NURSING CARE OF A FAMILY

WITH AN INFANT
.
 .

• Infants grow rapidly both in size and in their

ability to perform tasks. Although
development follows set of patterns, some of it
is dependent on cultural factors.
PHYSICAL GROWTH - CHANGES THAT OCCUR IN THE INFANT
YEAR REFLECT BOTH THE INCREASING MATURITY AND GROWTH OF
BODY ORGANS
 .

Changes
IV. Body Proportion - Mandible is more prominent
- chest circumference is generally less than that of the head at
birth by about 2 cm; even for some at 6 mos, and most by 12
mos.
- abdomen protuberant until the child has been walking until
toddler
- Cervical, thoracic, and lumbar vertebral curves develop as
infants hold up their head, sit, and walk.
 Changes
V. Body Systems CV = 120 – 160 by the end of the year 100 – 120
- The heart continues to occupy a little over half the width of
the chest
- PR may begin to slow with inhalation (sinus arrhythmia)
- BP = 80/40 to 100/60 mm Hg
- 5 to 6 months = Hgb is totally converted fetal to adult
- 6- 9 months = in serum iron levels : last of iron stores are
used
- RR : 20 – 30 b/m
- GI : ability to digest protein is present and effective:
- 1-3 mos: deficient amount of amylase; Lipase
entire 1st year of life
- Liver: immature
- Kidney: immature; more prone to dehydration
- Endocrine system: Immature; infant may not be able to
respond to stress effectively.
 Changes
Immune System:
• 2 months : immune system becomes functional
• 1 year: produce both IgG and IgM antibodies.

Thermoregulation:
• 6 months: adjusts to cold; an infant can shiver in response to
cold (which muscle activity and provides warmth) and
additional adipose tissue developed.

Body Fluids:
• extracellular fluid accounts for approximately 35% of
an infant’s body weight;
• intracellular fluid accounting for approximately 40% by the end
of the first year
( adult proportions of 20% and 40%)
Note: Infant is susceptibility to dehydration from illnesses such as
diarrhea: loss of extracellular fluid =loss of over a third of an
infant’s body fluid
 Changes
VI. Teeth The first baby tooth (typically a central incisor) usually erupts
at age 6 months, followed by a new one monthly. However,
teething patterns can vary greatly among children.
Note: Deciduous teeth are essential for protecting the growth
of the dental arc
 MOTOR DEVELOPMENT

• An average infant progresses through systematic motor growth during the

first year that strongly reflects the principles of cephalocaudal and gross to
fine motor development.
• Control proceeds from head to trunk to lower extremities in a progressive,
predictable sequence.

Types:
• Gross motor development (ability to accomplish large body movements)
• Fine motor development are prehensile ability (ability to coordinate hand
movements)
 A. GROSS MOTOR DEVELOPMENT
TO ASSESS GROSS MOTOR DEVELOPMENT, AN INFANT IS OBSERVED IN FOUR POSITIONS:

Positions
Age Ventral Suspension Prone Sitting Standing
1 mos. lifts the head momentarily, then drops lift their heads and turn has gross head lag stepping reflex can still
it again them easily to the side as in the first days of be demonstrated
life.
2 mos. hold their heads in the same plane as raise their heads and can hold their head hold their head up with
the rest of their body maintain the position, fairly steady when the same show
but they cannot raise sitting up, although it of support as in a sitting
their chests high enough does tend to bob position
to look around yet. forward.

