Infant Growth and Development by Dr. Kareem J. Dhaidan AL-Khafajy

Growth & Development of Infant Prepared by Dr. Kareem J. Dhaidan Kareem AL-Khafajy

Infant Normal Growth & Development Assessment of normal growth. Development is assessed as: Gross motor. Fine motor (sensory motor). Personal-social. Language. Cognitive. 31/05/2025 2

Normal Infant length During the first year in life, the infant gains in length roughly 2.5cm cm/month during the first 6 months of age. Average height is 65 cm at 6 months and 75cm at 12 months Increase by about 25 cm in 1st year 31/05/2025 3

Growth of head: The posterior fontanel closes at 2 months. The anterior fontanel closes at 12- 18 months. Cranial sutures The sutures between the cranial bones do not ossify until later childhood Head circumference increases about 1.5 cm/month during the first 6 month of age, then 1/2cm /month during the second 6 months of age. It is 43 cm at 6 months. At the end of the first year, it is 46 cm. 31/05/2025 4

Chest Circumference: At the end of the first year, chest circumference and head circumference are equal . N.B: Chest is usually measured at nipple line, for greater accuracy, take two measurements- one during inspiration and the other during expiration-and record the average. 31/05/2025 5

Skeletal growth The skeletal system is completely formed in cartilage at the end of 3 months of gestation Bone ossification and growth occur during the remainder of fetal life and throughout childhood Bone age can be determined by radiologic examination When bone age matches the child s chronological age, the skeletal structure is maturing at a normal rate 31/05/2025 6

Eruption of the milk teeth (deciduous teeth) The development of human dentition is a continuous process from 5th month in utero to Maturity By 5 7 months of life, The first deciduous teeth usually erupt Babies may differ in the timing of tooth eruption Teething is a normal continuous process of development and does not cause fever or respiratory problems Kareem AL-Khafajy

Eruption of the milk teeth 31/05/2025 8

Circulatory System Fetal life High levels of hemoglobin and red blood cells are necessary for adequate oxygenation After birth Oxygen is supplied through the respiratory system Hemoglobin decreases in volume Red blood cells gradually decrease in number until the third month of life The count gradually increases until adult levels are reached 31/05/2025 9

Gross motor development First month: Raises head momentarily when prone, hips extended Second months: When prone, raises chin off couch Thirdmonths: In a prone position, he will rest on forearm, keep head in midline, make crawling movements with legs, arches back, and supports head when held erect. Fourthmonths: Sits with support. Moro reflex disappears. 31/05/2025 10

Cont. Gross motor development. 6months Puts feet in mouth in supine position. Starts crawling. 7 months Sits without support leaning forward 8 months Rolls over from prone to supine. Sits well with no support 9-10 Creeps and pulls self upright. 11 months Stands unsupported. 12 months Walks supported. Toddles way and cruises around furniture. Walks well. Starts crawling upstairs. 31/05/2025 11

Motor development in infants 12mo_12.gif 12mo_14.gif 12mo_07.gif See full size image 9-11 months 12 months ParachuteWalks well creeping walks reflex 12 months .Supported . 6-12 months 31/05/2025 12

Fine motor development 1months: Follows a moving object to midline. Responds to sounds by blinking. 2 months: Hands often open. Grasp reflex is fading 3 months: Hands mostly open. Regards his hands. Can hold a rattle if placed in his hand. Follows object to 180 by eye. 31/05/2025 13

4 months inspects and plays with hands. Tries to reach objects with hands. Grasps objects with both hands. Can carry objects to mouth 5 months Turns head to sound. Brings hands together. 6 months Able to reach object by hand and get it. Grasps feet and pull to mouth Kareem AL-Khafajy

Cont. Fine motor development 7. Months Can transfer a rattle from hands to hand. Reaches objects and brings them to mouth. Has ambidextrous approach 8 months has beginning pincer grasp. Can feed himself with a biscuit. 9 months Tries picking things with fingers. Preference for use of dominant hand 31/05/2025 15

10 months Crude release of an object beginning. Grasps bell by handle. 11 months Can use a thumb and finger to pick a cube. Grasps by thumb and finger. 12 months Can pick small objects pellets "No longer puts objects in mouth. Builds a tower of 2 blocks but fails. Throw objects. Holds cup to drink. Kareem AL-Khafajy

