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INFANCY

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The First Year of Life

• Time of rapid growth and development.• Growth in the first year is extremely rapid.• It occurs in spurts, called saltatory growth.

Patterns of Physical Development

• Head to toe– Lift head to see object – Muscle control: pick up – Walk towards

• Near to far: trunk outward– Wave arms– Grab with palm of hand – Pick up with thumb and fingers

• Simple to complex– Eating with fingers – Spoon and fork

Weight

• Lose some after birth2.7 – 4.0 kg• 20-30 g/day/month 1st 6 months• 15g/day/month in 2nd 6 months

– Birth weight:• Doubled by 6 month• Tripled by 1 yr

– Heredity, feeding habits, and physical activity

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Weight Gain (per month)

AGE WEIGHT GAIN 0-3 months: 900 g 3-6 months: 600 g 6-9 months: 450 g 9-12 months: 360 g 1-3 years: 240 g/month(2.8 kg/yr) 4-6 years: 180 g/month (2 kg/yr)

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Infant Weight

• At birth: 2.7 – 4.0 kg– At 5 months: 2X birth weight.– At 12 months: 3 X birth weight.– At 2 years: 4 X birth weight.– At 3 years: 5 X birth weight.– At 5 years: 6 X birth weight.– At 7 years: 7 X birth weight.– At 8 years: 8 X birth weight.– At 9 years: 9 X birth weight.– At 10 years: 10 X birth weight.

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Weight Gain (per day)

AGE WEIGHT GAIN 0-3 months: 30 g/day 3-6 months: 20 g/day 6-9 months: 15 g/day 9-12 months: 12 g/day 1-3 years: 8 g/day (2.8kg/yr) 3-6 years: 6 g/day (2 kg/yr)

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Formula For Weight

• During InfancyWT (Kg) = [ Age (months) +9] /2.

• During 2-6 YearsWT (Kg) = Age (yrs) X 2+ 8.

• During 7-12 YearsWT (Kg) = [Age (yrs) X 7-5] /2.

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Length/ Height

• Supine length is measured for children of less than two years of age.

• After two years of age, standing height is taken as a measure of stature.

Height

• Avg newborn =20 inches 48 – 53 cm• Avg 1 year =30 inches 75 cm• Heredity: influences height more than

weight

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Length

• At Birth:– At birth: 48 – 53 cm– At one year = 75 cm.– At two years = 87.5 cm.– At four years = 100 cm.

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Length Gain

AGE GAIN 0-3 months: 3.5 cm/ month 3-6 months: 2 cm / month 6-9 months: 1.5 cm/ month 9-12 months: 1.2 cm/ month 1-3 years: 1 cm/month(12 cm/yr) 3-6 years: 0.25 cm/month (3 cm/yr)

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Gain In Length

• 1st year = 25 cm• 2nd year = 12 cm• 3rd year = 10 cm• 4th year = 3 cm• At puberty:

– Girls = 6-11 cm– Boys= 7-12 cm

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Formula for Calculating Height

From 1- 6 Years

Height (cm) = Age (Yrs) X 6 + 77

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Head Circumference

• At birth: 35.3 ± 1.2 cm.• Increases by 6 cm during the

first 3 months.• Further increases by another

6 cm during 3- 12 months.

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Gain in head circumference

• During 1st year = 12 cm.• During 2nd year = 2 cm.• During 3rd year = 1.5 cm.• From 3 to 14 years = 2.5 cm

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Changes in head circumference

AGE GAIN 0-3 months: 2 cm/ month 3-6 months: 1 cm / month 6-12 months: 0.5 cm/ month 1-3 years: 0.25 cm/month 3-6 years: 1 cm/year

Proportion

• Large: head and abdomen• Short/small: arms and legs• Head grows rapidly b/c brain development• Soft spots allow head to grow and close

Soft Spots

1st Year Physical Developments

Sight: Improves Rapidly

• Blurry at first, within week can focus on object 7-10 inches away 15-30 cm away

