Growth and development of Infant and milestones

1. GROWTH &
DEVELOPMENT OF
INFANT..

3. INTRODUCTION....
Child rearing is not an easy task; it presents
challenges to both new & “SEASONED” parents....
Its thrilling event in child's family because of its
GROWTH & DEVELOPMENT.

4. What is growth?
An increase in number & size of cells as they divide
and synthesize new portions
Increase size & weight of the whole or any of its
part.

5. What is development ?
A gradual change & expansion advancement from
lower to more advance stages of complexity.

6. What is infancy?
Period between birth to 12 months of age.
neonatal - birth to 28 days.
Infancy -1 to 12 months

7. BIOLOGICAL DEVELOPMENT...
Progressive maturation.
Center to periphery – cephalocaudal.
Head to toe - proximal distal.
Very rapid at 1st year-especially initial 6
months.

8. HEIGHT...
Height increases - 2.5cm(1”) per month@ 1st -6
months.
2nd -6 months increase half 1.5 cm(.5”) per
month.
Average this 65cm @ 6 months and 75cm @ 12
months.
The increase occur in the trunk than legs.

9. BODY WEIGHT...
Infant gain weight 30 gmsday until 6 months and
15 gmsday after 6 months.
At 6 months wt double & 1yr wt tripled to average of
10 kgs.

10. HEAD CIRCUMFERENCE...
ITS DETERMINANT OF BRAIN GROWTH
HC increases
-2cm month from birth to 3 months
-1cmmonth from birth to 4-6 months
-0.5cmmonth @ second 6 months.
Average hc is 43cm @ 6 months and 46cm at 12
months.

11. FONTANELLE...
Closure of cranial
suture:
*posterior
fontanel - 6 to 8 wks.
*anterior fontanel
– 12 to 18 months
Expanding head size
reflects growth &
differentiation of
nervous system.

12. CHEST CIRCUMFERENCE...
Chest circumference will be equal to head
circumference @1 yr of age.
Heart grows less than other parts of the body.
Size of heart is still large in relation to chest
cavity; its width is ~ 55%of chest width.

13. FACTORS AFFECTING INFANT
GROWTH....
GENITIC METABOLIC
ENVIRONMENT
NUTRITION

14. SENSORY CHANGES...
Vision:
Binocularity – begin 6wks end 4months.
Visual preference- 6 months.
Depth perception -7 to 9 months.
Acquity2040 -12 months.

15. HEARING...
Progressive myelination of auditory pathway
occur.
8-12wks turn head to sound side.
12-16wks looks same direction.
16-24wks looks up & down.
24-32wks respond to own name.
32-40wks localize sounds.
40-52wks know several word meaning,
respond& listen sound

16. SMELL
Able to smell breast milk.
Differentiate own mother milk & other
mother milk.

17. TASTE...
Sweet –eager to suck.
Sour – puckering.
Bitter- angry expression.
Tasteless –no facial expression.

18. TOUCH...
Tactile stimulation @ 1 month of age.
Any part of body, face, hands & soles of
foot seem most sensitive.

19. MATURATION OF BODY SYSTEMS...

20. RESPIRATORY SYSTEM...
Resp. rate slows and relatively stable.
Resp. movements continue abdominal. Factor
predispose respiratory problem:
Close proximity of trachea to bronchi.
Short straight Eustachian tube close to ear
Inability to produce IgA in mucosal lining.
Small airway.
Pliant rib cage –less recoil
Volume of dead space is large.

21. CARDIOVASCULAR...
Rythm - sinus arrythmia
Heart rate slow as infant grows...
Heart rate-
Systolic pressure raises- increase ability to
pump blood.
Blood pressure -

22. Hematological ....
Fetal Hb present up to 5 months –physiologic
anemia.
High level of fetal Hb depress production of
erythropoietin.
Maternal Fe stores present up to 5 to6 months.
End of 6th month low Hb level.

23. DIGESTIVE SYSTEM...
Immature digestive process up to 5-6 month.
Evidence in stool.
Low enzyme secretion for digestion.
Human milk compensate digestion process.
Hcl acid+ renin= casein (milk) to curd.
One / two bowel movements per day.
At 1 yr end 3 meal/day.

