Growing

1. INFANCY PERIOD: BIRTH TO 12 MONTHS
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 Full term: born 38 to 42 weeks after conception
 Preterm (Premature): born less than 37 weeks after conception
 Postterm (Postmature): born more than 42 weeks after conception
 Low birth weight: normal gestation, weighing less than 2.5 kgs
 Very low birth weight: below 1.5kg
 Extremely low birth weight: below 1kg
 Small for gestational age: 10% or more below expected weight,
based on length of gestation
Infant Classifications
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Measuring neonatal health & responsiveness
Apgar score: a quick assessment of the newborn’s heart rate,
respiration, color, muscle tone, and reflexes that is used to gauge
perinatal stress and to determine whether a neonate requires
immediate medical assistance.
Each item is given a score of 0, 1, or 2.
Total score of 0–3 is severe distress, 4–6 moderate distress, & 7–10
good adjustment
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General Measurements
 Weight: Average birth weight 2700–4000 grams
- 10% of birth weight is lost in first 3-4 days of life, primarily through
fluid losses & regained by 7 days if formula fed, 14 days if breastfed.
- The average weight being about 3400 g
 Length: Average birth length 48–53 cm. (19–21 inches).
 Accurate birth weights and lengths are important because they provide
a baseline for assessment of risk status and future growth.
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 Head: Average neonatal head circumference is 33–35 cm
about 2–3 cm (1 inch) larger than chest circumference.
— Head circumference is 70% of adult size
— Needs to consume 120 cal. /kg of weight per day
General Measurements
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—Molding, or overlapping of the soft skull bones, allows
the fetal head to adjust to the diameter of maternal pelvis; the bones readjust
within a few days producing a rounded appearance; molding may alter head
circumference; head and chest circumference may be equal for first 1–2 years
—Fontanels; Anterior diamond shape; Posterior fontanel triangular shape;
(between the unfused bones of the skull); Fontanels should be flat, soft, and firm;
may bulge when crying. The posterior fontanel closes at 2–3 months; anterior
fontanel closes at 12–18 months
—Maturation of the brain occurs at different rates in different areas; the prefrontal
cortex is last to mature (in adolescence).
Newborn Infant or Neonate (birth to 1 month)
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—Temperature, axillary—36.5°-37° C
—Heart rate: apical—120-140 beats/min
—Respiratory rate: 30–60 breaths per minute and irregular; count for one full
minute; neonates are abdominal breathers and obligate nose breathers
Vital Signs
Elimination
I.Meconium: infant’s first stool should pass within the first 24–48 hours
II.Transitional stools usually appear by 3rd day after initiation of feeding
III.Milk stool appears by 4th day, by 2nd week elimination pattern associated with the
frequency and amount of feeding. Breast fed-pasty, yellow, odor of sour milk; formula fed
light brown, firmer consistency, stronger odor.
IV.Urinary output 200–300 ml by the end of the 1st week
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 Cardiovascular
• Functional closure of fetal shunts occurs.
• Transition from fetal to postnatal circulation occurs.
 Respiratory
• Onset of breathing occurs as air replaces the fluid that filled the
lungs before birth.
 Renal
• System doesn't mature fully until after the first year of life; fluid
imbalances may occur.
 GI
• System continues to develop.
• Uncoordinated peristalsis of the esophagus occurs.
• The neonate has a limited ability to digest fats.
Physiology Of The Neonate
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 Thermogenic
 The neonate is susceptible to rapid heat loss because of acute change in
environment and thin layer of subcutaneous fat.
 Nonshivering thermogenesis occurs.
 The presence of brown fat (more in mature neonate; less in preterm
neonate) warms the neonate by increasing heat production.
 Immune: The inflammatory response of the tissues to localize infection
is immature.
 Hematopoietic: Coagulation time is prolonged.
 Neurologic: Presence of primitive reflexes & time in which they appear
& disappear indicate the maturity of the developing nervous system.
