1. Chapter 16Chapter 16
The InfantThe Infant

2. ObjectivesObjectives
• Describe the physical and psychosocial
development of infants from age 1 month to
12 months, listing age-specific events and
guidance when appropriate.
• Discuss the major aspects of cognitive
development in the first year of life.
• Relate the nursing responsibilities in health
promotion and illness prevention in infants in
the first year of life.
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3. ObjectivesObjectives (cont.)(cont.)
• Discuss the nutritional needs of growing infants.
• Compare breastfeeding, bottle feeding, and the
various infant formulas available.
• Describe how to select and prepare solid foods
for the infant.
• List four common concerns of parents about the
feeding of infants.
• Discuss the development of feeding skills in the
infant.
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4. ObjectivesObjectives (cont.)(cont.)
• Compare and contrast natural, organic, and
processed foods.
• Examine nutritional counseling for the infant.
• Identify the approximate age for each of the
following: posterior fontanel has closed,
central incisors appear; birthweight has
tripled; child can sit steadily alone; child
shows fear of strangers.
• Describe normal vital signs for a 1-year-old
infant.
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5. ObjectivesObjectives (cont.)(cont.)
• Discuss safety issues in the care of infants.
• Discuss the approach and care of an infant
with colic.
• Identify age-appropriate toys and their
developmental or therapeutic value.
• Discuss principles of safety during infancy.
• Discuss the development of positive sleep
patterns.
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6. MilestonesMilestones
• Describes general patterns of achievement at
various stages
– Often referred to as norms
– Nurse must understand normal range for
milestone achievement
• Establishment of sleep-wake cycle
• Social smile
• Drinking from cup
• Separation anxiety
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7. Average Vital Signs of the InfantAverage Vital Signs of the Infant
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8. Oral StageOral Stage
• Sucking brings comfort and relief from tension
• Important to hold infant during feedings
• Allow sufficient time for infant to suck
• Infants on IV fluid/nutrition need additional
attention and a pacifier to ensure the need for
sucking is satisfied
• When infants are able to use their hands more
skillfully, they will gradually derive pleasure and
comfort from other sources
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9. Motor DevelopmentMotor Development
• Grasp reflex disappears around 3 months of
age
• Prehension occurs around 5 to 6 months of
age and follows an orderly sequence of
development
• Parachute reflex appears around 7 to 9
months as a protective mechanism
• Pincer grasp well-established by 1 year of
age
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10. 10Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
The Development of Locomotion,The Development of Locomotion,
Prehension, and PerceptionPrehension, and Perception

11. 11Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc.
The Development of Locomotion,The Development of Locomotion,
Prehension, and PerceptionPrehension, and Perception (cont.)(cont.)

