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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
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Factors that influence growth and
development
› Genetic background
› Environment
› Health
› Gender
› Race
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Weight and height
› First 6 months
 Birth weight doubles
 Height increases about 6 inches
› By 1 year of age
 Tripled birth weight
 Grown 10 inches to 12 inches
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Head and skull
› Head circumference
 Birth averages about 13.75 inches (35 cm)
 Slightly larger than chest
 1 year of age – head circumference has
grown to about 18 inches (47 cm)
 5 to 7 months – chest catches up with head
 After 7 months – chest exceeds head
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Head and skull (cont.)
› Fontanels and cranial sutures
 Posterior fontanel is usually closed by the
second or third month of life
 Anterior fontanel is usually closed between the
12th and the 18th month of life
 Sutures between the cranial bones do not
ossify until later childhood
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Skeletal growth and maturation
› The skeletal system is completely formed in
cartilage at the end of 3 months’ gestation
› Bone ossification and growth occur during
the remainder of fetal life and throughout
childhood
› “Bone age” can be determined by
radiologic examination
› When bone age matches the child’s
chronological age, the skeletal structure is
maturing at a normal rate
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Eruption of deciduous teeth
› Calcification of the deciduous teeth starts early
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in fetal life
Shortly before birth, calcification begins in the
permanent teeth
6–8 months of life lower incisors usually erupt
Teething is a normal process of development
and does not cause fever or respiratory
problems
Nutritional deficiency or prolonged illness
Fluoride
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Circulatory system
› Fetal life
 High levels of hemoglobin and red blood cells are
necessary for adequate oxygenation
› After birth
 Oxygen is supplied through the respiratory system
 Hemoglobin decreases in volume
 Red blood cells gradually decrease in number until the
third month of life
 The count gradually increases until adult levels are reached
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Circulatory system (cont.)
› Average blood pressure during the first year
of life is 85/60 mmHg.
› Accurate determination of the infant’s heart
beat requires an apical pulse count
› First year of life – the average apical rate
ranges from 70 (asleep) to 150 (awake)
beats per minute and as high as 180 beats
per minute while the infant is crying
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Body temperature and respiratory rate
› Body temperature
 Follows the average normal range after the
initial adjustment to postnatal living
› Respirations
 Average 30 breaths per minute, with a wide
range (20 to 50 breaths per minute) according
to the infant’s activity
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Neuromuscular development
› As the infant grows, nerve cells mature and
fine muscles begin to coordinate in an
orderly pattern of development
› Average rates of growth and development
are useful for purposes of making
comparisons
› A large time lag may require greater
stimulation from the environment or a
watchful attitude to discover how overall
development is proceeding
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Tell whether the following statement is true
or false.
When assessing the infant head you would
expect the anterior fontanel to be
closed by 3 months of age.
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False
Rationale: The posterior fontanel is usually
closed by the 2nd or 3rd month of life.
The anterior fontanel may increase
slightly in size during the first few months
of life. After the 6th month it begins to
decrease in size, closing between the
12th and the 18th months.
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First develops a sense of trust when fed on
demand
Eventually learns that not every need is met
immediately on demand
Slowly becomes aware that something or
someone separate from him or herself fulfills
needs
Gradually learns that the environment
responds to desires expressed through
personal efforts and signals
Finally becomes aware that the
environment is separate from self
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Infant’s development depends on a
mutual relationship with give and take
between the infant and the environment
in which the family caregivers play the
most important role
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First few weeks of life
› Actions such as kicking and sucking are reflex activities
Next sequential stage
› Reflexes are coordinated and elaborated
Latter part of first year
› Intentional movements to bring changes; expects that
certain results follow certain actions
› Cannot apply abstract reasoning; understands through
five senses
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Rapid growth during first year creates a need
for nutrients greater than at any other time of
life
 First 4 to 6 months breast milk or commercial
formula
 Nutrients that may need to be supplemented
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› Vitamins C and D
› Iron
 Breast-fed infants need supplements of iron, as well as
vitamin D
 By 6 months of age, iron-rich foods are needed as
supplements
› Fluoride
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Addition of solid foods
› Time or order requirement for starting foods is
not exact
› 4 to 6 months of age – the infant’s milk
consumption alone is not likely to be
sufficient to meet caloric, protein, mineral,
and vitamin needs
› Iron supply becomes low
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Infant feeding
› Extrusion (protrusion) reflex
› Give part of formula first before giving solid foods until infant
learns to eat
› Protect the baby’s clothes
› Start foods in small amounts – 1 or 2 tsp daily
› Prepare the food smooth, thin, lukewarm, and bland
› Offer new foods one at a time
› Allow 4 or 5 days before introducing another food
› Add chopped foods at about 9 or 10 months of age (if teeth
have erupted)
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Preparation of foods
› Various pureed baby foods, chopped junior foods,
and prepared milk formulas are available on the
market
› Vegetables and fruits can be cooked and strained
or pureed in a blender and are as acceptable to
the baby as commercially prepared baby foods
› Preparation and storage of baby food at home
require careful sanitary practices
 Baby’s appetite indication of quantity to prepare
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Self-feeding
› 7 or 8 months of age
 May grab spoon from the caregiver, examine it,
and mouth it
 May stick fingers in the food to feel the texture
and to bring it to the mouth for tasting
 This is an essential, although messy, part of the
learning experience
› After preliminary testing
 The infant’s next task is to try self-feeding
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Weaning the infant
› Must be attempted gradually without fuss or
strain
› 5 or 6 months sip from cup
› Bottles in bed can lead to bottle mouth or
nursing bottle caries
› Milk needs (calcium, vitamin D) may be met
by offering yogurt, custard, cottage cheese,
and other milk products until the infant
becomes accustomed to the cup
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Women, infants, and children food program
(WIC)
› Supplemental federal food program for pregnant,
breast-feeding, or postpartum women and infants
and children as old as 5 years of age
› Free to eligible persons living in a WIC service area,
based on financial and nutritional need
› Provides nutritious supplemental foods, nutrition
information, and health care referrals
› Foods include iron-fortified infant formula and
cereal, milk, dry beans, peanut butter, cheese,
juice, and eggs
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Susie Smith, 6 months old, is in the clinic for her
well-baby check-up. Susie’s mother asks
about vitamin supplements. What would be
your best response?