 Hepatic: The neonate may demonstrate jaundice
Physiology of the Neonate
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 Integumentary
 The epidermis & dermis are thin & bound loosely to each other.
 Sebaceous glands are active.
 Musculoskeletal: More cartilage is present than ossified bone.
 Reproductive
 Females may have a mucoid vaginal discharge &
pseudomenstruation due to maternal estrogen levels.
 Small, white, firm cysts called epithelial pearls may be visible at
the tip of the prepuce.
 The scrotum may be edematous if the neonate is presented in the
breech position.
Physiology of the Neonate
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 Assessment of reflexes is an essential component of the neurological
assessment, along with assessment of posture, muscle tone, head
control, and movement
 Reflexive movements that are characteristic of newborn behavior begin
to appear by the end of the first trimester.
 Among the first of the reflexes to appear is the Babinski toe sign with
later appearance of the swallowing and sucking reflexes.
 Reflexive movements of the newborn are indicative of the motor
behavior control exerted by the newborn’s spinal cord and medulla.
Neurological
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Reflexes
 Many of the reflexes present at birth will normally disappear
around the fourth month of age.
 These include Moro’s reflex, the rooting reflex, and the palmar
grasp reflex.
 Absence of these reflexes or persistence of these reflexes past the
period they would normally disappear may indicate severe
problems of the central nervous system.
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- Movements are sporadic, symmetrical & involve all extremities
- Extremities flexes, knees flexed under abdomen
- Turns head from side to side when prone; briefly lifts head off
bed.
- The newborn is not capable of purposefully rolling the body from
one side to the other.
- Little head control and marked head lag is normal.
Motor Development
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First hour of life quiet, alert, eyes wide opened with vigorous
sucking
Next 2–3 days sleeps most of the time, recovering from birth
Sleeps 20–22 hrs/day, with brief waking periods of 2–3 hrs
Sleep periods vary from 20 minutes -6 hours, little day or night
variation
Wake newborn to feed q4hours (recommended by most
practitioners)
Sleep–Wake Pattern
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Visual function at birth is limited, improving rapidly during the
next few years as the structure develops.
Newborn vision is about 20/200 to 20/600; cones perceive red
and green.
Focus on objects 8–10 inches away and can perceive Forms
Preference for human face apparent
The blink reflex is present in normal newborns.
Tear glands begin to secrete within the first 2 weeks of life, and
the infant may experience problems with mucus plugging the
tear duct.
Transient strabismus is a normal finding during the first few
months.
Vision
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Auditory systems function at birth
Hearing begins prenatally; fetuses can hear during the last few
months before birth.
Because hearing thresholds are higher for newborns, sounds
must be louder for newborns to hear them compared to adults
Hearing impairment at birth may be related to Vernix and
amniotic fluid that is temporarily in the ears.
Newborns can determine the direction of a sound.
Congenital hearing loss is strongly linked to genetic influences.
Hearing
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 Newborns respond to touch.
 Newborns can feel pain, heat, cold, and pressure
Touch & Smell
Newborns can distinguish between odors.
The newborn will react to strong odors such as ammonia and
fresh onion.
Infants are able to detect the smell of their mother’s breast milk as
early as 6 to 10 days after birth.
The ability to smell and differentiate smells continues to improve
as the child matures
Infants have a small nasal bridge and are obligate nose breathers
until 1 month of age.
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—The sense of taste is immature in newborns, although they can
distinguish among sugar, lemon, and salt.
—Newborns prefer sweet tastes.
—Sensitivity to strong tastes becomes heightened at 2 - 3 months.
—The sense of taste is not fully developed until approximately 2
years of age.
Taste
Tonsils
—. The tonsils, located in the pharyngeal cavity, are part of the
lymphatic system.
— Tonsillar tissue is usually not evident in the newborn
—The tonsils in young children are generally larger than in adults.
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— Mews and makes throaty noises.
— Shows interest in human face..
Psychosocial Development
—Interactions during routine care between newborn
and parent lay foundation for deep attachment
Socialization And Vocalization
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— Reflexive.
