DEVELOPMENTAL EVENTS IN INFANCY
A. Learning Self-regulated Behaviors
• Sucking reflex is one of the earliest to appear during prenatal
development; this reflex is elicited by almost any stimulation to the
lips, cheeks, or mouth areas.
• One of the initial decisions in providing care at this time must be
whether to breast or bottle-feed the infant.
• Most normal infants required feeding once every 3 or 4 hours the
first few months after birth.
• Babies generally feed themselves when they are able to hold a cup
and drink from it as well as coordinate their hands to bring food to
• The shift from liquid to solid foods
• Most infants are weaned when several signs indicate readiness to
begin taking solid foods. These signs include drinking from a cup,
grasping a spoon easily, drinking more than a quart of formula
daily, and enjoying playing with food.
• A major concern in the weaning process is providing an adequate
amount of protein and iron in the infant’s diet to meet growth
requirements. Lack of adequate sources of these nutrients in
infancy can lead to malnutrition and eventually result in
• The first solid food normally given is strained cereal mixed with
stained fruit; it may be introduced slowly to the baby once a day
for a week or so and gradually increased to twice a day.
• Strained foods such as vegetables and meat are gradually
introduced between 3-6 months of age
• Finger foods and foods that can be easily manipulated by spoon are
introduced at 9 months of age. These include pudding, creamed
food, and others
• Sleep during the first several months after birth is interrupted only
long enough for the baby to be fed. This pattern of alternating
periods of sleeping with feedings changes to longer intervals of
wakefulness during the third month.
• During the remainder of the time until the baby approaches its
second year, sleep needs decrease to 10-14 hours daily.
Basic Motor and Locomotor Skills
• Control over the muscles of the body appears first in the head
region and proceeds to the feet (cephalocaudal) and from the
trunk region out to the extremities (proximodistal).
• During the first month, the baby’s movements are random.
• Reflex activity in the neonatal and early infancy period assists the
individual in becoming ready to walk.
• Accompanied by the maturation of muscle groups and nerve
fibers, the development of upright locomotion occurs by
sequences of events following the cephalocaudal pattern.
• Typically, girls ca be observed to walk at an earlier average age
than boys. The usual range among girl infants is between 10-14
months whereas for boys it occurs between 12-16 months.
B. Establishing a Sense of Basic Trust
Basic trust emerges through different interactional activities
between the mother and baby.
The feeding situation provides ample opportunity for the infant to
explore the caregiver through vision touch.
A consistent caregiver who holds the infant in a consistent manner,
and who has a consistent pattern of behavior during feeding
enables the infant to learn to trust.
This early discovery of a consistent pattern of life helps the infant
predict that certain events or sensations will occur if he/she
behaves in particular ways.
example: a baby learns that a lust cry will make the caregiver
attend to his needs.
Interactions with the physical environment also contribute to the
infant’s learning that there is predictability or consistency within
example: a baby discovers that movements in the crib make his
mobile move in response
C. Learning Self-differentiation
Self-differentiation begins when the infant learns that objects can
be manipulated or that he/she is a separate entity from significant
Separation anxiety, or the distress experienced by the baby upon the
absence of the caregiver appears during the sixth or seventh month
The return of the caregiver or object reinforces the baby’s learning
that the parent or object has not gone away forever and assists the
child in developing trust; this is called object permanence.
THE NURSE ROLE IN HEALTH PROMOTION OF
A.Promoting Infant’s Safety
• Be certain any object that an infant can grasp or bring to the
mouth is either safe to eat or too big to fit in the mouth.
• Inspect toys and pacifier for small parts that could be aspirated
or broken off.
• Do not feed infants food such as popcorn or peats because these
can easily be aspirated.
• Never leave the infant on an unprotected surface
• Place a gate at the top and bottom of stairways, do not allow the
infant to walk with a sharp object in the hands or mouth.
• Raise crib rails and make sure they are locked before walking away
from the crib.
• Do not leave the child unattended in a high chair.
Motor Vehicle Accident
• Do not be distracted by an infant while driving.
• Do not leave an infant unattended in a parked car.
• Do not place an infant seat in the passenger side.
• Do not place plastic bags within infants reach.
• Do not use pillows inside the crib.
• Store unused appliances such as refrigerators or stoves with the
• Remove constricting clothing such as a bib from neck at bedtime.
• Never present medication as candy.
• Buy medications in containers with safety caps and put away
immediately after use.
• Place all medications and poisons in locked cabinets or shelves.
• Hang plants or set on high surfaces.
