Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

Make your likes visible on Facebook?

Connect your Facebook account to Prezi and let your likes appear on your timeline.
You can change this under Settings & Account at any time.

No, thanks

N404: Infant Growth and Development

No description
by

Tami Bland

on 30 January 2016

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of N404: Infant Growth and Development

Tami Bland, DNP, CPNP
Nutrition / Infant and Toddler Growth and Development
Cephalocaudal
Proximodistal
A young couple comes to your clinic for their prenatal visit and you are discussing infant feeding. The mother states that she is concerned that human breast milk may not provide all the nutrients that the baby needs. According to the American Academy of Pediatrics, if her baby is exclusively breast fed, when should the child begin receiving oral vitamin D supplementation?
Never
Within the first month of life
2 months
4 months
6 months
Within the first month of life
AAP recommends breastfed & formula fed <33 oz/day receive Vit D supplement.
Preterm: < 37 weeks' gestation
Neonate: <1 month
Infant: 1 month to 1 year
Toddler: 1 to 3 years
Preschooler: 3 to 6 years
School-Age: 6 to 12 years
Adolescent: 12 to 18
Nutrition
Higher calorie/kg intake
Preterm Infant
Ounce for ounce, this age has the highest metabolic rate and intake requirements of all ages.
Infant
Preschooler
School Age
Need 2000-3000 calories per day (depending on activity level) due to rapid growth
Adolescent
Problems with feeding:
poor suck
uncoordinated suck
too small stomach
poor intestinal absorption
renal immaturity
complicated by any other medical problems
Breast is Best!! (but may need fortification)
Nurses have very important role in teaching parent how to feed their baby.
Supplement breastfed infants with Vit D
Top recommendation: breastfeed exclusively for 6 months and continue breastfeeding for full 12 months.
Cereal at 6 months (Fe content important)
Veggies first at 6-8 months, then fruits.
No honey before 1 year!
Fluoride for all babies with teeth getting formula made without tap water or fed breast milk.
Brush those teeth!!!
Toddlerhood
Wean between 6 and 12 months
A time of physiologic aorexia
Eat only at table or in high chair!
Small portions! (about 1 Tbsp/year)
Limit juice!!!
16 to 24 oz of low-fat milk.
3 meals + 2 snacks
Self-feeding.
Social meals.
Meals become more social
Food jags
Limit juice!!
Limit fast food
Include in meal preparation
metabolic needs change through growth spurts
Nutritional teaching key!
family meals important
milk often neglected
Monitor closely for overweight and obesity
Barriers to healthy eating
availability of "junk food"
lack of parental involvement
media messages
calcium very important, especially for girls
often using supplements for sports
GROWTH MEASUREMENT
Anthropomorphic measurements include weight, length, and head circumference. Standing height begins
once child can stand.
Chest circumference
important in neonatal
assessment.
BMI calculations begin at 2 year
Appropriateness of value is age dependent

>85%: overweight

>95%: obese

>99%: severely obese
Put the following gross motor milestones in the correct sequence:
A. sits without support
B. head control
C. rolls over
D. when prone, supports weight on forearms
E. pulls to stand


Put the following gross motor milestones in the correct sequence:
1. head control
2. when prone, supports weight on forearms
3. rolls over
4. sits without support
5. pulls to stand
Infant
Neurologic System
head circumference is indicative of brain growth
anterior fontanel usually open to 12-18 months for brain growth (may close by 9 months)
reflexive behavior replaced by purposeful movement
Primative Reflexes
righting