— Newborn learns to turn to the nipple
— Learn Gains satisfaction from feeding and being held, rocked,
fondled, and cuddled that crying results in parents’ response
—.Has an intense need for sucking pleasure.
— Quiets when picked up.
Cognitive & Emotional Development
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—Infancy most rapid period of growth; especially during the first 6
months
—Growth monitored by plotting on standardized growth chart
Infant (1 month to 1 year)
Weight
—Infants gain 680 g per month until age 5 months,
—Birth weight doubles at 5–6 months
—An average weight for a 6-month-old child is 7.26 kg
—Weight gain slows during the second 6 months
By 1 year of age the infant’s birth weight has tripled, to an
average of 9.75 kg
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—Grows 2.5 cm (1 inch) per month for the first 6 months
—Slows during the second 6 months
—Grows 1.25 cm (1⁄2 inch) for second 6 months
—Average height is 65 cm at 6 months and 74 cm at 12 months
—Birth length increases by 50%, mainly in the trunk, by 1 year
Length
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—Closure of the cranial sutures occurs, with the posterior fontanel
fusing by 6 to 8 weeks of age and the anterior fontanel closing by 12
to 18 months of age (the average age being 14 months).
—Head circumference increases approximately 2 cmmonth
from birth-3 months, 1 cmmonth from 4 to 6 months,
and 0.5 cm per month during the second 6 months.
—The average head size is 43 cm at 6 months & 46 cm at 12 months
—By 1 year of age head size has increased by almost 33%.
Head Growth
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—Increases by 2–3 cm. for the first 6 months (1 inch
less than head circumference)
- 6-12 months (0.5 cmmonth)
—Chest and head circumferences equal at 1 year
—The heart grows less rapidly than does the rest of the body. Its weight is usually
doubled by 1 year of age, whereas body weight triples over the same period.
—The size of the heart is still large in relation to the chest cavity; its width is
approximately 55% of the chest width.
Chest Circumference
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—Heart rate 80–130
—Respiratory rate 30–50 up till 6 months; 20–30 till 2 years
—B/P 90/50 on average
Vital Signs
Dentition
—Beginning signs of tooth eruption by 5–6 months
—Chewing and biting 5–6 months
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—Rudimentary fixation on light or objects; ability to follow light
to midline; and differentiates light and dark at birth
—Hearing and touch are well developed at birth
—Rudimentary color vision begins at 2 months and improves
throughout the first year
—Able to fixate on moving object 8–10 inches away, 45 degrees
range at 1 month
Sensory
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— Follows objects 180 degrees at 3 months
—Beginning hand eye coordination at 4 months
—Can fixate on very small objects at 7 months
—Begins to develop depth perception 7–9 months
—Able to discriminate simple geometric forms at 12 months
—Able to follow rapidly moving objects at 12 months
—Locates sound by turning head to side, looking in same direction
at 3 months
Sensory
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• Most newborn infants sleep when not eating, being changed or bathed
• Most infants sleep 9–11 hours a night by 3–4 months
• Total daily sleep is approximately 15 hours
• Nighttime sleep hours and amount & length of naps vary among infants
• Most infants take routine morning & afternoon naps by 12 months
• Sleep with REM (rapid eye movements) may represent about 50% of
the time newborns spend sleeping; this percentage gradually decreases
with age.
Sleep
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Gross Motor Developmental Milestones
Milestone Age
Good head control 2–3 months
Rolls––front to back 4–5 months
Rolls––back to front 5–6 months
Sits alone 5–6 months
Creeps or crawls 7–8 months
Pulls to standing, cruises 9–10 months
Stands alone 11–12 months
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Fine Motor Developmental Milestones
—Grasps & briefly holds objects & takes them to mouth at 3 months
—Uses palm grasp with fingers encircling object, transfers cube from
hand to hand at 6 months
—Crude thumb-finger pincer grasp, bangs hand held cubes together
at 9 months
—Places tiny object, such as raisin into container, makes marks with
crayon at 12 months
—Builds tower of two cubes, scribbles with crayon at 15 months
Assessment Alert
Head lag at 6 months requires further neurological evaluation.