• Test warmth of formula or food before feeding
• Do not smoke or drink hot liquids while holding an infant.
• Turn handles of pans toward back of the stove.
• Place lit candles away from infants.
• Do not leave infants unsupervised near hot water faucets.
• Keep electric wires and cords out of reach.
B. Promoting Infant Development in Daily Activities
Bathing and dressing
• An infant does not necessarily need to bathed everyday; the
infant’s face, hands and diaper area needs to be washed.
• To prevent seborrhea or scaly scalp, the infant’s head and scalp
must be washed at least every other day.
• If seborrhea lesions to develop, they adhere to scalp in yellow,
crusty patches and the underlying skin may become slightly
• Patches can be softened by applying oil or petroleum jelly on the
infant’s scalp; crusts can be removed by shampooing the hair the
next morning using a soft or fine toothed brush.
• Bath time helps an infant learn different textures and sensations
and provides opportunity for parents to touch and communicate
with the child.
• Infants needs soft-soled shoes, socks or booties to keep them warm.
• Binding clothes should be avoided so as not to restrict their
• The most important time for children to receive fluoride is from 6
months to 1 years.
• Breastfed infants do not receive a great deal of fluoride from breast
milk, so it may be recommended that they receive fluoride drops
once a day
• Parents should be taught to begin brushing their child’s teeth even
before teeth erupt; use a washcloth over the gum pads.
• Once the teeth begin erupting, all surfaces should be brushed with
a soft brush or washcloth once or twice a day
• Toothpaste is not necessary for the infant because it is the
scrubbing that facilitates removal of plaque.
• Initial dental check-up should be made once the child is 2 years old
and continue at 6-month intervals throughout adulthood.
• Do not allow infant to wear soiled diaper for a lengthy period of
time; change diapers at least every 2 to 4 hours.
• During each diaper change, parents should wash the skin with clear
water or alcohol-free wipes and allowed to air dry.
• Use petroleum jelly to keep urine and feces away from the infant’s
• Baby powder can be used; however. Caution parents not to shake
the powder directly on infant’s skin, instead, sprinkle powder on
their hands before applying on the infant.
• Protect infant from sunburn; expose him/her to the sun for only
short periods, beginning to 3-5 minutes the first day, and gradually
increasing exposure on the succeeding days.
• Sunscreen is not recommended for infants less than 6 months.
• Arrange an enclosed outdoor space for the child to crawl and walk.
• Encourage the use of walkers to exercise their leg muscles.
C. Promoting Nutritional Health
The first year of life requires a high-protein, high-calorie intake.
A normal full-term infant can thrive a commercial iron-fortified
formula or breast milk without the addition of any solid until age 6
Introduce solid foods when the extrusion reflex disappears; this life-
saving reflex prevents an infant from swallowing or aspirating
foreign objects that touch the mouth
Introduce one food at a time, waiting 5 – 7 days between new items.
• The first food generally given to infants is cereal which is fortified
with B vitamins and iron. Cereal should be mixed in a small bowl
with enough fluid to make the mixture fairly liquid.
• Vegetables and fruits are the second ad third food to be introduced.
Vegetables have higher iron content than fruits. Caution parents
not to add butter or salt to the preparation.
• Meat is introduced at 9 months and egg yolk at 10 months. The egg
yolk contains the bulk of the iron content of an egg while the white
portion contains the protein.
• With the introduction of solid food, parent should arrange for the
child, to be feed three meals a day, if that is the family’s pattern,
and to join the family at the table.
Introduce the food before formula or breastfeeding when the infant
Use a minimum amount of salt and sugar on solid foods to keep the
number of additives to a minimum.
To prevent aspiration, do not place food in bottles with formula.
During this period, the infant might be resistant to chewing for a
day or two and be slightly irritable. Also, a breastfed baby might
refuse to feed because of pain.
High fever, convulsions, vomiting, diarrhea, and otic pain are not
normal signs of teething.
Use of over the counter medicines are not encouraged because these
may contain benzocaine, a topical anesthetic. If this is applied too
far back in the throat, it could interfere with the gag reflex.
Acetaminophen may be given every four hours, up to four times a
Instruct parents to check with the health care provider before giving
any medication to the infant.
B. Thumb Sucking
Assure parents that thumb sucking is a normal behavior as long as it
does not deform the jaw line and it stops when the child enters
Sucking reflex peaks at 6-8 months, whereas thumb sucking peaks
about 18 months.
C. Use of Pacifiers
An infant who completes a feeding but seems to appear restless and
actively searches for something to put inside his/her mouth may
need a pacifier.