3 mos. Child lifts and maintains the head well • lifts the head and Has only slight head Begin to try to support
above the plane of the rest of the body . shoulders well off the lag when pulled to a part of their weight.
table and looks sitting position
Landau reflex - an infant’s head, legs, around when prone.
and spine extends. When the head is • Prone to side lying
depressed, the hips, knees, and elbows
flex ; (-) Cerebral Palsy or other
Neurological Problem
 Positions
Age Ventral Suspension Prone Sitting Standing

4 mos • lift their chests off the bed - No head lag when • begin to be able to
and look around actively, pulled to sitting support their weight
turning their heads from side position on their legs
to side • Stepping reflex
• turn from front to back faded
• Neck-righting Reflex, which
begins at this age. When an
infant turns the head to the
side, the shoulders, trunk, and
pelvis turn in that direction,
too.
5 mos • rests weight on their forearms • straighten the back • continues the ability
when prone. when held or to sustain a portion
• Turns completely over propped in a sitting of weight
position • Tonic Neck reflex
extinguished
• Moro reflex fading
 Positions
Age Ventral Suspension Prone Sitting Standing
6 mos Parachute • rest their weight on • sit momentarily without • support nearly their
reaction - infants are their hands with extended support full weight
suddenly lowered toward an arms • have only a limited
examining table from ventral • raise their chests and the ability to sit
suspension, the arms extend upper part of their independently
as if to protect themselves abdomens off the table.
from falling
7mos • child sits alone with • child bounces with
hands held forward for enjoyment
- (-) Cerebral palsy
balance.
8 mos • Sit securely without
any additional support
9 mos • can creep from the • sit so steadily they can • can stand holding
prone position lean forward and regain onto a coffee Table
their balance. • Some can pull up to
standing position
 Positions
Age Ventral Suspension Prone Sitting Standing
10 mos • can pull themselves to a
standing position by holding,
but they cannot let
themselves down again

11 mos • “cruise” or move about the crib

or room by holding onto objects
such as the crib rails, chairs,
walls, and low tables
1 year • children stand alone at least
momentarily
B. FINE MOTOR DEVELOPMENT

Age Fine Motor

1 mos. • strong grasp reflex
2 mos. • The hands are held open, not closed in fists
3 mos. • reach for attractive objects in front of them
• Assure parents this is part of normal development
4 mos. • bring their hands together and pull at their clothes
• Thumb opposition (ability to bring the thumb and fingers together) is beginning
• Palmar and plantar grasp reflexes have disappeared.
5 mos. • can accept objects that are handed to them by grasping with the whole hand
• can reach and pick up objects without the object being offered and often play with their
toes as objects
6 mos. • can hold objects in both hands
• will drop one toy when a second one is offered for the same hand
• can hold a spoon and start to feed themselves (with much spilling)
• Moro, palmar grasp, and the tonic neck reflex have completely faded
 .
Age Fine Motor
7 mos. • can transfer toys from one hand to the other
8 mos. • random reaching and ineffective grasping have disappeared as a result of advanced eye–
hand coordination
9 mos.
10 mos. • ability to bring the
• thumb and first finger together in a PINCER GRASP
• pick up small objects
• Use one finger to point to objects
• offer toys to people but then cannot release them
1 year • draw a semi straight line with a crayon
• enjoy putting objects such as small blocks in containers and taking them out again
• hold a cup and spoon to feed themselves fairly well (if they have been allowed to
practice)
• can take off socks and push their hands into sleeves
• can offer toys and release them
.
.
 DEVELOPMENTAL MILESTONES
Language Development
Age Development
1 mos. • make small, cooing (dovelike) sounds
2 mos. • child differentiates a cry; caregivers can distinguish a cry that means “hungry”
from one that means “wet” or from one that means “lonely.” Note: IMPORTANT
MILESTONE
• ability to make throaty, gurgling, or cooing sounds also increases
3 mos. • will squeal with pleasure
4 mos. • very “talkative,” cooing, babbling, and gurgling when spoken to.
5 mos. • says some simple vowel sounds (for example, “goo-goo” and “gah-gah”)
6 mos. • learn the art of imitating; may imitate parent’s coughing
7 mos. • can imitate vowel sounds well (for example, “oh-oh,” “ah-ah,” and “oo-oo”)
9 mos. • usually speaks a first word: “da-da” or “ba-ba
10 mos. • masters another word such as “bye-bye” or “no.”
12 mos. • can generally say two words besides “ma-ma” and “da-da”; they use those two
words with meaning.
 Play
Age
1 mos. •
Development
.
1-month-olds can fix their eyes on an object •
Toy
Mobiles (Musical, Black
and white or bright
colored)
• children also spend a great deal of time watching • parent's face
their parent’s face
• Hearing is a second sense that is a source of pleasure • Music Box, Musical rattle
• mobiles or cradle gyms
2 mos. • hold light, small rattles for a short period of time but
strung across their crib
then drop them
3 mos. • handle small blocks or small rattles • Blocks and small rattles