An infant who does not pull up to a standing position by 11 or 12 months needs
evaluation for dysplasia of the hip.
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Cognitive Development (Piaget)
Sensorimotor (birth to 2 years)
 Learning takes place through the child’s developing sensory and
motor skills
 The child progresses from reflexive activity to purposeful acts
 Initially the infant focuses on own body; discovers own body
parts at 2–4 months; gradually shifts attention to objects in the
environment
 Learning by simple repetitive behaviors: repeating pleasing
actions; learning that sucking gives pleasure, leads to generalized
sucking of fingers, rattle
 Prolonging interesting actions for reasons that result; grasping
and holding becomes shaking, banging& pulling. Shaking
makes one noise, shaking more or less makes a different noise
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—Imitates simple acts and noises
—Beginning understanding of object permanence, searches
for dropped objects.
—Object Permanence: the understanding that objects
continue to exist even when they cannot be seen, heard, or
touched.
 Can find partially hidden object at 6 months
 Briefly searches for dropped object; begins to
understand object permanence 7–9 months
 Develops sense of object permanence at 10 months
 Searches for objects where seen last, even if not hidden
at 12 months
Sensorimotor (birth to 2 years)
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Object Permanence
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• Language Development
—Vocalization is distinct from crying at 2 months
—Vocalizes to show pleasure; squeals at 3 months
—Laughs at 4 months
—Begins to imitate sounds at 6 months
—One syllable utterances ma, da, mu, hi at 6 months
—Chained syllables baba, dada at 7 months
—Dada, mama with meaning at 10 months
—Five word vocabulary at 12 months
Assessment Alert
Language Developmental Milestone is: First words with meaning “dada,” “mama”
around 10 months.
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—Trust vs. Mistrust (birth to 1 year)
—Infants whose needs for warmth, comfort, love, security, and food
are met learn to trust. Infant’s whose needs are significantly delayed
or unmet, learn to mistrust
—Erikson reasons that the quality of parent–infant interactions
determines development of trust or mistrust
Psychosocial Development (Erikson)
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—Parents and infants develop a strong bond that grows into deep
attachment as the parent cares for the newborn
—Stares at parents’ face when parent talks to infant at 1 month
—Smiles socially at 2 months
—Recognizes familiar faces at 3 months
—Demands attention, enjoys social interaction with people at 4 months
—May show aggressiveness by occasional biting
—Plays peekaboo and pat-a-cake at 11 months
Psychosocial Behaviors
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—Separation Anxiety: emerging awareness that infant is an individual distinct
from primary attachment caregiver
 Separation Protest: crying when the caregiver leaves
Due to anxiety about being separated from their caregivers
a. Develops around 9 months; peaks at around 18 months
b. Suggestions for parents
(1) Recognize that bedtime, going to childcare, having a childcare provider at
home are all separations
(2) Gradually introduce child to new situations and caretakers
(3) The child learns to accept separation through multiple, brief separations and
reunions
(4) Games such as “peek-a-boo” and “hide-and-seek” may be helpful
Emotion and personality development
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—Begins to express fear; animal noises, the dark
—Stranger anxiety Emerging awareness and preference for mother
/ primary caregiver; early indicator of healthy attachment process
emerging around 6 months & intensifies in the following months
Fears
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•
—Oral stage (birth to 1 year)
—Actions center on oral activities. The infant sucks, tastes, bites,
chews, swallows, and vocalizes for pleasure
Psychosexual Development (Freud)
Communication with Infant
—Talking softly, singing, rocking, cuddling
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 During the first year of life, at least six visits to the health care facility
are recommended.
 These are essentially considered well-baby visits and usually occur at 2
weeks, 2 months, 4 months, 6 months, 9 months, and 12 months.
