GROWTH AND DEVELOPMENT

  1. Infant (28 days-1 year)
    1. Erikson’s theory of personality development
      1. Central task: basic trust vs. mistrust; central person: primary caretaker.
      2. Behavioral indicators:
        1. Crying is only means of communicating
        2. Quieting usually means needs are met.
        3. Fear of strangers at 6-8 months.
      3. Parental guidance/teaching
        1. Must meet infant’s needs consistently - cannot “spoil” infant by holding, comforting.

          2. Child Preventive Care Timeline
        2. Neonatal reflexes fade between 4 and 6 months, replaced with increase in purposeful behavior, e.g., babbling, reaching.
        3. Fear of strangers is normal - indicates attachment between infont and primary caretaker.
        4. Child may repeat over and over newly learned behaviors, e.g., sitting or standing.
        5. Weaning can begin around the time child begins walking.
        6. Review preventive care time line and Recommended Health Screenings with parents of infants.
    2. Physical growth (by 1 year)
      1. Height (length): 50% increase by first birthday.
      2. Weight:
        1. Doubles by 4-7 months, triples by 1 yr.
        2. Gains 5-7 oz/wk in first 6 months of life.
        3. Gains 3-5 oz/wk in second 6 months of life.
      3. Vital signs

        4.  

        Normal Vital Signs: Measurements and Variations with Age

        Respiratory       Blood

        Heart            Rate          Pressure

        Age (yr)

        (beats/min)     (breaths/min)     (mm Hg)

        Newborn

        5

        120-160          30-40           70/55

        100-140          25-35           90/55

        80-120          20-30           90/56

        70-100          18-24           95/56

        10

        14

        18

        60-90           18-22          102/62

        55-90           16-20          110/65

        55-90           16-18          116/68

        Source: Adapted from Wong, D: Whaley and Wong’s Nursing Care of Infants and Children, ed 6. monthssby, St Louis, 1999.


      4. Cardiac system:
        1. Heart begins to function effectively.
        2. Decreased heart rate, increased blood pressure from neonatal values.
      5. Pulmonthsnary system:
        1. Predisposed to upper respiratory infections due to anatomical differences (e.g., eustacian tube is shorter and straighter in infant).
        2. Decreased respiratory rate from neonatal values.
      6. Gastrointestinal system:
        1. Swallowing improves.
        2. Stomach enlarges to hold greater volume.
        3. Digests monthsre complex foods as enzymes increase (by 4-6 months).
      7. Genitourinary system:
        1. Immature; waste products poorly eliminated.
        2. Easily prone to fluid and electrolyte imbalances.
      8. Immune system:
        1. Functional by 2 months.
        2. Produces IgG and IgM antibiotics.
      9. Neurological system:

        1. Fontanels:
          1. Anterior-open or patent through first 12 months.
          2. Posterior-closed by 2 months.
        2. Head circumference increases as brain grows rapidly.
        3. Neurological reflexes (e.g., Landau, parachute) appear; neonatal reflexes (e.g., Moro, rooting) disappear.
      10. Sensory:
        1. Hearing improves from “quieting” to a sound, to locating a sound easily and turning toward it.
        2. Vision improves from 8-18 inches, to searching for hidden objects and following moving objects.
      11. Teething:
        1. Generally begins around 6 months.
        2. First two teeth: lower central incisors.
        3. By 1 year: six to eight teeth.