4 mos. • Four-month-old children need a playpen or a sheet • Rolling over is so

spread on the floor so they have an opportunity to intriguing it may serve as
exercise their new skill of rolling over a “toy”

5 mos. • infants are ready for a variety of objects to handle • plastic rings, blocks,
squeeze toys, clothes pins,
rattles, and plastic keys
6 mos. • sit steadily enough to be ready for bathtub toys • rubber ducks or plastic
• teething boats
• teething ring
 DEVELOPMENT OF SENSES
Vision
Age Development
1 mos. • regard an object in the midline of their vision (something directly in front of
themselves). Around 18 inches. They follow at a short distance.
2 mos. • focus well (from about age 6 weeks) and follow objects with the eyes (although still
not past the midline); BINOCULAR VISION
3 mos. • can follow an object across their midline
• typically hold their hands in front of their face and study their fingers for long periods
of time (hand regard)
4 mos. • recognize familiar objects, such as a frequently seen bottle, rattle, or toy animal.
Follow their parents’ movements with their eyes.
6 mos. • Infants are capable of organized depth perception. This increases the accuracy of their
reach for objects as they begin to perceive distances accurately.
7 mos. • Pat their image in a mirror.
• Depth of perception has matured; can perform such tasks as transferring toys from
hand to hand
10 mos. • Infant looks under a towel or around a corner for a concealed object (BEGINNING OF
OBJECT PERMANENCE)
 Age
Hearing Development

1 mos. •
.
quiets momentarily at a distinctive sound such as a bell or a squeaky rubber toy

2 mos. • infants will stop an activity at the sound of spoken words.

3 mos. • turn their heads to attempt to locate a sound

4 mos. • when infants hear a distinctive sound they turn and look in that direction

5 mos. • they can localize sounds downward and to the side, by turning their head and
looking down

6 mos. • locate sounds made above them

10 mos. • can recognize their name and listen acutely when spoken to

• can easily locate sound in any direction and turn toward it. A vocabulary of two
words plus “ma-ma” and “da-da” also demonstrates an infant can hear.
12 mos.
 .
Touch
• Needs to be touched to experience skin-to-skin contact
• Clothes should feel comfortable and soft rather than rough; diapers should be dry rather than wet

TASTE
• Infants demonstrate that they have an acute sense of taste by turning away from or spitting out a taste they
do not enjoy.

SMELL
• can smell accurately within 1 or 2 hours after birth
• respond to an irritating smell by drawing back from it.
• appear to enjoy pleasant odors and learn early in life to identify the familiar smell of breast milk.
 EMOTIONAL DEVELOPMENT
Age Development
1 mos. • They quiet best and eat best for the person who has been their primary caregiver.
2 mos. • SOCIAL SMILE (6 weeks)
3 mos. • Increased social awareness by readily smiling at the sight of a parent’s face
• Laugh out loud at the sight of a funny face.
4 mos. • Recognize their primary caregiver and prefer that person’s presence to others
5 mos. • Show displeasure when an object is taken away from them
6 mos. • May begin to draw back from unfamiliar people.
7 mos. • Begin to show obvious fear of strangers. Shrieks .
8 mos. • Fear of strangers; Phenomenon is often termed EIGHTH MONTH ANXIETY,
OR STRANGER ANXIETY (Goldson & Reynolds, 2008)
9 mos. • Very aware of changes in tone of voice. They will cry when scolded.
12 mos. • Overcome their fear of strangers and are alert and responsive again when
approached.
 COGNITIVE DEVELOPMENT