 During these visits, the nurse collects data regarding the infant’s growth
and development, nutrition, and sleep; the caregiver–infant relationship
and any potential problems.
 The infant’s weight, height, and head circumference are documented,
and the infant receives immunizations to guard against disease.
 Family teaching, particularly for first-time caregivers, is an integral part
of health promotion and maintenance
Routine Checkups
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TB= Lt upper arm
DPT= Lt. outer mid. Thigh IM
HepB1= Rt. outer mid .thigh IM

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 Children are immunized against hepatitis B virus, Rota virus,
diphtheria, tetanus, pertussis, rotavirus, Haemophilus influenzae
type b, polio, measles, mumps, rubella, pneumococcal disease,
and tuberculosis disease. In addition, they may be immunized
against the hepatitis A virus.
 Immunizations are begun shortly after birth.
Immunizations
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—Encourage parent to stay and provide care for infant; hospitalized
infants experiencing repeated bodily intrusions, multiple caregivers,
and separation from the parent are at risk for difficulty with
establishing boundaries and building trust
—Diminish stranger anxiety by limiting the number of caregivers
who have contact with the infant
Nursing Intervention Alert
Parents of infants that are ill, have congenital defects, or who are
hearing or visually impaired will need extra support and teaching on
how to compensate and minimize developmental delay for those
children. Nurses play an instrumental role in teaching, modeling
interactions, and care for the compromised infant.
Nursing Care of the Hospitalized Infant
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 Speak softly and handle gently, but firmly, have calm, unhurried
approach
 Keep infant in view of parent; if possible have parent hold
infant; upright position tolerated best; encourage parent to cuddle
infant after procedure; if parent not available place familiar
stuffed animal near infant
 Diminish stranger anxiety; have primary nurse perform or
assist with procedure; limit number of strangers entering room
during procedure
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 Sensorimotor considerations; use sensory soothing measures;
firm gentle handling and stroking; hugging and cuddling;
soothing, calming, quiet voice
 Analgesics as needed
 Do not perform painful procedures in crib
 Expect older infants to resist; restrain safely if needed
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 Caring for the infant:
I. Care of umbilicus and circumcision
II. Support of thermoregulation in neonate
III. Prevention of diaper rash, skin care
Parent Teaching
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To prevent diaper rash:
I. Soiled diapers should be changed frequently.
II. Check Q2-4 hours while the infant is awake to see if the diaper
is soiled. Waking the baby to change the diaper is not necessary.
III. Cleanse the diaper area with water and a mild soap if needed
IV. Commercial diaper wipes also may be used, but they are an
added expense
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IV. Care of the teeth
 Clean teeth with damp cloth
 Frozen teething ring to reduce inflammation and manage pain
 Tylenol may be given for teething pain disrupting sleep and feeding
 Topical baby Oral Jel, benzocaine, may be used if instructions
followed carefully.
 Prevent dental carries by avoiding having infant falling asleep with
bottle, causing milk to linger, avoid apple juice bottles for older
infants before sleep
 Fluoride supplement at 6 months and up for breast or formula fed, if
water supply not adequately fluorinated
V. Shaking a baby can result in Shaken Baby Syndrome which causes
hemorrhaging & swelling in the brain, spinal cord injury, or eye damage
Parent Teaching
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Safety Promotion and Injury Prevention
 Injuries are a major cause of death during infancy, especially for
children 6 to 12 months old.
 The three leading cause of accidental death injury in infants were
I. Suffocation
II. Motor vehicle–related injuries
III. Drowning
—Use infant car seat
—Check bathing water temperature/formula temperature
—Ensure crib mattress fits snugly; no pillow in the crib
—Position supine or supported on side for sleep until infant can turn
over because prone position may increase sudden infant death
syndrome (SIDS). SIDS-unexpected unexplained death of a
seemingly healthy infant
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54. Nursing Intervention Alert
Alert parents to major causes of injury & death: aspiration of
foreign objects, suffocation, falls, poisoning, burns, motor vehicular
injuries, & teach prevention.
