Growth and development of the infant

Learning Guide - 3

Text Book
Kozier & Erbs Fundamentals of Nursing
concepts, process and practice. 8 th
edition.
Chapter 21
Pages: 369 373.

Biologic growth
Weight: By 5 months infants weight is double of
birth weight. By 1 year weight is 3 times that of
birth weight.
Height: At 6 months 65.5 cm and at 1 year 74.5 cm.
Head and chest circumference: Chest
circumference equals head circumference by 9-10
months and chest circumference is larger after 1
year.
The growth of the infant can be monitored by using
growth charts.

Growth Charts

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Closure of fontanel:
Posterior fontanel closes by 4-8 weeks.
Dentition:
Mandibular central incisors
Maxillary central incisors
Lateral mandibular incisors
Lateral maxillary incisors

5-7 months
6-8 months
7-10 months
8-11 months

Vision
4 months

Sensory development

Recognize familiar objects

and follow moving objects.
6 months Perceive color.
9 months Recognize familiar faces
and smiles at them.
12 months Depth perception (can
recognize the edge of the bed).

Sensory development
Hearing
5 months Infant pauses to listen to mothers sound.
9 months Locates source of sounds and recognizes
familiar ones.
1 year
Listens to sounds and responds to simple
commands.

Reflexes: Some of the neonatal reflexes

disappear, as the nervous system gets
mature.
Stepping reflex
Palmar grasp
Rooting reflex
Moro reflex
Tonic neck reflex
Plantar grasp
Babinski

after 2 months
after 3 months
after 4 months
after 4 months
after 4 months
after 8 months
1 year

Motor development
Development of babys ability to move and to control the
body.
1 month Lifts head momentarily when prone,
turns the
head when prone, head lag
when pulled to sitting
position.
2 monthsRaise head from prone position.
4 monthsHolds head erect and steady, may start to crawl.
5 monthsSits with support.

1-5 months

Raise head from prone position

Holds head erect and steady,

may start to crawl.

Sits with support

Motor development 6-12 months

6-8 months

Sits without support.

9 month

Crawls, creeps, pulls self to

stand. Beginning of pincer grasp.
Drinks from cup with some
spilling.

12 months

Start walking, good pincer grasp,

Turns pages in a book.

Motor development 6-12 months

Sits without support

creeps
Start walking

Drinks from cup

pincer grasp

good pincer grasp

Psychosexual development - Freud

According to Freud infants are in the oral stage of
development. Infants reaction to stress is crying and
crying is the infants way of communicating stress.
They reduce tension by sucking and mouthing objects.
Feeding should be pleasurable and provided when
required.
Fixation at this stage may lead to difficulty in trusting
others, nail biting, drug abuse, smoking, over-eating,
alcoholism, argumentativeness and over dependence.

Psychosocial development - Erikson

According to Erikson the developmental task for the infant is
trust vs. mistrust. Infants depend on the parents for all their
physiologic and psychological needs. Fulfillment of these
needs is required for the infant to develop a basic sense of
trust. Consistent care, handling, stroking and cuddling by the
parents is essential for healthy psychosocial development.
Disturbed parent-child relationship can result in failure-tothrive syndrome. Infants show delayed development without
any physical cause. They are often malnourished and fail to
gain weight and to grow normally.

Cognitive development - Piaget

Infants are in the sensory motor phase of cognitive
development. Three important events take place in the
sensory motor phase.
1. Separating infants self from other persons like mother
or objects in the environment.
2. Developing concept of object permanency. Infants
recognize that people or things exist even though they are
not seen.
3. Using symbols to think of a situation or an object that
is not present in the immediate environment.

The sub-stages of this phase are:

Stage 1 (0-1 month): Use of reflexes. Infant
shows repetitive reflex actions such as sucking.
Infants assimilate these experiences and learn to
suck only the breast or bottle. Later a hungry
infant will not accept a substitute for breast or
bottle.

Stage 2 (1-4 months): Primary circular reaction.

Voluntary actions replace the reflexive behaviors.
Infant learns to mentally coordinate the stimuli
associate with the same experiences.
E.g. A hungry infant at first stops crying only when
the nipple is put into its mouth. Later associates
mothers comforting talk before feeding and stops
crying while hearing the mothers voice.

Stage 3 (4-8 months): Secondary circular

reaction.
Infants learn to repeat accidental actions, which are
pleasant to them.
E.g. A rattle makes a noise accidentally. Infant
learns to repeat the same action.

Stage 4 (8-12 months):

Coordination of secondary schemas.
Infant uses an action that is means to an end.
Develops object consistency or permanency. If
mother hides a rattle infant will search and find it.
Develop early understanding of cause and effect.
Imitates sounds and actions of other people in the
environment.