Psychosocial Development of the Infant First develops a sense of trust when fed on demand By 2 months distinguishes mother or primary care giver Eventually learns that not every need is met immediately on demand Slowly becomes aware that something or someone separate from oneself fulfills one s needs 31/05/2025 17

Gradually learns that the environment responds to desires expressed through one s own efforts and signals such as crying bring the attention of mother Finally becomes aware that the environment is separate from self 31/05/2025 18

By 3 to 4 months: smiles in response to smile of others .shows interest in other family members By 7 to 8 months :shows fear of strangers (strangers anxiety). By 9 to 10 months: play simple games with adults ,e. g. bye-bye . play with adult games such as peek-a-boo by 10 months. Kareem AL-Khafajy

peek-a-boo by 10 months

Eye -to -eye contact, smiling and vocalization are the evidences of attachment between the infant and his parent, especially his mother. According to Erickson, through the infant interaction with care-giver (mainly the mother), especially during the feeding. He learns to trust others through the relief of basic needs, i.e., to trust those who give pleasant sensations. Sense of trust will result also from being held, talked to, cuddled, warmed, and so... on. If this sense of trust in others is not learned, the reverse, a sense of mistrust is acquired 31/05/2025 21

SEQUENTIAL STAGES OF THE COGNITIVE DEVELOPMENT OF THE INFANT First few weeks of life - Actions such as kicking and sucking are reflex activities Next sequential stage Reflexes are coordinated and elaborated Latter part of first year - Intentional movements to bring changes; expects that certain results follow certain actions - Cannot apply abstract reasoning; understands through five senses Kareem AL-Khafajy

Health promotion of the infant Nutrition requirements Promoting sleep Dental care Accident prevention Toy selection 31/05/2025 23

Supplemental Nutrients Vitamins C and D Iron Breast-fed infants need supplements of iron, as well as vitamin D By 6 months of age, iron-rich foods are needed as supplements Fluoride 31/05/2025 24

Introducing Solid Foods Protect the baby s clothes Give part of the formula before giving solids Start foods in small amounts, 1 or 2 tsp daily Prepare the food smooth, thin, lukewarm, and bland Offer new foods one at a time Allow 4 or 5 days before introducing another food to detect any allergy or intolerance Add chopped foods at about 9 or 10 months of age (if teeth have erupted) 31/05/2025 25

Self-Feeding 7 or 8 months of age May grab spoon from the caregiver, examine it, and mouth it May stick fingers in the food to feel the texture and to bring it to the mouth for tasting this is an essential, although messy, part of the learning experience After preliminary testing The infant s next task is to try self-feeding 31/05/2025 26

Components of Health Promotion and Maintenance of the Infant Routine checkups Immunizations Family teaching Education about accident prevention 31/05/2025 27

Well-Baby Visits Occur at 2 weeks, and at 2, 4, 6, 9, 10 and 12 months The nurse collects data regarding: Growth and development (weight, height, head circumference) Nutrition and sleep The caregiver infant relationship Any potential problems Immunizations are given to guard against disease Family teaching is provided 31/05/2025 28

Health protection of the infant Immunization BCG (Tuberculosis) Hepatitis A and B Polio DPT (Diphtheria, Pertussis, and Tetanus Measles German measles (rubella) Mumps Varicella (chickenpox) Haemophilus influenza meningitis (HIB) Pneumococcal disease 31/05/2025 29

Injury prevention Falling down Aspiration Poisoning Suffocation Burns Motor vehicle accidents 31/05/2025 30

Injury prevention 1. Accidental injuries are a major cause of death during infancy; common causes include: a) Falls off beds and down stairs b) Aspiration of small objects c) Poisoning from overdose of medications or ingestion of toxic household substances Kareem AL-Khafajy

d) Suffocation due to unintentional covering of the nose and mouth, pressure on the throat or chest, or prolonged lack of air such as in a closed parked car e) Burns from hot liquids or foods, scalding bath water, excessive sun exposure, or electrical injury f) Motor vehicle accidents, most commonly linked to improper use or non-use of an infant car seat. Kareem AL-Khafajy