Safety
 Infants should be placed on their back to sleep. A pillow or bedroll can
be used to keep the baby in place.
 Prevention of ingestion/aspiration of foreign objects
a. Keep pins, buttons, and other small objects off the floor & out of reach
b. Do not feed infants hard foods (e.g., nuts, hard candies)
c. Do not give infant balloons
d. Do not prop infant’s bottle
e. Select pacifier with shield too large to enter infant’s mouth
f. Learn emergency procedure for dealing effectively with choking
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—Infants’ activity is primarily narcissistic and revolves around their own body.
Body parts are primarily objects of play and pleasure.
—From birth to 3 months, infants’ Play is dependent; pleasure is demonstrated by
a quieting attitude (1 month), a smile (2 months), & a squeal-cry (3 months).
—From 3 to 6 months infants show more discriminate interest in stimuli and
begin to play alone with a rattle or soft stuffed toy or with someone else. They
interact much more during play.
—Play with large toys with movable parts, noisemakers, stacking toys, blocks,
pots, pans, push and pull toys, large puzzles with few pieces
—Read to infant: nursery rhymes, books with various textures, books with large
bright pictures; encourage infant to turn pages
Play, stimulation and toys
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—By 4 months of age they laugh aloud, show preference for
certain toys, and become excited when food or a favorite object is
brought to them. They recognize an image in a mirror, smile at it,
and vocalize to it.
—By 6 months to 1 year, play involves sensorimotor skills. Infants
play actual games such as peek-a-boo and pat-a-cake. They
demonstrate verbal repetition and imitation of simple gestures.
—Play is solitary or one sided, infants choose with whom they
will interact.
Play, stimulation and toys
The bright colors of a toy provide visual stimulation for the infant.
Play, stimulation and toys
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—Breast milk is a complete and healthful diet for the first 6 months;
importance of breast-feeding mother being well nourished
—Support choice to use commercial iron fortified formula if breast-feeding
not desirable to mother or not a feasible option; recommend mixing
powdered formula with bottled water, if water supply has lead or other
impurities
—No additional fluids needed during first 4–6 months, will fill infant up,
not allowing for adequate nutritional calories
—Cows milk, imitation milks are not acceptable
—as well Breast milk or formula primary source of nutrition in second 6
months
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—Gradual introduction of solid foods during second 6 months; starting
with cereals, fruits, vegetables, and meats
—Do not feed nuts, food with pits, hot dogs, or any foods that could block
the airway or have risk of choking
—Honey not given in first year, a source of botulism
—Supplements include: vitamin D, iron by 4–6 months (fetal iron
stores are depleted), vitamin B12 may be needed if mother’s intake
is inadequate
—Fluoride beginning at 6 months
—Extremely reduced protein and calorie diets can result in diseases
(e.g., Marasmus and Kwashiorkor) that impair development and can
be fatal
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TEMPERAMENT
 The infant’s temperament influences the type of interaction that
occurs between the child and parents and other family members.
 The more dissonance (or lack of harmony) between the child’s
temperament & the parent’s ability to accept & deal with the
behavior, the greater the risk for subsequent parent-child conflicts.
Temperament has a strong biologic component & the environment,
particularly the family, may modify temperament
Describing and Classifying Temperament
I. Easy child
II. Difficult child
III. Slow-to-warm-up child
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—Consistently and promptly meeting infant’s needs builds trust;
does not “spoil” infant
—Setting limits is appropriate and will be required in establishing
nighttime routine
—Corporal punishment is unacceptable
Discipline
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 Gastrointestinal pain, fussy period, crying does not stop &
continues for more than 3 hours, or the infant appears
inconsolable, often pulling up the legs and passing gas.
 In breast-fed infants, colic sometimes is a reaction to something
the mother has eaten.
 In other infants, colic may result from sensitivity to milk or milk
products. Colic may indicate a medical problem, but this
circumstance is very rare.
 Episodes generally peak at about 6 weeks of age and stop at
about 3 months of age.