Language development
2 months
5 months
8 months
10 months
1 year

Sounds ah, eh, uh

mimics sounds of others.
Says dada, ma-ma
Can say no or hi
2 or 3 words.

Moral development Kohl berg

Infants are in the level 1 of moral development.
Preconventional morality. They are ego centric in
nature. Do not know rules or cannot judge good or
bad. For them what is pleasant is good and what
is unpleasant is bad.
Social interactions and experiences are important
for the infants development.

Health promotion of infants

1. Nutrition
Newborn and young infants are fed on breast milk or
on a formula. The stomach capacity increases rapidly.
Age

Quantity

No. of feeds/day

Up to 1 month
2-4 months
4-6 months
6-8 months

2-3 oz
3-4 oz
4-5 oz
6-8 oz

6-10
5-6
4-5
3-4

The formula should contain 400IU vitamin D per quart.

Additional vitamin C and Iron supplements are needed.

Weaning: Introduction of solid foods. Weaning should be

started by 5-6 months of age.
Age

Consistency

Food

4-6 m

Pureed strained or
mashed food.

Cereal rice, mashed fruits

6-8 m

Foods that can be

bitten/chewed

biscuits, over dried toast,

cooked vegetables, small
pieces of fruits.

8-10 m Junior foods or mashed Strained meat, fish

or chopped table foods.
12 m

Well cooked table

foods

cheese, eggs

Sequence of introduction
1.
2.

Cereals rice, oatmeal, barley.

Fruits and vegetables mashed
bananas,
apple, pears and peaches.
3. Meat meat soup
4. Fish
5. Eggs and cheese

2. Skin care
Daily bath. Infant should be dried immediately and
wrapped after the bath. Dress the infant appropriate
for the climate. Cover the head with a cap in cold
temperature. Change the dirty diapers without any
delay. Room temperature should be between 2025oC.

3. Play and stimulation

Infants are stimulated by holding, touching, looking into the
face, and talking in a soothing voice. Large colorful hanging
objects over the crib stimulate them. They also like rocking,
stroking, talking and singing.
Toys for small infants include rattles, colorful hanging objects,
moving toys and musical toys.
Older infants like plastic blocks, rings, stuffed animals, rubber or
plastic cars or boats.
1 year carts, wagons, bells, whistles and musical toys.

4. Rest and sleep

By 4 months infants develop a pattern of sleep
through night and short periods of daytime naps.
Older infants sleep for about 14 hour a day while
newborns sleep for 20-22 hours a day.

5. Safety (Prevention of accidents)

Common accidents include burns, suffocation,
automobile accidents, falls poisoning and chocking.

Safety measures
Do not leave the baby alone.
Use side rails for crib.
Hold infant upright during feeding, cut food in
small pieces, and do not feed peanuts or
popcorn.
Keep dangerous substances cleaning lotions,
paints, medicines etc. out of
reach of the
infant.
Provide safe toys with no detachable parts or
sharp edges.
Cover electrical outlets.

Vaccination

DPT, Hib, OPV, PCV 2, 4 and 6 months

BCG
3 months
Hepatitis B
2 and 6 months
MMR
1 year

Health problems and developmental

problems

1
2
3
4
5
6

Regurgitation
Vomiting
Diarrhea
Constipation
Crying
Strabismus

Learning activity #4
Situation

Intervention

Rationale

1. Crying
infant

Feed
Change diaper
Cover with blanket
Cuddle

To relieve hunger.
To promote comfort.
To protect from cold.
To provide psychological
security.

2. Infant in
cold
environm
ent

Cover with blanket.

Cover the head with
a cap.
Use room heater.

Decreases heat loss from

the body.
Head has a large body
surface area.
To increase the
environmental temp.

3. Infant in
warm
envt.

Remove extra clothing. To prevent accumulation

of heat.
Use a/c or fan.
To room temp. &
Increase fluid intake
promote vent.
To prevent dehydration

4. Infant
with
stuffy /
occluded
nose

Instill nasal drops

Use humidifier
Remove secretions
using a syringe pump.

To loosen the secretions

and to remove it.

5. Infant
with dirty
diaper

Change diaper
immediately.
Wash with warm water
and dry well.
Use cream to prevent
diaper rash

Organic matters
decompose by bacterial
action leading to skin
irritation and rashes.

6. Infant is just
learning
to crawl.

Keep the baby on floor. To prevent

accidents.
Use side rails for cot.
Lock cupboards.
Cover electrical outlets

7. Hospitalized
infant
lacking
stimulation
and
interaction

Provide stimulation by
providing colorful toys,
light music, touch,
gentle talk and play.

To stimulate
different senses.