A. Primary circular reaction

• Explores objects by grasping them with the hands or by mouthing them.
• Appear to be unaware of what actions they can cause or what actions occur
independently.
B. Secondary Circular Reaction (6 months)
• Infants can grasp the idea their actions can initiate pleasurable sensations.
C. Coordination of Secondary Schema
• 10 months discover OBJECT PERMANENCE
• 1 year of age, they are capable of reproducing interesting events and
producing new events.
HEALTH PROMOTION OF
INFANT AND FAMILY
.
 PROMOTING ACHIEVEMENT OF DEVELOPMENTAL
TASK: TRUST VERSUS MISTRUST

A synonym for trust in this connotation is love.

Examples:
• Feeding
• Diaper changing
• Being held
By this process, infants learn to trust that when they have a need
or are in distress, a person will come and meet that need.
Note: Infants thrive on routine and consistency. The care be
given largely by one person
 PROMOTING INFANT SAFETY
Aspiration Prevention:
• Check size of solid food being served
• Caution parents to be certain nothing comes within an infant’s reach that would not be safe
to put into the mouth.
• Use clothing without decorative buttons
• Check toys and rattles
• Should use one-piece construction pacifier with a flange large
• Allow no plastic bags within infant’s reach.
• Do not use pillows in a crib.
• Buy a crib that is approved for safety (spacing of rails is not over 23⁄8in [6 cm] apart).

Fall Prevention teach parents to be prepared for their infant to roll over by 2 months of age
• Never leave an infant on an unprotected surface.
• Place a gate at the top and bottom of stairways; do not allow an 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 crib.
• Do not leave a child unattended in a highchair; avoid using an infant walker.
Motor vehicle
• Never transport unless an infant is buckled into an infant car seat in the back seat of the car.
Be aware of the proper technique for placing an infant in a car seat.
• Do not be distracted by an infant while driving.
• Do not leave an infant unattended in a parked car (can become dehydrated from excess heat,
move gear shift, or be abducted).

Drowning
• Do not leave infants alone in a bathtub or unsupervised near water (even buckets of cleaning
water).

Animal bites
• Do not allow an infant to approach a strange dog; supervise play with family pets.
Poisoning
• Never present medication as a candy.
• Buy medications in containers with safety caps; put away immediately after use.
• Never take medication in front of infants. Place all medication and poisons in locked cabinets or
overhead shelves.
• Never leave medication in a pocket or handbag.
• Use no lead-based paint in any area of the home.
• Hang plants or set on high surfaces.
• Post telephone number of the poison control center / 911by the telephone

Burns
• Test warmth of formula and food before feeding (use extra precaution with microwave warming).
• Do not smoke or drink hot liquids while holding or caring for infant.
• Buy flame-retardant clothing for infants.
• Use a sunscreen on a child over 6 months when out in direct or indirect sunlight; limit the child’s
sun exposure to less than 30 min at a time.
• Turn handles of pans toward back of stove.
• Use a cool-mist, not a hot-mist, vaporizer; remain in room to monitor so child cannot reach
vaporizer.
• Monitor infants carefully near candles. Do not leave infants unsupervised near hot-water faucets.
• Do not allow infants to blow out matches (don’t teach children that fire is fun).
• Keep electric wires and cords out of reach; cover electrical outlets with safety plugs.
PROMOTING NUTRITIONAL HEALTH OF
AN INFANT
Recommended Dietary Reference Intakes for an Infant:
• high-protein, high-calorie, Vitamins and Minerals
• Calorie allowances can be gradually reduced during the first year from a level of 120 per
kilogram of body weight at birth to approximately 100 per kilogram of body weight at the end
of the first year.
• Breastfed infants gain less weight than those who are formula fed.