24. Liver....
Immature organ in gastro system.
Gluconeogenisis, formation of plasma protien &
ketone ,storage of vitamins& deamination –
imature.
SUCKING & SWALLOWING:
Sucking start 15 -18 wks onwards.
* nutritive sucking
*non nutritive sucking.

25. Swallowing...
Food lie in shallow groove on top of tongue.
milk flow along side of mouth between tongue cheek
& gum pad
bolus move downward the posterior wall of pharynx,
displace the soft palate.

26. Immune system....
IgG from mother last for 3 months.
Remain for 6 months.
Adult level @ 1yr.
6 – 12 months high chance of infection.
IgA, IgD, IgE reach maximum @ early
childhood.

27. FLUID& ELECTROLYTE...
75% of body is water & extra cellular fluid.
As % of fluid decreases, ECF from 40% at term to
20% adulthood.
ECF composed blood plasma, interstitial fluid,
lymph .
More fluid loss- dehydration.

28. Renal system
Kidney immature – dehydration.
Maturation complete @ 2nd yr.
Filtration of glomeruli reduced.
Voiding increased.
Specific gravity – 1.000 to1.010

29. Endocrine ...
Adequately developed @ birth but function is
immature.
Lack of haemostatic control because- various
functional deficiencies
imbalance in fluid & electrolytes
glucose concentration
amino acid metabolism

30. Motor development
Fine motor development:
3rd month – palmar grasp
4th month – look for object to hands.
5th month – voluntarily grasp object.
6th month - manipulative skills.
7th month – transfer object hand to
hand.

31. Contd...
8th month – crude pincer grasp.
10th month – let object to other.
11th month – put object in a container &
remove.
1 year – build tower of 2 block .

32. Gross motor development....
1.Head control –
3 to 5 month.
Lift head 90* - 4th month

33. Rolling over..
Ability to turn abdomen to back – 5th
month.
Turn back to abdomen – 6th month

34. Sitting...
Head control 3-4 month
Convex curve of back 4th month
straightening of back 6th month
Spinal column straight sit alone, lean forward-
7th month
sit alone – 8th month

35. Locomotion....
7-8 month bear weight on their leg.
Crawling to creeping @ 9th month.
11th month walk hold with support.
1year walk alone.
Locomotion....

36. Motor age assessment...
Motor quotient = motor age x100
chronological age
Inference:
>85 – normal limits
<70 – dvpt . Delay
70-85 _ boderline.

37. Psycho social dvpt....
Erickson – trust vs mistrust.
Developing sense of trust:
FIRST 6 MONTHS:
• CARING NEEDS.
• FEEDING
• COMFORT
• STIMULATION
• WARMTH & SHELTER
• DIAPER CHANGE
• LOVE & AFFECTION

38. SECOND 6 MONTHS....
Recognize & respond others.
Watch mom& reach her.
Sense of control.
Teething management.

39. Sense of mistrust...
Insufficient feeding.
Improper care.
Harsh tone & frightening
Tension & anxiety of marital relationship.
Fear of danger .
Separation anxiety

40. Cognitive development...
Piaget – sensory motor phase  :
6 stages -4 stage for infancy(1-12 month)
*use of reflexes- birth to1 month.
*primary circular reaction.1- 4months.
*secondary circular reaction4-8 months.
*co- ordination of secondary schemas
9-12 months

41. Development of body image..
It parallel sensory motor development.
Kinetic & tactile experience 1st body
image
Mouth - pleasurable sensation.
Hand & fingers – next.

42. Language development...
Infants 1st verbal communication -
CRYING
Message of urgency, hunger,
displeasure.
Crying tend to reduce @ 12wks.
Parents need guidance in consoling
techniques such as holding, swaddeling,
massaging, rocking, walking, stimulating
sucking.

43. Vocalization....
1st month – cry, small throaty sounds.
2nd month – coos, vocalize to familiar
voice
3rd month – squealsaloud to show
pleasure,vocalize @ smiling, babbles,
coos, chuckles.
4th month – makes consonant n,k,g,p,b,
laugh aloud.