NURSING CONSIDERATIONS ASSOCIATED WITH ACCIDENT Prevention include: a) Instructing parents to maintain a safe environment for the infant by keeping breakables, sharp objects, and harmful substances out of reach. b) Alert parents to age-specific potential injury sources and accident-prevention strategies. c) Encourage parents to avoid repetitive negative expressions for the sake of safety and to stress positive aspects of the infant's behavior, such as playing with suitable toys. 31/05/2025 33

HEALTH PROMOTION OF THE INFANT a. Toy selection Infant toys serve several purposes, including: a) Stimulation for psychosocial development b) Diversion for relieving boredom, pain, and discomfort c) A means of communicating and expressing feelings d) Aid in the development of sensor motor skills 31/05/2025 34

2. INFANT TOYS SHOULD BE SAFE AND AGE APPROPRIATE. Examples of safe, age-appropriate infant toys include: a) Age 1 to 3 months: mobile, music box, stuffed animal with no detachable parts, and rattle b) Age 4 to 6 months: squeeze toys, busy box, and play gym c) Age 7 to 9 months: various cloth textures, 31/05/2025 35

splashing bath toys, blocks; and balls d) Age 10 to 12 months: durable books with large pictures, building blocks, nesting cups, large puzzles and push-pull toys. 3-Toy safety considerations include. a) No sharp part edges b) No detachable parts (e.g. wheel tops) Kareem AL-Khafajy

b. Sleeping patterns 1. During the first month after birth, an Infant sleeps most of the time not spent in eating. With age, daily sleep time decreases as awake and alert times increase. 2. In the first year of life, an infant typically takes morning and afternoon naps. 31/05/2025 37

3. Bedtime rituals began in infancy help Prepare the infant for sleep and prevent future bedtime and sleeping problems. 4. Parents should establish that the infant s crib is for sleeping, not for playing, and prevent reinforcing wakefulness during the night by picking up the infant whenever he or she wakes and cries. Kareem AL-Khafajy

Nutrition Requirement 1. Consistent oral intake of sufficient calories provided by a caring parent sets a positive pattern for an infant's future eating behaviors. 2. Feeding schedule suggestions for an infant from birth to age 6 months receiving breast milk or formula on demand include: a) Age 1 month: 4 oz.(1oz:30 ml). six times a day 31/05/2025 39

b) Age 2 months: 4 oz. five times a day (one night feeding is eliminated) c) Age 5 months: 5 oz. five times a day d) Age 6 months: 4 oz. five times a day (as solid food feedings begin, milk feedings decrease) 3. At age 6 to 12 months, solid food becomes appropriate because of the infant's developmental readiness (e.g. the infant can assume an upright position, the extrusion reflex lessens, and the digestive tract matures Kareem AL-Khafajy

4. Solid food should be introduced progressively: first, cereal with iron, followed by pureed fruits, then vegetables, then meats. Each new food should be added to the infant's diet separately at intervals of 4 to 7 days each to determine allergies. 31/05/2025 41

5. Suggestions for complementary feeding include: a) Eliminate one breast feeding at a time for one cup feeding b) Begin practicing with sips from a cup at age 5 to 6 months, when motor ability has developed. c) Introduce juice in a cup to help prevent dental caries. 31/05/2025 42

Dental health 1. An infant's primary (deciduous) teeth erupt at about age 6 months. Assessment guide: age of child in months minus 6 months equals' number of primary teeth. 2. Clean an infant's teeth with a damp cloth; brushing is too harsh for the infant's tender gums. 31/05/2025 43

3. Assess the need for a fluoride supplement; consult with the physician. 4. Despite a widespread belief to the contrary, fever, vomiting, and diarrhea usually are not associated with teething but rather indicate illness. Kareem AL-Khafajy

NURSING CARE DURING HOSPITALIZATION OF THE INFANT Encourage continued stimulation, empathetic care, and loving attention from family caregivers Encourage caregivers to feed, hold, diaper changing , and participate in their infant s care as much as they can 31/05/2025 45

Collect data regarding the needs of the caregivers and the infant and plan care with these needs in mind Identify and acknowledge the caregivers apprehensions and develop plans to resolve or eliminate them Make arrangements for rooming-in for the family caregiver Kareem AL-Khafajy