baby on abdomen, pretty common during 1st 3 months

            - Seborrheic Dermatitis – cradle cap, chronic, recurs, no itching, tx w/frequent shampoo & fine tooth comb, or mineral oil w/fine comb then shampoo

            - Failure To Thrive -

            - SIDS -

NOTHING on this website is to take the place of a physician's advice. Everything in this site is meant to be only a helpful tool for me and my nursing student friends.

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