44. Contd...
5th month – squeals,make cooing vowel
sounds,with consonant ah,goo....
6th month – imitate sounds,babbling
resembles mono syllable utterance
ma,mu,hi,di , vocalise to toys, mirror
image, takes pleasure on hearing sounds
7th month – verbal sounds & chained
syllables(baba,dada,kaka)

45. Contd...
8th month – respond to simple verbal
command, comprehend “no no”
10th to 12th month – dada,mama,byebye,
say1 word hi, bye, no.
says 3to 5 words,comprehend
meaning,imitate animal sounds,recognise
object by name.

46. Psychosexual development...
First 6 months:
*oral dependent stage – sucking
*oral aggressive stage – biting & sucking(
breast,bottle,toys)

47. Contd...
Young infant:
# primary narcissism/ self love immediate
gratification.
# this ID process the pleasure principle later
become ego structure that operate reality
principle.

48. Spiritual development....
Fowler ,Stage I: primal faith.
Due to attachment with parents child
develops – faith,
hope,
autonomy.
Undifferentiated faith.

49. Moral development
Kohlberg,stage I: preconventional morality.
Stage 0:birth – 2 yrs(infant +early toddler.
>egocentric.
>unable to judge ,understand rules, what I
is good, what is bad.
>guided by what to do & what not to do

50. Play & stimulation....
Play response @ infancy:
Birth – 5 months:
>activities like kicking,
wiggling,
playing with their hands,
reaching for objects,
Attempting to turnover, vocalizing

51. Contd....
5-8 month:
find pleasure in motor activity.
play with feet.
sitting.
bouncing the body.
grasping/ play in yard by hitching.

52. 8-10 month...
Presence of motor activity.
Vocalization – cont pleasure.
Sit alone, like to stand on high chair.
Roll, crawl, creep, reach toys.

53. 10 – 12 months....
Play alone for long periods
Enjoy pulling, standing position.
Grasp ball,
picking-dropping toys.
Try to walk with assistance.

54. Selection of play materials...
Toys should stimulate visual, auditory, tactile,
kinetic stimulation
Well constructed & safe.
Durable, light weight, easily handled.
Smooth with round edges & no sharp points.
Varied in texture, washable.
Bright colored appropriate use of it

55. Need of infant....
Emotional needs
Social needs
Biological needs
•Love &security
•Dependence to independence
•Self control
•Developing self esteem
•Nutrition
•Play
•Sleep
•Dental health

56. Love& security...
Important needs for infant.
Through words & action.
Smile –smile back.
Bathing & clean clothing.
Loving, intimate, warmth.
Unconditional love.

57. Dependence progress to
independence...
Attempting to feed.
Co-operation in
dressing.

58. Discipline leads to self control...
Inappropriate term in infant care.
Help to handle anxiety situation.
Prevent developing – “spoiled child syndrome.”

59. Developing self esteem....
Appraisals of infants mile stone
achievement.
Communicate love through action.

60. Biologic needs – nutrition...
Birth - 6 months:
>30 gms of wt raise daily.
>energy need-120 kcal/kg/day.
>From exclusive breast milk /formula feed (6
months)
>demand feed is needed.
>Addition of vitamin, fluoride & iron

61. Contd...
Vit – C to prevent infant scurvy.
Vit- D 400 IU daily.
0.25mg/dayfluoride/day.
Fe supply- fortified foods.
6 months to1 yr:
>weight gain 15 gms/day.
>100kcal/kg/day

62. contd/...
Human milk+ formula feed.
Whole cows milk than skimmed milk.
Additional food:
Readiness to chew
Absence of extrusion reflex.
Ready to sit.
Food items:

63. Food items...
Strained finely mashed foods.
Chewen biscuits.
Steamed food & vegetables.
Fruit juices, desserts.(custards,gelatin)
Soups, egg & cheese.(boiled,poached)
Boil, baked, steamed fish & eggs.
HCCM, RAGGI PORIDGE.

64. METHOD OF INSTRUCTION....
PLEASANT EXPERIENCE.
New food at hungry.
Start with small spoon feeding.
Place food back of tongue without
pressure.
Variety of new food should introduced.
No hurried to eat.
Permit to stop eating

65. Contd...
Permit to touch the
food.
New food introduce
with mixing formula
feed
New food
introduced one at a
time
Small serving.