• 1 month, focus on objects 3 feet away By 3 ½ months, vision almost as good as an adult• Prefer patterns with high contrast and faces

– alternating stripes, bull’s eyes– Prefer color red

Depth Perception

2nd month: recognize that object is three-dimensional, not flat

Binocularity: fixation of two ocular images into one cerebral picture begins to develop by 6 weeks and established by 4 months

Hand-Eye Coordination

• Develop hand-eye coordination: – Move hands and fingers in relation to what is

seen• 3-4 months: reach for what they see

– Essential for:• Eating • Catching a ball • Coloring • Tying shoes

Hearing

• develops before birth• At birth, can tell general direction sound is

coming from• Prefer human voice

– soothing voice calms– loud voice alarms

Smell and Taste

• Within 10 days can tell mom’s smell• Can distinguish taste by 2 weeks old

– show preference for sweet taste• Learn about world by using mouth

Voice

• Cry becomes softer as lungs mature• Physical growth of throat muscles, tongue,

lips, teeth, and vocal cords• Tongue and mouth interior change making

speech development possible

Teeth

• Begin to develop in 6th week of pregnancy– Primary teeth begin to appear between 6-7 months of age– Complete set by 20 months (1 year, 8 months)

• Teething can be painful process– Can refuse food or drool a lot, increased desire for liquid,

coughing, and fever• how to help minor teething pain:

– teething biscuits or rubber teething rings– rub ice cube on gums to ease pain temporarily– teething medication

Motor Skills

• Abilities that depend on use and control of muscles

• Mastering motor skills requires intellectual, social, emotional, and physical development– Control head by 1 month– 2-3 months can lift their chest– By 9 months crawling- adds opportunity for

learning

The Developing Brain

Rules to Build a Brain By

• Keep it simple and natural– Rich environment- lots of loving interaction and

talking• Match experiences to the child’s mental

capacities– Learn by physical experiences

• Practice makes perfect– Repetition

Rules to Build a Brain By continued

• Make sure the child is actively involved– Learn by doing

• Provide variety, but avoid overloading– Give range of experiences, avoid being

overwhelmed• Avoid pushing the child

– Learn better if emotionally involved

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Language Acquisition

Cooing: Repetition of vowel sounds

by infants Babbling: Repetition of

meaningless language sounds

(e.g., babababa) Single-Word Stage: The child says

one word at a time Telegraphic Speech: Two word

sentences that communicate a

single idea (e.g., Want yogurt)

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Language development

12 weeks cooing, smiles when talked to

16 weeks turns head in response to human voice

20 weeks makes vowels and consonant sounds

6 months babbling (all sounds)8 months repeat certain syllables

(ma-ma)12 months understands and says

some words

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Psychosocial development

• Erik Erikson: First Psychosocial Stage: Trust vs. Mistrust

• Consistent loving care by a mothering person is essential to build a trust relationship.

• Mistrust develops when basic needs are inconsistently met.

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Piaget’s Cognitive Stages

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Sensorimotor Stage (0-2)

• Stage One (birth-1 mo.)• Use of reflexes

• Stage Two (1 - 4 mos.)• Primary circular reactions: Actions that are at first random and

activate a reflex are attempted again to try and induce the experience again (recognition of causality). The interesting events are occurring within the body (plays with hands, fingers, feet).

• Stage Three (4 - 8 mos.)• Secondary circular reactions: The interesting events in this case

are located in the external world (Making Interesting Sights Last)• Beginning of object permanence: shows separation anxiety • Able to imitate selective activity

37Infants’ imitation of facial expressions

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Sensorimotor Stage, Cont’d

• Stage Four (8 - 12 mos.)• Coordination of secondary

schemata • New Adaptations and

Anticipation• Intentionality occurs in

interactions with the environment and the infant is moving towards goal directed behavior: works to get toy that is out of reach

• Fully developed object permanence

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Moral development (Kohlberg)

• Level 1: Preconventional morality (0-9y)• Stage 1: the punishment-and-obedience orientation.

– Children determine the goodness or badness of an action in terms of its consequences.

