Prenatal

• Infancy


  A child under the age of 1 year
• Growth is rapid in the first year, then slower in the second year with big developments in cognition and language
• Weight of an infant

  • Average birth weight is 3.4kg (3400g)
  • Normal birth weight range is 2.5 kg to 4.5 kg
  • Newborns lose 5%-10% of their birth weight by the second day, then steadily regain it
  • Birth weight doubles by 6 months and triples by end of 1st year
  • Rate of growth slows - by 2 years (12kg)
• Height of an infant

  • Average birth length is 50cm (full term baby, range 48-53cm)
  • During first six months height increases 2.5cm per month
  • 1 year old's are approximately 76cm tall
  • Rate of growth slows by 2 years - most of the growth is in the legs
  • Height doubles by age 2

  
• Head Circumference


  • At birth 33-35.5 cm
  • The weight of the brain almost doubles by year 1
  • Growth of the head is indicative of brain maturation (motor and sensory development)
  • At birth most infants are able to hear sounds
• Nutritional needs during infancy

  1. Infant sucking and swallowing and rooting reflexes enable them to search for and secure their food

  2. First year - nutrition is met by Breast feeding or iron-enriched formula
• Breast feeding


  • AAP recommends breast feeding for at least 6 months of life
  • Colostrum contains proteins, salt, carbohydrates, immunoglobulins
  • Actual breast milk appears 3rd day after delivery
  • Newborns need 8 to 12 feedings per day initially
• Weaning & Introduction to solid foods

  1. Introducing solid foods should be done gradually - one feed at a time

  2. In addition to breast milk or formula, introduction of solid foods after 5 months

  3. Introduce only single grain cereal then egg whites, wheat, citrus fruits not to be given until first year

  4. First solid diet - rice cereal mixed with formula

  5. Introduce only one new food at a time for several days

  6. General rule 1 to 2 teaspoons each new food

  7. 1 year - 3 meals and 2 snacks

  8. Introduce iron rich foods - cereals, meat
• Weaning - schedule of foods, Birth to 12 months

  • Birth - 6 months: Breast feeding or iron-fortified formula
  • 5-6 months: Add iron-fortified instant cereal, begin with rice, avoid wheat for first year
  • 7-8 months: Add strained fruits and vegetables, plain yogurt, strained meat, toast, crackers, add iron-fortified formula
  • 9-10 months: Add finger foods, cooked bite size meat, vegetables, unsweetened fruits, yogurt, add iron-fortified formula
  • 11-12 months: Add soft table foods - dry sweetened cereals, cheese slices, noodles
• Advantages of Breast Milk

  • No preparation required
  • Inexpensive or free
  • Mother must be present or expressed
  • Milk is easily digested
  • Low in saturated fat
  • Promotes bonding
  • Baby gets immune factors from mother
  • Delays mother's menstruation
• Advantages of Bottle Formula


  • Requires preparation
  • More costly
  • Frees up mother's time
  • Formula is not as easily digested as breast milk
  • High in saturated fat
  • Allows father to feed and bond with baby
  • Exact amount baby ingests is known
• Foods to be avoided for infants

  • Nuts, popcorn, whole kernel corn, chunks of meat (e.g., hot dogs), chips
  • Berries, grapes, cherries, raw fruit and vegetables (e.g., apples, carrots, celery)
  • Sticky, stringy (fibrous) and chewy foods (e.g., peanut butter, caramel, honey)
  • Small, hard, or round candy (e.g., jellybeans, peppermints, butterscotch, m & m's)
  • Honey
• Sudden Infant Death Syndrome (SIDS)


  • Also known as "crib death"
  • Responsible for the death of about 1 out of every 500 babies
  • Common between 1 and 4 months
  • Cause is unknown
  • Association between SIDS and sleep pattern
  • Occurs between midnight and 6 am
• Preventive measures for SIDS


  1. Infants sleep on back or sides

  2. Offer pacifier - reduces risk

  3. Avoid soft materials - quilts, comforters, or pillow in sleep area

  4. Co-sleeping in parents' bed is discouraged

  5. Use Standards Safety Cribs
• Infant Safety Measures


  • Use of approved cribs, car seats, prevention of drowning, suffocation and aspiration
  • Never leave the infant unattended
  • Prevention of drowning, suffocation and aspiration because infants have locomotion -causing risk for accidents
  • Inspection of all toys as infants explore putting everything in their mouths
  • Support the head and neck of the infant, never shake the infant-SHAKEN BABY SYNDROME- to prevent seizure and death
  • Prevention of lead poisoning from lead paints, small toy paints, chips
• Developmental milestones - Motor development

  1. Gross Motor Development: Ability to control large muscle groups, e.g. to crawl

  2. Fine Motor Development: Able to use hands and fingers, grasp (palmar grasp reflex), requires hand-eye coordination
• Sequence of Motor Development

  • From Head to Toe: CEPHALOCAUDAL
  • First, ability to control the head, shoulders, arms
  • Then learn to control their legs
  • The posterior fontanel is triangle in shape - closes by 8 weeks (2 months)
  • The anterior fontanel is diamond - closes by 12-18 months of age
• Developmental Milestones by Age

  • 1 Month: Head lag (poor head control), reflexes (grasp, Babinski, rooting, tonic neck), responding to touch and voices, sensory motor communications
  • 2-3 Months: Head side to side, briefly hold head up, grasp reflex diminishes, holds head and smiles, eyes more coordinated, focuses on objects, "social smile"
  • 4-5 Months: No more head lag (red flag if found after 4 months), rolls from abdomen to back, sits with back support, reaching and grasping objects, takes hold of objects and brings to mouth
  • 6-7 Months: Birth weight doubles by 6 months, sits with supports & has head control, rolls both ways, sits alone, self-feeding, pincer grasp begins, "stranger anxiety" begins
• Rolls from abdomen to back

  2 months
• Sits with back support

  • 5 months
• Reaching and grasping objects

  • 5 months
• Take hold of objects and brings to the mouth

  • 5 months
• Safety measure- accidental aspiration
• Raises head 90 degree angle

  • 5 months
• Birth weight: DOUBLES by 6 months
• Sits with supports & has head control

  • 6 months
• Rolls both ways


  • 6 months
• Sits alone


  • 7 months
• Can sit up without support

  • 7 months
• Hold a bottle , cracker and brings to mouth

  • 6 months
• self feeding


  • 7 months
• Pincer grasp" begins- (uses thumb and index finger to pick up and grasp objects – small items )


  • 7 months
• Nursing care
• STRANGER ANXIETY


  Begins at 6 months
• Identify faces and strangers

  • 6-7 months
• STRANGER ANXIETY


  Keep the Parents near
• STRANGER ANXIETY


  Assign same nursing staff each shift
• Stands with pulling up-holding chair or object

  • 8 months
• Crawling on all four limbs, very mobile

  • 9 months
• Needs to fall backwards in order to sit down

  • 9 months