66. Sleep
Nocturnal pattern of sleep start @3-4
months.
Total daily sleep- 15 hrs.
Nap vary infant to infant.
Sleep problem:
dyssomnias
parasomnias

67. Sleep disturbance..
Night time feeding
Developmental
night crying.
Refusal to go to
sleep.
Night time fears.
Trained night
crying.
Intervention:
offer no bottle in
bed.

68. Intervention:
> offer no bottle in bed
>use infant crib for sleep.
>establish bed time rituals.
>Not to place play things on the bed.
>sleep monitering

69. Dental health...
Teething –eruption of deciduous teeth.
@ 6 month lower incisors erupt followed
by upper incisors.
assessment of = age of child in months-
6
deciduous teeth

70. Problems of teething
Discomfort @ break of peridontal membrane.
s/s: drooling,
increased finger sucking,
biting on hard objects.
Irritable, difficult sleeping
mild temperature elevation
ear rubbing, loss of appetite

71. Care of teething...
Topical anaesthetic ointments.
Acetaminophen, brufen.
Place ice cap cloth to relive pain.
To reduce inflammation.

72. Infant shoes...
Inflexible shoes cause:
- delay in walking
-in toeing & out toeing
-poor development of supporitve
foot muscle.

73. Counseling regarding shoes...
The shoe should be:
provide protection.
should retain its fit.
made durable with smooth
interior,
soft & flexible in toe area.
change shoe size 3 months.
1.5 cm space between shoe &
toe tip.

74. Immunization...

75. Preventive pediatrics accident...
Aspiration
suffocation.
Poisoning.
Burns
Falls
Motor vehicles
Bodily damage
Drowning.

76. ASPIRATION
Never shake baby powder directly
Hold infant for feeding
Keep floor free of small objects
Inspect toys for removable parts
Store container tightly out of infant
reach
Keep button lead ,syringe, caps and
small object out of child reach

77. DROWNING/SUFFOCATION
Keep all plastic bags stored out of
infant
Never leave infant alone in bath
Remove bibs at bedtime
Use firm mattress and loose blanket,
no pillow
Eliminate unnecessary pool of water
keep one hand on child at all times
when in tub

78. FALLS
Always rise crib rails
Never leave infant on a raised,
unguarded surface
Restrain infant in seat and never
leave
Dress infant safe shoes and clothing
Avoid using high chair until child can
sit well

79. POISONING
Make sure paint doesn’t contain lead
Place toxic substances on a high
shelf or locked
Keep medication substances on a
high shelf or locked
Discard used container of poisonous
substances
Keep cosmetics out of child reach

80. BURNS
Install smoke detectors in home
Check temp before feeding
Don’t leave child in parked car
Use cool mist vaporizer
Keep hanging table cloth out of reach
Keep electrical wire hidden/out of
reach

81. MOTOR VEHICLE ACCIDENT
Don’t place infant on seat of car/lap
Don’t place child in carriage
Transport child safely

82. BODILY DAMAGE
Keep sharp, jagged objects out of
child reach
Keep diaper pins closed
Give toys that are smooth and
rounded
Avoid long pointed objects
Avoid toys excessively loud

83. NURSING DIAGNOSIS
Risk for injury related to poor
environmental condition
Risk for infection related to poor
immune system
Risk for growth and development
dysfunction related to any illness, lack
of basic care
Knowledge deficit of parents related
to growth and development of infant

84. NURSING DIAGNOSIS CONT’D
Ineffective family coping related to
entry of infant in the family
Risk for imbalanced nutrition related
to poor feeding ,vomiting,diarrhoea
Risk for altered sleep pattern related
to feeding
Risk for body image disturbance
related to poor gender identification

85. JOURNAL REVIEW
Effect of maternal prenatal smoking
on infant growth and development of
obesity
WHO’s infant feeding
recommendation
Biomechanics of growth and
development in the healthy human
infant
Postnatal depression and infant
growth and development in low

86. Theory application...
Nightingales theory.
Roy adaptation theory.
Handersons need theory.
Orems self care theory.
Pepalus psycho dynamic theory.