– They avoid punishment and obey unquestioningly those who have the power to determine and enforce the rules

– They have no concept of the underlying moral order

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Play

• Solitary Play: When a

child plays alone even

when with other

children

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Principles of Motor Development

• Gross movements before fine movements• Pattern of development is usually the same,

but the rate differs greatly from child to child and from culture to culture.

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2-3 months

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• First Month– Turns head to clear nose from bed– Keeps hands fisted or slightly open– Head lag when pulled from lying to sitting

• Second month– Holds head up while on tummy almost 45 degrees

• Third month– Lift head and chest of the bed– Turns head to sounds– Reaches for objects with both hands

Gross Motor Development

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• Fourth month– Rolls from back to side– Able to raise head and chest off surface to angle

of 90 degrees

• Fifth month– Rolls from abdomen to back– May sit if supported– When supine, puts feet to mouth

• Sixth month– Transfer toy from one hand to next– army crawl on tummy– Rolls from back to abdomen

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• Seventh month– Pushes up on hands and knees– Sits w/ little support– When held in standing position

bounces actively• Eighth month

– Sit without support– Creeps– Stands leaning against something

• Ninth month– May crawl upstairs

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• Tenth month– Stands w/ little support– Cruises the room.

• Eleventh month– Stands alone

• Twelfth month– Walks

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• At 4 month: brings hands together and shake rattle.

• At 6 month: palmer grasp.• At 7 month: pass object from hand to another.• At 8 month: advanced eye-hand coordination.• At 10 month: pincer grasp.• at 12 month: holds cup or spoon

Fine Motor Behavior

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Hematologic System

Hgb A production

largely replaces Hgb F

by 4 months

(physiologic anemia

due to fetal RBCs

destruction)

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Respiratory System

• RR slows.• Upper respiratory infections tend to be more

severe due to small lumen of respiratory tract and inefficient mucus production.

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• Become functioning at 2 months.

• Produce both IgG & IgM antibodies by the first year.

Immune System

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Emotional

• At 6 weeks: social smile.• At 4 months: recognize his primary

caregiver.• At 7-8 months: stranger anxiety,

continue until 12 months.• At 8 months: separation anxiety,

continue until preschool period.• Both are related to infant’s ability to

discriminate between familiar and nonfamiliar people

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Dentation

• First tooth erupt 5-7 months• Has 6-8 deciduous teeth by the first year of

age.• The sequence of eruption is:

– At 6 months: lower central incisors.– At 7 months: lower lateral incisors.– At 8 months: upper central incisors.– At 9 months: upper lateral incisors.

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GI System

• Can digest protein at birth.• Amylase deficiency until 3rd month of age

( cannot digest complex CHO)• Lipase deficiency during entire 1st year.• Infant needs frequent feedings.• Extrusion reflex exists until 3-4 months.• Introduction of solid food 4-6 months.

Handling and Feeding Infants

Gentle Handling of an Infant

• Never shake a baby• Shaken baby syndrome- when someone severely

shakes the baby usually to make them stop crying– Damages the brain– Learning problems– Mental retardation– Blindness– Deafness– death

Gentle Handling of an Infant continued

• Safe ways to handle a stressful situation with crying:– Put baby down in a safe place and calm down– Ask a friend or relative to care for the baby– Take deep breaths– Talk out your problems

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Energy Requirement

Age Energy requirement< 6 months Wt (kg) x 108/ day6mo-1 year Wt (kg) x 98/ day

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Water requirements = amt in foods + fluids

Age Amount• 3 days 80-100 ml/kg/day• 10 days 125-150 ml/kg/day• 3 mo 140-160 ml/kg/day• 6 mo 130/155 ml/kg/day• 9 mo 125-145 ml/kg/day• With BF and formula: none additionally needed in

first 4 to 6 months

Feeding Methods

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Infant Nutrition

Birth through 4-6 months

Breast milk

OR

Iron-Fortified infant formula

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Breast- Versus Bottle-Feeding

• Debate focused on whether breast-feeding is better for the infant than bottle-feeding

• American Pediatric Association strongly endorses breast-feeding throughout the first year of life

• Benefits– Appropriate weight gain– Fewer allergies– Fewer illnesses– Reduced childhood cancer and reduced incidence of breast cancer in

mothers and their female offspring– Lower incidence of SIDS– Stronger attachment bond

Breastfeeding Basicshttp://video.about.com/breastfeeding/Breastfeeding.htm

Why Breastfeed?

