Weight Gain:◦ 1st 6 mos: 1.5 #/mo til 5 mos; ◦ Wt doubles by 6 mo; average 16#◦ Triples by 1 yr; average 21.5#

Height:◦ Increases 1”/mo 1st 6 mo◦ Average 25.5” at 6 mo◦ By 1 yr. ↑d by ~50%; average 29”

Head Circumference:◦ Imp. determinant of brain growth◦ ↑s 2 cm/mo from birth to 3 mos; 1 cm/mo from 4-

6 mos; .5 cm from 6-12 mos.◦ Average 17” at 6 mos and 18” at 12 mos◦ Increased by 33% by 1 yr.

Chest Circumference:◦ Almost = to HC by end of 1st yr◦ Heart wt double by 1 yr; width is 55% of chest

Neuro Reflexes: Some disappear and new ones appear (p. 494, Table 12-1)

Vision:◦ Binocularity starts at 6 wks; well developed by 4

mos◦ Depth perception 7-9 ost◦ Infant has visual preference for human face ; by 6

mos distinguish bet. familiar and strange faces; follows developmental sequence

Hearing: progressive myelination of auditory pathway; goes from generalized response to specific responses of locating sound◦ Moro or startle reflex to loud noise as neonate◦ By one yr. knows several words and their

meaning

Respiratory system: abdominal breathing◦ Predisposed to acute resp. problems d/t

physiology (small airways, ↓ IgA and mucous production → ↑risk of infection, short & straight eustachian tube allows infection to go from pharnyx to ear, etc.)

Heart rate slows; rhythm often that of sinus arrhythmia; ↑s w/inspiration and ↓s w/ expiration

Cardiovascular:◦ Fetal hemoglobin present

1st 5 mos til adult hgb replaces it◦ Fetal hgb results in ↓d life span of RBCs so ↓d #

which results in physiologic anemia. BUT ◦ Maternal stores are present til 5-6 mos so not a

problem. ◦ Hgb levels often do ↓ about 6 mos and Fe

supplement becomes necessary as erythropoiesis is stimulated. (fortified rice cereal is great resource)

Digestive system: at first solid foods are passed incompletely broken down in feces

Breast milk or formula recommended by AAP for first year of life. Less food allergies, and better use of calories and nutrients

By end of yr. can eat 3 meals/day, evening bottle or breastfeeding, and have 1-2 BMs daily (although still prone to diarrhea, vomiting and dehydration w/any gastric irritation)

Immune system: receives maternal IgG at birth that covers 1st 3 mos and begins to synthesize IgG; 40% of adult levels by 1year

◦ IgM adult levels by 9-12 mos◦ IgA, IgD, IgE level not until early childhood

Palmar Grasp, using whole hand, progresses to the Pincer Grasp, using thumb & index finger

6 mos: hold bottle, grasp feet, feed selves cracker

7 mos: transfer objects from 1 hand to other; bang objects together

10 m: let go of object on purpose

Maturation in: posture, head balance, sitting, creeping, standing, walking

Head control: 4-6 mos well established; no head lag by 6 mos or refer

Rolling over: abd to back 5 mo; back to abd 6 mos; parachute reflex 7 mos

Sitting: sits alone at 7 mos w/hands support; 8 mos unsupported; 10 mos prone to sitting

Locomotion: cephalocaudal pattern◦ Begins by pushing w/arms and propelling selves

ackwards◦ Crawling to creeping at 9 mos◦ 11 mos walk holding onto furniture◦ 1 yr walk w/1 hand held◦ If does not pull to stand by 11-12 mos refer for

eval

Sense of Trust vs Mistrust Trust of self, of others, and of the world –

provides foundation for all next phases Trust that their feeding, comfort,

stimulation and caring needs will be met Mistrust results from too much or too little

frustration Consistency of care is essential

Two oral/social stages First is food intake; newborn can tolerate

little frustration; then learn other ways to interact thru grasping; tactile stimulation extremely imp. in child/caregiver relations

Second is biting, more active & aggressive interaction w/environment; relief from teething and sense of power or control

Sensorimotor phase: Birth to 24 mos Separation – learn to separate selves from

other objects in environment Object permanence – objects that leave

the visual field still exist (9-10mos) Use of symbols or mental representation

(i.e. bye-bye means Daddy goes to work) Begin to imitate, play, and show affect

Body Image: time of exploration of body parts; hands, feet, fingers are all play things & objects of pleasure

Sexual identity: as explore body are capable of genital self stimulation; male erections are common

Social development: importance of human physical contact cannot be stressed enough

Primary caregiver can be the mother, father, grandparent, etc.