12. Emotional DevelopmentEmotional Development
• Consistency must be established to develop
trust, which is vital to the development of a
healthy personality
• Infants who are consistently picked up when
they cry tend to have fewer crying episodes and
less aggressive behavior as toddlers
• Infants will easily accomplish various activities if
they are not forced before they reach readiness
• When infant shows readiness to learn a task,
parents should provide encouragement
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13. Need for Constant Care andNeed for Constant Care and
GuidanceGuidance
• Sensory stimulation is essential for the
development of the infant’s thought
processes and perceptual abilities
• A crying child should be soothed
• If the infant appears hungry, do not delay the
feeding in order to adhere to a specific
routine
• An infant can recognize warmth and affection
or the lack thereof
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14. Development and CareDevelopment and Care
• Important to note that no two infants are the
same
• Physical patterns cannot be separated from
social patterns
• Abrupt changes do not take place with each
new month of life
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15. Community-Based Care:Community-Based Care:
A Multidisciplinary TeamA Multidisciplinary Team
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16. Health PromotionHealth Promotion
• Nurse’s responsibilities
– Guide parents and assist in the acquisition of
necessary skills to ensure the healthy growth
and development of their infant
– Provide appropriate community referrals as
indicated
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17. Coping with an Irritable orCoping with an Irritable or
Lethargic InfantLethargic Infant
• Whether irritable or
lethargic, many of the
same interventions
can be used
• An irritable baby cries
and may be difficult
to soothe
• A lethargic baby may
“shut down” and
sleep in order to
avoid an excessively
stimulating (loud or
noisy) environment
• Shield infant’s eyes
from bright light
• Sit quietly with infant;
don’t talk or sing
• Eliminate as much
noise as possible
• Talk in a soft voice
• Swaddle snugly
• Change infant’s
position slowly
• Provide nonnutritive
sucking
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18. ColicColic
• Periods of
unexplained
irritability and crying
in an otherwise
healthy and well-fed
infant
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19. Developing Positive Sleep PatternsDeveloping Positive Sleep Patterns
• Newborns sleep in 4-hour intervals
– By 4 to 6 months, can be up to 8 hours
• Synchronizing circadian rhythm of infant to
family routine is a learned behavior
• Position infants on their backs on a firm
mattress
• Infants rely on parent to soothe them back to
sleep if awakened during the night
– Assist infant to learn self-soothing behaviors
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20. Illness Prevention: ParentIllness Prevention: Parent
EducationEducation
• Stress importance of
periodic health checks
• Ensure infant receives
recommended
vaccinations at
appropriate times
• Provide education and
anticipatory guidance
for the developmental
changes that occur
• Stress importance of
changing diaper when it
becomes wet or soiled
• Monitor growth of infant
by documenting
measurements on a
growth chart
• Ensure adequate fluid
and nutrition are
provided
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21. Illness Prevention: PhysicalIllness Prevention: Physical
ExaminationExamination
• Physical examination in the clinic setting at
least five times in the first year
– Hearing and vision assessments as indicated
– Screening tests administered as required
– Growth grids and developmental screening
– Immunizations
– Nutritional counseling
– Provide appropriate education and/or
explanations to the parents
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22. ImmunizationsImmunizations
• Stress repeatedly importance of
immunizations and timing of administration
• Delays can lead to increased risk of serious
illness or even death
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23. Nutrition CounselingNutrition Counseling
• Solid food can slowly be added beginning
around 6 months of age
– The tongue extrusion reflex has completely
disappeared
– GI tract is mature enough to digest food
• Between 4 and 6 months, sucking is more
mature, and munching or an up-and-down
chewing/chomping motion ensues
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24. Parental ConcernsParental Concerns
• Prior to teaching about infant nutrition, the
nurse should assess
– Parental knowledge
– Infant developmental behavior, readiness
– Parent-child interaction
– Cultural and ethnic practices
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25. Breastfeeding and Bottle FeedingBreastfeeding and Bottle Feeding
• Human milk is best for infants younger than 6
months
• Formulas that are cow’s milk based and iron-
fortified are recommended by the AAP
• Whole cow’s milk not given until after 1 year
of age
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26. Absolute Contraindications toAbsolute Contraindications to
BreastfeedingBreastfeeding
• Galactosemia
• Phenylketonuria
• HIV-positive mother
• Chemotherapy
• Radioactive isotope therapy
• Illicit drug use
• Active, untreated pulmonary tuberculosis
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27. Prebiotics and ProbioticsPrebiotics and Probiotics
• Prebiotics
– Nondigestible food
ingredient
– Indirectly stimulates
growth or activity of
bifidobacterium (a
microorganism)
– Assures balance of
bacteria is
maintained
• Probiotics
– Protective to GI
tract
– Used to treat
diarrhea
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28. Safe Bottle FeedingSafe Bottle Feeding
• Check expiration date on container
• Follow instructions on how to mix, store, and
give formula to infant
• Always use clean containers to mix/store
formula
• Do not heat bottle in microwave
• Do not save formula that is left from a
feeding; can lead to diarrhea
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29. Adding Solid FoodsAdding Solid Foods
• Do not introduce new food if infant is ill, as
adverse effects such as allergic reactions
may not be appropriately identified
• Rice cereal is recommended as first food
• Do not mix cereal or baby food with formula
• Introduce one food at a time in small amounts
• Delay introduction of foods known to cause
allergic responses, such as orange juice, fish,
nuts, strawberries, chocolate, and egg whites
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30. Nursing TipNursing Tip
• New solid foods should be introduced before
the milk feeding to encourage the infant to try
the new experience
• As solid food intake increases, the amount of
formula or milk should decrease to avoid
overfeeding
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31. Recommended Fat Intake DuringRecommended Fat Intake During
InfancyInfancy
• Infants require almost three times more calories
per kilogram of weight than adults
• Easily digestible fats are needed for growth and
development, including brain development
• By age 6 months, the digestive tract has the
ability to digest fats present in food
• A well-balanced diet provides appropriate fat and
cholesterol intake
• A low-fat diet should not be given to infants under
2 years of age
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32. Health PromotionHealth Promotion
• Encourage breastfeeding
• Discourage overfeeding
• Teach recognition of signs of satiety
• Prevent early introduction of solid foods
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33. WeaningWeaning
• Signs of readiness include
– Infant eagerly looks forward to new tastes and
textures found on the spoon
– May not want to be held close during feedings
– May start to “bite” the nipple as teeth erupt
– Imitates parents/siblings
• Should be gradual, start with daytime then
progress to nighttime
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34. Organic and Natural FoodsOrganic and Natural Foods
• Do not contain any additives
– Strict guidelines/regulations on soil, fertilizers,
herbicides/pesticides
– If animal, no drugs or hormones are used prior
to processing
• Nutritive value has not been shown by
evidence-based research to be superior to
nonorganic foods
• Stress importance of reading food labels
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35. Infant SafetyInfant Safety
• Car safety
– Rear-facing for infants younger than 1 year or 22 lb
• Fall prevention
– Never leave an infant unattended on a flat surface
– Crib rails should be raised and securely locked
– Protect from stairways and pools
• Toy safety
– Should be appropriate for stage of development
– No small or removable parts that can be easily swallowed
– A child’s response to a toy may indicate readiness to learn
new skills
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36. Summary of Major DevelopmentalSummary of Major Developmental
Changes in the First YearChanges in the First Year
• Weight doubles by 6
months of age and triples
by 1 year of age
• Head and chest
circumference are equal
by 1 year of age
• Maternal iron stores
decrease by age 6
months
• Depth perception begins
to develop at age 9
months
• Infants older than 4
months can voluntarily
roll over
• By age 1 year, infants can
take some independent
steps
• Primitive reflexes are
replaced by voluntary
movements
• Tooth eruption begins at
age 6 months, when
“biting” activities begin
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37. Question for ReviewQuestion for Review
• What is the best way to reduce the incidence
of sudden infant death syndrome (SIDS)?
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38. ReviewReview
• Objectives
• Key Terms
• Key Points
• Online Resources
• Review Questions
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