• Healthy• Free• Bonding• Natural• Builds immune system• Mom burns more calories and loses weight

quicker

How long should you breastfeed?

• Recommend 1st 6 months• First milk- colostrum

– High in fat, protein, antibodies

• 20 minutes on each breast• Feed on demand• 5-6 wet diapers• 3-4 dirty diapers• http://video.about.com/breastfeeding/Breast-Feedin

g-Positions.htm

Nutrition

• Avoid gassy foods:– Broccoli, green leafy vegetables, spicy foods

• Mom’s diet becomes baby’s diet

Video Clips and Pictures

• http://www.ameda.com/breastpumping/videos/popup_video.aspx?id=LatchOnEnglish

• http://www.breastfeeding.com/helpme/helpme_video_4_bf_positions.html

• http://www.breastfeeding.com/helpme/helpme_videos/18_how_baby_sounds_bfing.html

• http://similac.com/feeding-nutrition/diaper-decoder

How to Feed with a Bottle

• Hold baby is semi-upright position• Support neck and head with the head held

above the stomach• Hold the bottle at an angle

– Prevents swallowing air• Never prop a bottle

– Choking hazard, tooth decay, digestive problems

Burping a Baby

• Burping helps expel air the baby swallowed• You should burp a baby once during feeding

and once after

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4 through 7 months

Breast milk

OR

Iron-Fortified infant formula

Iron-Fortified infant cereal

Vegetables

Fruit

Infant Nutrition

Types of Formula

• Powder, concentrate, ready to feed (RTF)

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8 through 11 months

Same as 4 through 7 months

PLUS

Meat

Egg yolks

Infant Nutrition

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11 months

Finger foods

Cup

Infant Nutrition

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Tips for Introduction of Solid Foods

Start slowly

Only 1 new food every 4-5 days

Hold baby during feeding

First food: Iron-Fortified infant rice cereal

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Tips for Introduction of Solid Foods

Use single-ingredient foods

Read food labels

Avoid desserts

Avoid foods that can choke infants

Introducing New Foods

• Introduce solids around 4-6 months• Cereal first

– Mix with breast milk or formula to make it runny– Feed with a spoon, never in a bottle

• Vegetables, then fruits– 1 new food at a time for at least 3 days– Feed with a spoon, never in a bottle

• Never feed straight from the jar• 8-10 months, start using fingers; eventually move to

spoons

What Infants Need to Stay Healthy

• Enough calories to provide rapid growth• Protein, iron, vitamins B, C, and D• Food that is easy to digest• Adequate amounts of liquid

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Feeding Problems

• Colic (<3months): gas production, and bloating– Cause? Not always known: formula fed! (high in carbohydrate) – Overfeeding : swallowing too much air.– Breastfeeding?

• Foods in the mother’s diet• Cow’s milk, or other items

• Spitting up– Normal occurrence: after meals, mouthful of milk.– Unless projectile vomiting: Organic problem: pyloric sphincter

closure

Sleep

• Newborns sleep 12-20 hours a day– By 1 year has 2-3 sleep periods including naps

• Preparation for sleep:– Change diaper and clothes, wash face/hands– Rock to calm the baby– Put the baby in the bed on it’s back– Follow the same routine to provide comfort each

time

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Common Health Concerns

• Teething: gum sore, tender can lead to decreased intake and cry.

• Thumb sucking: does not deform the jaw as long as it stops by school-age.

• Diaper dermatitis: prolong contact with urine or feces.• Constipation: increased with formula fed.• Sleep problems: as a result of colic or other health

problems.