parachute
Protective Reflexes
Moro
root
suck
asymmetric tonic neck
plantar and palmar grasp
step
Babinski (only one that lasts close to 1 year)
Periodic breathing
Increased risk for respiratory infection:
narrow nasal passages
more compliant trachea and chest wall
shorter and narrower bronchi and bronchioles
funnel shaped larynx
larger tongue
few alveolie
lack of IgA in upper respiratory tract
Respiratory System
heart doubles in size over 1st year
PR 120-140 in newborn, 100 in 1 year old
BP increases from 60/40 to 100/50
peripheral capillaries mature to thermoregulation over first year
Cardiovascular System
Teeth
natal and neonatal teeth may be associated with other anomalies
first primary teeth on average at 6-8 months starting with lower central incisors
average 12-month-old has 4 to 8 teeth
Digestion
decreased saliva for first 3 months
stomach capacity 0.5-1.0 oz at birth
amylase (carbs) and lipase (fats) deficient until about 5 months
immature liver - conjugation of bilirubin and medications immature
Stools
meconium stools for first few days
formula fed - less consistent, more loose, mustard color
newborns 8-10 stools per day
after newborn period many don't stool every day
straining with bowel movement normal
Gastrointestinal System
more susceptible to dehydration due to increased extracellular fluid
frequent urination
reduced renal perfusion
and reaches full maturity
by 2 years
Genitourinary System
newborn acrocyanosis and mottling is normal
thinner skin leads to increased absorption of topical medications and poorer temperature regulation
Integumentary System
fetal hemaglobin (HbgF) in large amounts at birth - shorter lifespan then HgbA, so increased risk for anemia in first 2-3 months as HbgF replaced by HgbA
Iron storage only sufficient for about 6 months
Premature infants miss maternal transfer of iron during last 3 months
Hematopoietic System
immunity from mom during the first 3-6 months due to IgG transfer
infant production of IgG about 60% at 1 year
IgM production begins at birth with IgA, IgD, and IgE gradually increasing
Immunologic System
Toddler
Brain 80% of adult size by 3 years
Myelinization complete around 24 months
Neurologic System
alveoli increasing but not adult until 7 years
trachea and airways grow
but relatively small
large tonsils and
adenoids
short and straight
Eustachian tubes
Respiratory System
Heart rate continues to decrease
BP continues to increase
easy to compress capillaries
Cardiovascular System
stomach increasing in size - 3 meals a day
stool passage decreases in frequency
digestion still not mature
bowel control usually achieved by 3 years
Gastrointestinal System
adult bladder and kidney function by 16-24 months
urinary output 1 mL/kg/hour
decreased urinary frequency due to increased bladder capacity
Genitourinary System
lengthening of bones and strengthening of muscles
pot-bellied look due to weak abdominal muscles
Musculoskeletal System
Organ System
Maturation

Physical Growth
slower velocity of growth compared with infant
growth is in spurts
average of 3-5 pounds and 3 inches per year
generally 1/2 adult height at 2 years
anterior fontanel should be closed by 18 months
head size more proportional at 3 years
Toddlers
very rapid growth requires close monitoring for signs of abnormality
newborns lose up to 10% body weight
birthweight regained by 10-14 days
birthweight doubled by 6 months, tripled by 12 months
length increases by 1 inch per month for first 6 months, 1/2 inch for next 6 months
head circumference 1 cm > chest at birth
rapid head growth over first year - monitored at each visit
Infants
Motor Skill
Development

12-15 months = walks well; throws ball underhand

18 months = runs; walks upstairs with hand held; pushes or pulls toys

24 months = walks unassisted up and down stairs; kicks ball; throws ball overhand; jumps with two feet off the floor
Gross Motor
1 month = lifts head momentarily when prone;
startle and rooting reflexes predominate
2 months = raises head 45 degrees
3 months = raises head and chest 90 degrees
4 months = rolls prone to supine, steady head control with no head
lag; moro reflex fading
5 months = rolls supine to prone
6 months = sits tripod; rolls in both directions;
most reflexes have disappeared
7 months = sits with no support
8 months = sits unsupported
9 months = crawls rapidly
10 months = pulls to stand, cruises furniture
12 months = takes a few independent steps
Gross Motor
1 month = follows with eyes to
midline only; hands tightly fisted
2 months = places hand in mouth
3 months = reaches dangling object
4 months = bats at objects; reaches for
objects with both hands
5 months = grasps rattle at will
6 months = releases objects in hand to take
another; holds bottle
7 months = transfers objects
8 months = bangs objects together
9 months = gross pincer grasp (rakes)
10 months = fine pincer grasp
12 months = put objects in containers
Fine Moter
Infant
15 months = feeds self; turn pages in a book; builds a two block tower; points to one or more body parts