Introduction of Solid Food (4-6 months)

• Delaying helps prevent overwhelming an infant’s kidneys with a heavy solute load that can
occur when protein is ingested.
• It also delay the development of food allergies in susceptible infants and be another way to
help prevent future obesity (Sass, 2007).
 Teach parents:

• Introduce one food at a time, waiting 5 to 7 days between new items.

• Introduce the food before formula or breastfeeding when an infant is hungry.
• Introduce small amounts of a new food (1 or 2 tsp) at a time.
• Respect infant food preferences; a child cannot be expected to like all new tastes equally
well.
• Use only minimal to no salt and sugar on solid foods to minimize the number of
additives.
• Remember that the extrusion reflex is present for the first 4 to 6 months of life, so any
food placed on an infant’s tongue will be pushed forward.
• To prevent aspiration, do not place food in bottles with formula.
• Introduce foods with a positive, “You’ll like this” attitude.
• feed infant in the parent’s arms as if bottle-feeding or breastfeeding.

Extrusion Reflex - fades at 3 to 4 months.

Types of food and Quantities
A newborn’s stomach can hold approximately 2 tablespoons (30 mL). By 1 year, a stomach can
hold no more than about 1 cup (240 mL)

Age Food Rationale

5–6 Iron-fortified infant cereal Aids in preventing iron-deficiency So rich in iron parents should
mixed with breast milk, anemia; the least allergenic type of continue feeding it at least through
orange juice, or formula food; an easily digested food the first year

7 Vegetables Good source of vitamin A; adds new * Usually offered at lunch

texture and flavors to diet
8 Fruit Best source of vitamin C, good source * It can be given in addition to
of vitamin A; adds new texture and cereal for breakfast and dinner.
flavors to diet
9 Meat Good source of protein, iron, and B *Offer beef and pork 1st, then
vitamins Chicken
*Part of the evening meal
10 Egg yolk Good source of iron *May be prepared by
hard-boiling
*Wheat, tomatoes, oranges, fish, and egg whites should be omitted if there are allergies in the family, because these
foods are most likely to cause allergies.
Establishment of Healthy Eating Patterns
• Remind parents that they should individualize their approach according to the cues their child
is giving them for readiness.
• If an infant does refuse to eat, ask the parents what foods they are offering.
• If intake is inadequate and the child is, indeed, a fussy eater, ask about the parents’ methods of
feeding.
• An infant who is fatigued or overstimulated may not eat well.
• Encourage parents not to force infants to eat if they do
• not seem hungry.

Weaning
• Sucking reflex starts to diminish at 6-9 months, infant can dink from cup at 9. This is the best
time to wean
Things to teach to parents:
 choose one feeding a day and then begins offering fluid by the new method at that feeding.
 After 3 days to 1 week, when an infant has become acclimated to the one change, the mother
changes a second feeding.
 No set of number of weeks should be prescribed to complete weaning.
Self-Feeding
• At 6 months of age, infants become interested in handling a spoon and beginning to
feed themselves.
• Parents who insist on continuing to spoon-feed past the time infants want to feed
themselves can cause infants to balk at eating.
• When infants no longer attempt to feed themselves at a meal but merely begin to play
with their food it is time to end the meal. This behavior indicates that they have had
enough.
Adequate Intake With a Vegetarian Diet
• Should continue to be breastfed or ingest an iron-fortified, balanced, commercial
formula for the entire first year.
• When solid foods are added at 6 months, an assortment of foods should be provided,
including :
a. vegetables: avocados, potatoes, and broccoli;
b. fruits such as apples, prunes (high in iron), and bananas;
c. infant cereal;
d. tofu;
e. wheat germ;
f. legumes;
g. brewer’s yeast;
h. and synthetic vitamin D.
PROMOTING INFANT DEVELOPMENT IN
DAILY ACTIVITIES
Bathing
• Some infants do need their head and scalp washed frequently (every day or every other day) to
prevent seborrhea, a scaly scalp condition often called cradle cap (Smoker, 2007)

Diaper –Area care

• Change diapers frequently, about every 2 to 4 hours.
• If an infant develops a rash from sleeping in wet diapers, air drying or sleeping without a diaper
may be a solution.
• Routinely using an ointment such as Desitin or A&D ointment
• Parents do not need to use baby powder.