Absence of a quality caregiver, esp 1st 3 yrs. of life can →severe mental & physical retardation.

Reactive Attachment Disorder (RAD): maladaptive or absent attachment bet. infant & parent. Signs occur b/4 5 yo.: not cuddly w/parent, no eye contact, poor impulse control, destructive to self and others→no conscience

Separation Anxiety: Between 4-8 mos. as begins to have awareness of self & parent as separate → object permanence makes aware parent can be absent→anxiety

Approach at eye level, talk softly, don’t smile big, allow to stay on parent’s lap & keep familiar object w/them

Stranger Fear: between 6-8 mos. show fear of strangers

Protest-loud protest to departure of significant other, crying, trying to get to parent, rejects contact with strangers(eg.RN)

Despair-withdrawn from others, appears depressed, uncommunicative

Denial/Detachment- appears happy, interested in environment, forms superficial relationships (eg. RN). Usually seen after prolonged separation from parents.

Crying: 1st means of communication Normal to cry 1-4 hr/day during first 6 wks

of life; ↓s by 12 wks Initially for physiologic need to discharge

energy and d/t changes in CNS, later they cry for attention, fear or frustraton

Vocalization by 5-6 wks; 6mo imitate sounds

By age 1 can say 3-5 words and may understand as many as 100 words

Show visual preference to human face as early as 1 wk

Social smile 6-8 wks 3 mos: ↑ interest in environment 4 mos: laugh aloud 6 mos: personable;

play peek a boo; extend arms to be picked up

11 mos+: ↑independence; feed self, help dress, follow simple directions

Narcissistic – revolves around own body 3-6 mos: play alone w/rattle or soft toy or

with someone else – begins to interact 4 mos: show preference for toys & get

excited if favorite food or object is given 6 mos to 1 yr: peekaboo & pat-a-cake Quality of personal interaction that occurs

w/play is what is most imp Play is referred to as solitary.

Screening tools available: focus on sleep, feeding, play, diapering & dressing activities

Temperament influences the interaction between infant-parent & infant-others

The more dissonance bet. child & parent’s ability to accept and deal w/the behavior, the more risk for subsequent parent-child conflicts

Excessive self-centered and immature behavior, resulting from failure to enforce consistent, age-appropriate limits

Demand to have own way, inconsiderate of others, intrusive, obstructive, manipulative behavior

It is NOT: crying in early infancy/colic, negativism, temper tantrums of toddlers, difficult temperaments or ADHD

Nonnutritive sucking of fingers in infancy & early childhood if OK unless it extends into late preschool yrs.

Malocclusion may occur if thumb sucking persists past 4-6 yrs or permanent teeth in

Pacifiers may ↑risk of malocclusion and influence social & speech development

Thumb sucking peaks at 18-20 mos If persists in listless, apathetic child→

problem

First primary teeth: lower central incisors 6-10 mos

Upper central incisors 8-12 mos Age of the child in mos – 6 = # of teeth for

the 1st 2 yrs. Encourage cold teething ring, oral Tylenol or

ibuprofen, baby Orajel, etc. Distinguish between teething (↓appetite,

rubbing ear, mild temp) & illness (fever >102, n/v)

Inflexible shoes w/hard soles can delay walking and impede foot development

Shoes provide protection only Should be able to bend in half by squeezing

the heel and toe w/your hand Shoe size changes ~ every 3 mos bet 12-36

mos

Major cause of death, esp. 6-12 mos. D/T increased locomotion & manipulative

skills plus curiosity about the environment Aspiration/Choking – common

household items can be deadly to infants: coins, buttons, beads, broken toys, button batteries, bottle tops, safety tear down strips (plastic), baby powder, etc.