A baby who has colic also enjoys pacifier because he/she interprets
pain as hunger.
If the infant is formula fed, parents should check the nipple of the
feeding bottle that the holes are small enough and the rubber is
Caution parents not to make pacifiers from a nipple stuffed with
cotton because it can lead to aspiration.
Parents should not attempt to wean the child from a pacifier from 3
months of age and during the time that the sucking reflex is fading
(usually at 6-9 months).
D. Head Banging
Head banging is used by infants to relax and fall asleep; this
behavior is considered normal.
Parents should pad the crib rails so infants cannot hurt themselves
and reassure them that head banging is a normal mechanism for
relief of tension.
Head banging past pre school age suggests a pathologic basis and
needs further evaluation.
E. Sleep Problems
Breastfed babies tend to wake up more often than those who are
formula fed because breastmilk is more easily digested.
Interventions for coping with this situation include delaying
bedtime by an hour, shortening afternoon sleep period, not
responding immediately to the child at night due to the possibility
that he/she might fall back to sleep, and providing soft toys or music
and allowing the infant to play during waking time.
Constipation usually occurs with formula-fed infants if their diet is
deficient in fluid.
As long as stools are not hard and contain no evidence of fresh
blood, this is normal infant behavior.
If constipation persists beyond 5 or 6 months of age, encourage
parents to check with the infant’s health care provider. Temporary
measures to relieve constipation include adding foods with bulk,
such as fruits or vegetables, and increasing fluid intake.
All infants with a history of constipation for more than a week
should be examined for anal fissure or tight anal sphincter. If tight
anal sphincter exists, parents are instructed to manually dilate the
sphincter two to three times daily until it dilates sufficiently.
Hirschprung’s disease may be manifested by constipated as early as
infancy. Symptoms of this disorder include ribbonlike stool,
diarrhea and abdominal distension.
F. Loose Stools
Stools of breast-fed infants are generally softer than those of
If a mother is taking laxative while breastfeeding, its effect is
demonstrated as very loose stools in the infant
Malabsorption syndrome or Celiac disease may manifest itself first
by loose stools and distended abdomen and deficiency of fat-soluble
Infants with associated symptoms such as abdominal cramping, loss
of appetite, decrease in voiding and weight loss should be examined
by a health care provider.
Paroxysmal abdominal pain which occurs in infants under 3 months
of age; its cause is unclear
It may occur in susceptible infants from overfeeding, swallowing too
much air while feeding, or from a formula high in carbohydrates.
Infant cries loudly and assumes a fetal position; his/her face
becomes flushed, fists clench and abdomen is tense.
Take a complete health history if infants with colic symptoms
because intestinal obstruction or infection may mimic an attack of
colic and be misinterpreted by the casual interviewer. Ask the
• Duration of the problem and its frequency; colic symptoms usually
last up to3 hours a day and occurs at least 3 days every week.
• What happens prior to the attack, associated symptoms of the
• Number and type of bowel movement.
• Family medical history because allergy to milk may stimulate colic
• Baby’s feeding pattern, breast-fed or formula-fed, and type of
• How parents/guardian feed the baby and whether they are burping
A basic rule for any abdominal discomfort is to avoid application of
heat in case the child is a suspect of appendicitis.
Caution parents to seek advice from their health care provider
before administering antiflatulents.
In most infants, colic disappears at the age of 3 months, because it
becomes easier to digest food and the infant maintains a more
upright position when feeding.
Miliaria or Prickly heat rash, occurs most in warm weather or when
the babies are overdressed or sleep in overheated rooms.
Symptoms include pinpoint, reddened papules with occasional
vesicles and pustules surrounded by erythema; usually appear on
the neck and spread upward to around the earlobes and onto the
face or down to the trunk.
Bathe the infant twice a day during hot weather using water and
with a small amount of baking soda to remove the rash.
To prevent further rash eruption, dress the infant with clothes that
have less-irritating fabric.
H. Baby-Bottle Syndrome
Occurs when an infant is put to bed while drinking from a bottle;
this results in decay of the upper teeth and lower posterior teeth.
Liquid from the propped bottle continuously soaks the upper front
teeth and lower back teeth; the problem becomes more serious
when the bottle is filled with milk and fruit juice because it has
more amount of sugar.
To prevent this problem, advise the parents not to put their infants
to sleep while drinking from a bottle.
If it is really necessary, advise parents to fill the bottle with water
and use a nipple with a smaller hole. They might want to dilute milk
with water if the baby insists on drinking milk.
See you next Monday...