Care of Teeth
• At 6 months to12 can receive fluoride. From water or toothpaste
• Teach parents to begin “brushing” even before
• teeth erupt by rubbing a soft washcloth over the gum pads.
• Once teeth erupt, all surfaces should be brushed with a soft brush or washcloth once or twice a day.
• Initial dental checkup by 1 year of age; checkups should continue at 6-month intervals until
adulthood.
Dressing
• Should be easy to launder and simply constructed
• When they begin to creep, they need long pants to protect their knees.
• they need only soft-soled shoes or socks or booties to keep their feet warm.
• when they begin walking, the soles of their shoes need only be firm
• enough to protect their feet against rough surfaces.

Sleep
• 10 to 12 hours and naps during the day
• Caution parents not to place pillows in an infant’s bed to avoid suffocation.
• Always place infants on their back to sleep (to prevent SIDS)
Use of a pacifier while an infant sleeps may further reduce this risk (Damato, 2007)

Exercise
• Expose the child to the sun for only very short periods, 3 to 5 minutes the first day, a
little more the next day, and so on up to 15 to 20 minutes at a time(No sunscreen until
6 mos)
• Toward the end of the first year, infants need space to crawl and then to walk.
 PARENTAL CONCERNS AND PROBLEMS
RELATED TO NORMAL INFANT DEVELOPMENT

• Teething • Spitting up .
.
• Thumb-sucking • Diaper dermatitis
• Use of pacifier • Miliaria, or prickly heat rash
• Head banging • Infant Caries (Baby-Bottle
• Sleep problem Syndrome)
• Constipation • Obesity in Infants
• Loose stools
• Colic
 REVIEW POINTS
• The infant period is from 1 month to 12 months.
• Double their birth weight at 4 to 6 months and triple it at 1 year.
• Develop first tooth at 6 months; by 12 months, have six to eight teeth.
• Important gross motor milestones:
2 months - lifting the chest off a bed ,
6 to 8 months - sitting at
9 months - creeping,
10 to 11 months - “cruising”
12 months - walking
• Important fine motor accomplishments
7 months- ability to pass an object from one hand to the other and a
10 months - pincer grasp
• Important milestones of language development
2 months - differentiating a cry
5 to 6 months - making simple vowel sounds, and
12 months - saying two words besides “ma-ma” and “da-da”
The more infants are spoken to, the easier it is for them to acquire language.
• Providing infants with proper toys for play helps development. All infant toys need to be
checked to be certain they are too large to be aspirated.

• Important milestones of vision development:

• 3 months - ability to follow a moving object past the midline and ability to focus
securely without eyes crossing

• According to Erikson, the developmental task : trust versus mistrust.

• Safety is important. Infants must be protected from falls and aspiration of small objects.

• Solid food is generally introduced into an infant’s diet: 4 to 6 months.

Before infants can eat solid food, they must lose their EXTRUSION REFLEX.

• Common concerns related to infant development include teething, thumb-sucking, use of

pacifiers, sleep problems, constipation, colic, diaper dermatitis, baby-bottle syndrome
(decayed teeth from sucking on a bottle of formula while they sleep), and obesity. Nurses play
a key role in teaching parents about these problems and measures to deal with them.

• Remember that parent–infant attachment is critical to mental health. Urge parents to continue
to give as much care as possible to sick infants to maintain this important relationship.