Food: nuts, hard candies, HOT DOGS (must be cut into small irreg. pieces), grapes, dried beans

2nd only to homicide as leading cause of death in infants by injury

Latex balloons – leading cause – use mylar balloons; don’t inflate latex gloves

Bed/crib – blankets, pillows, wedging bet. Bed and wall, sharing bed w/adult, cords from drapes/blinds, mesh siding, crib slats

Plastic bags – occurs within minutes

Leading cause of accidental death > 1 yr Improper restraint or lap riding Infants face rear til 20# and as close to 1 yr

as possible Middle of back seat is safest Never place rear facing in seat with air bag Usually Public Health Dept or police station

can inspect, give guidelines, & sometimes provide car seat

Most common after 4 mos.- rolling over Changing table, high chairs, walker, swings,

infant seats Heavy objects get pulled on and over as

they try to stand up May trip often when learning to walk – avoid

slippery socks or shoes and watch clothing that could trip them up

Fairly safe until they become mobile 2 yr olds highest, then 1 yr olds Plants, batteries (esp. button), ingestion,

inhalation (2nd hand smoke), purses, cigarettes, medicine, etc

Give parents poison control #, advice to keep meds and poisons locked and store high out of reach

Always store in original container

Smoke alarms near bedroom areas and on each level

Scald burns from tap water – lower hot water heater to 120 F – check bath water

Check food warmed in microwave – outside may be cool but inside hot

Turn handles toward back of stove, keep hot items far from edge of table or counter

Sunburn – no direct sun < 6 mos, then sunscreen and cover

Cover electric outlets and guard heat producing elements

NEVER leave child in car – esp. in hot weather

Can occur in only inches of water ALWAYS supervise in tub, baby pool, near

toilet, or even buckets of water Not recommended to take swim instruction

if under 4 yrs. (AAP) – too young to understand risks

Increase risk of infection & convulsions from swallowing lg. amt. of water

Sharp objects – toothpicks, knives, tools Forks – wait til mastered spoon (18 mon) Infant homicide – 6.4% Excessive noise – hearing loss Animal attacks – d/t jealousy Nurses Role: anticipatory guidance;

prepare parents for upcoming developmental changes and teach injury prevention; child proofing home; home safety checklist

1st 6 mos – human milk best complete diet 1st 4 mos only breast or formula AAP recommends breast milk or formula

for first year of life; then whole milk No additional fluids; no water or juice Be aware of cultural beliefs: honey, water,

sugared wine during early days of life Honey → may predispose to botulism til 12 mos Encourage breast fdg mom’s who return to

work to pump q 3-4º and refrigerate milk

Expressed milk keeps for 5 days @ 39ºF Can freeze for up to 12 mos Maternal fatigue biggest threat to cont. Never thaw or rewarm in microwave Formula: do not use tap water unless

sure of lead & fluoride content Cow’s milk: unacceptable until 1 yr old;

hi renal solute load & def. in Fe, Zn, vit.C

Not before 4-6 mos because:◦ Not compatible w/digestion◦ Exposes to food antigens → ↑ food allergy◦ Unable to push away or avoid fdg → overwt◦ Fe def. anemia

2nd 6 mos: Fluoride begins if needed◦ Solid foods start: better head control, tooth

eruption begins, GI tract matured, extrusion reflex gone, better eye-hand coordination, etc

Iron fortified cereal first: easily digested, low allergenic content

Add one new food @ a time, every 5-7 days

After 6 mo, can add juice w/cereal Cont. cereal til 18 mo because need iron Juice from a cup – not a bottle – no more

than 5 oz/day; white grape juice best! Never warm juice in microwave

Good reference on p. 524 for introducing solid foods in the first yr.

No set sequence for adding foods Most important: only one solid

introduced q 5-7 days → note if reaction occurs

By 1 yr. can eat well cooked table foods Microwave not recommended – caution

parents on dangers; see Homecare p.522 Weaning: 2nd 6 months; introduce cup