Colic

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_ Several interventions can alleviate this problem
 Creating a soothing and restful environment for the infant.
 Changing the infant’s formula may also decrease symptoms
(soy formula has been helpful)
 If the mother is breast-feeding, she should eliminate from her
diet any foods that produce gas (e.g., cabbage, onions, broccoli)
and reduce her caffeine intake.
 She should also eliminate milk products from her diet,
particularly if there is a family history of milk intolerance or
other allergies.
Colic

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 If the infant is bottle-feeding, a formula that is not based on cow’s
milk can be tried.
 Usually, colic caused by food intolerance will improve in 1-2 days.
 Laying the infant on his or her stomach across the parent’s knees,
with a pacifier, while rocking often helps relieve any discomfort.
 Warm baths may also relax & soothe, creating a more comfortable
state and helping to induce sleep
Colic

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 Common condition 3-4 days after birth (about 50% of
infants)
 Caused by immaturity of liver
 Symptoms include yellowing of skin and eyes
 Usually not dangerous; disappears without treatment
 Severe cases without treatment can lead to brain damage

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 Vitamin D Deficiency. Rickets, a disease affecting the growth and
calcification of bones, is caused by a lack of vitamin D.
 The absorption of calcium and phosphorus is diminished because
of the lack of vitamin D, which is needed to regulate the use of
these minerals.
 Early manifestations include softening of the occipital bones and
delayed closure of the fontanelles.
 There is delayed dentition.
 As the disease advances, thoracic deformities, softening of the
shafts of long bones & spinal & pelvic bone deformities develop.
Vitamin D Deficiency

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 Milk allergy is the most common food allergy in the young child.
 Symptoms that may indicate an allergy to milk are diarrhea,
vomiting, colic, irritability, respiratory symptoms, or eczema.
 Infants who are breast-fed for the first 6 months or more may
avoid developing milk allergies entirely unless a strong family
history of allergies exists.
 Children with severe allergic reactions to milk are given
commercial formulas that are soybean.
Milk Allergy

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 Children with lactose intolerance cannot digest lactose, the
primary carbohydrate in milk, because of an inborn deficiency
of the enzyme lactase.
 Symptoms include cramping, abdominal distention, flatus, and
diarrhea after ingesting milk.
 Commercially available formulas soybean.
 The child needs supplemental vitamin D.
 Yogurt is tolerated by these children.

68. Marasmus
Marasmus affects babies who get insufficient protein and too few
calories, as can easily occur if a mother is malnourished and does
not have the resources to provide her child with a nutritious
commercial substitute for mother’s milk.
A victim of marasmus becomes very frail & wrinkled in appearance
as growth stops and the body tissues begin to waste away. Even if
these children survive, they remain small in stature and often suffer
impaired social and intellectual development.
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69. Kwashiorkor
Kwashiorkor affects children who get enough calories but
little if any protein. As the disease progresses, the child’s hair
thins, the face, legs, and abdomen swell with water, and severe
skin lesions may develop.
In many poor countries of the world, one of the few high-
quality sources of protein readily available to children is
mother’s milk. So breast-fed infants do not ordinarily suffer
from marasmus unless their mothers are severely malnourished;
however, they may develop kwashiorkor when they are weaned
from the breast and denied their primary source of protein.
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 Generally refers to infants and young
children whose weight is below the 3rd
percentile on National Center for
Health Statistics (NCHS) growth
standards
 Traditional categories include organic
FTT, nonorganic FTT, and mixed
etiology FTT
 Newer categories include
neurodevelopmental FTT &
socioemotional FTT
Failure-to-Thrive (FTT)
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71. Nonorganic Failure To Thrive
An infant growth disorder, caused by lack of attention
and affection, that causes growth to slow dramatically or
stop is a growth disorder that appears early, usually by 18
months of age.
Babies who display it stop growing and appear to be
wasting away, in much the same way that malnourished
infants with marasmus do.
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