a. Susie is still being breast fed so she doesn’t
need nutritional supplements
b. Susie will become anemic if you don’t start
feeding her iron rich solid foods
c. Just start supplementing your breast milk
with some commercial baby formula fortified
with iron
d. Most babies, by the time they are about
Susie’s age, need supplements of iron
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d. Most babies, by the time they are about
Susie’s age, need supplements of iron.
Rationale: At about 4 to 6 months of age,
the infant’s milk consumption alone is not
likely to be sufficient to meet caloric,
protein, mineral, and vitamin needs. In
particular the infant’s iron supply
becomes low and supplements of ironrich foods are needed.
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Routine checkups
› Well-baby visits usually occur in the second week, and then
months 2, 4, 6, 9, and 12.
› The nurse collects data regarding
 Growth and development (weight, height, head
circumference)
 Nutrition and sleep
 The caregiver–infant relationship
 Any potential problems
› Immunizations are given to guard against disease
› Family teaching is provided
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Immunizations
› Protection is available against a number of
serious or disabling diseases, such as diphtheria,
tetanus, pertussis, rotavirus, hepatitis A and B,
polio, measles, mumps, German measles
(rubella), varicella (chickenpox), Haemophilus
influenzae, meningitis, pneumococcal
diseases, and meningococcal disease.
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Immunizations (cont.)
› The American Academy of Pediatrics
recommends a schedule of immunizations for
healthy children living in normal conditions
› An immunization need not be postponed if the
child has a cold but should be postponed if the
child has an acute febrile condition or a
condition causing immunosuppression, or if he or
she is receiving corticosteroids, radiation, or
antimetabolites
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Immunizations (cont.)
› The most common side effect is a low-grade
fever within the first 24 to 48 hours and
possibly a local reaction, such as tenderness,
redness, and swelling at the injection site
› Encourage child to drink fluids, and holding
and cuddling is comforting to the child
› Caregiver has a right to refuse immunization
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Family teaching
› During well visits, offer guidance to help
caregivers prepare for the many changes
that occur with each developmental level
› Discuss any infant sleep and activity
concerns that the caregiver has
› Provide ample time and opportunity for the
caregivers to ask questions and get
information
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Family teaching (cont.)
› Bathing the infant
 Daily bath is unnecessary but is desirable and
soothing in very hot weather
 An infant in a tub should always be held
securely
 Seborrhea
 Scented or talcum powder should not be used
after the bath
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Caring for the diaper area
› Soiled diapers should be changed frequently
 Check every 2 to 4 hours
 Cloth vs. commercial diapers
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Dressing the infant
› One rule of thumb is to dress the infant with the
same amount of clothing that the adult finds
comfortable
› Shoes with stiff soles actually hamper the
development of the infant’s foot
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Promoting sleep
› Most infants sleep 10 to 12 hours at night and
take 2 to 3 naps during the day
› Sleep disturbances may be learned
behaviors
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Dental care
› Brushing the teeth with a small, soft brush
usually is not started until several teeth have
erupted
› Toothpaste not recommended
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Accident prevention
› Discussing safety issues with caregivers is
important
› Provide information about car safety, childproofing, and preventing aspiration, falls,
burns, poisoning, and bathing accidents
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What are the most common side effects
from immunizations?
a. Irritability and vomiting
b. Nausea and swelling at injection site
c. High grade fever and pain at injection
site
d. Localized tenderness and low grade
fever
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d. Localized tenderness and low grade
fever
Rationale: The most common side effect is
a low-grade fever within the first 24 to 48
hours and possibly a local reaction, such
as tenderness, redness, and swelling at
the injection site.
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Long-term hospitalization may present
serious problems, even with the best of
care.
Touching, rocking, and cuddling are
essential elements of nursing care
Provide age-appropriate sensory
stimulation
As the nurse, your relationship with family
caregivers is extremely important.
Caregivers may sometimes assist during
treatments and other procedures
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Collect data regarding the needs of the
caregivers and the infant and plan care with
these needs in mind
Identify and acknowledge the caregivers’
apprehensions and develop plans to resolve or
eliminate them
Make arrangements for rooming-in for the family
caregiver
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