18 months = removes shoes; builds a three block tower; spontaneously scribbling

24 months = undress themselves, builds four block tower; copies a straight line
Fine Motor
Toddler
1 month = eats 2-3 oz, every 2-3 hours
2-4 months = eats 3-4 oz every 3-4 hours
4-6 months = eats 4-5 oz, 4 times/day, begins rice cereal
6-8 months = eats 6-8 oz, 4 times daily, adds vegetables/fruits;
begin weaning to cup; may begin juices
8-10 months = eats 6 oz, 4 times daily, adds meats/finger foods
10-12 months = eats 6-8 oz, 4 times daily, eats soft table foods
feeds self with cup and spoon
Fluid Requirements: Newborn 140-160 mL/kg/day
Infant 100 mL/kg/day for first 10 kg
50 mL/kg/day for next 10 kg
Calorie Requirements: Newborn 105-108 kcal/kg/day
Infant 1-6 months 108 kcal/kg/day
6-12 months 98 kcal/kg/day
Breastmilk and standard formula has 20 kcal/oz
Sensory Development
Vision
20/50 to 20/40 vision
Hearing
same as adult
Taste and Smell
continues to develop, but poor discrimination puts toddler at risk for accidental ingestion
Exploration of the world through the senses is the "work" of the toddler
Toddler
Sight
Newborn: nearsighted, focuses at 8-15" at birth, prefers dark/light contrast
binocular vision by 4 months
full color vision by 7 months
Hearing
newborn hearing is as acute as adult and prefer parent's voice at birth
Smell
can differentiate smells at 1 week
prefers sweet from birth - develops nonsweet taste
Touch
may be most important for newborn
Infant
Development
Toddler
Infant
Sensorimotor Period (birth to 2 years)
Use of reflexes (birth to 1 month)
sucking, rooting, grasping; use of senses
Primary circular reactions (1 to 4 months)
pleasure gained from a response causes repetition
Secondary circular reactions (4 to 8 months)
beginning of cause and effect
Coordination of secondary schemes ( 8 to 12 months
more
intentional
behavior
object
permanence
stranger
anxiety

Nursing application
toys and murals
for interesting
environment and
distraction
Cognitive - Piaget
Oral Stage
pleasure largely from mouth
greatest attachment is to mother

Nursing application
pacifier for painful procedures or encourage breastfeeding
Psychosexual - Freud
Trust Vs Mistrust
trust is fostered by basic needs being met
fosters optimism

Nursing application:
hold often, especially after painful procedures
encourage parents to room-in
Psychosocial - Erickson
Sensorimotor (birth to 24 months)
Tertiary circular reactions
(12 to 18 months)
curiosity, experimentation,
exploration
Mental combinations (18 to 24 months)
object permanence fully developed
language allows more complex thought
Preoperational (2 to 7 years)
words are symbols
poor logic
Preconceptual stage (2 to 4 years)
egocentrism

Nursing application
name objects and give simple explanations
ensure safe environment
Cognitive - Piaget
Anal Stage (1 to 3 years)
control over body secretions is prime force in behavior

Nursing application
ask about toilet
training being
sensitive to
cultural
implications
have potty
chairs available
but do not
begin during
hospitalization or illness
Psychosexual - Freud
Autonomy Vs Shame and Doubt (1 to 3 years)
independence shown through controlling body excretions, saying no, directing motor activity
constant criticism creates shame and doubt in their abilities
important to recognize feelings and needs of others

Nursing application
allow self-feeding and as much self-care as child is capable of doing
Psychosocial - Erickson
Communication
Infant
Toddler
Expressive
Receptive
Birth-2 months
3-6 months
sounds elicit startle reflex
turns and looks for sounds
prefers human voice
crying
comfort sound with feeding
coos
vocalizes to familiar voice
vocalizes during play & pleasure
squeals
laughs aloud
less crying
vowel and consonant sounds
watches speaking mouth
shifts gaze between sounds
understands own name
uses sound to get attention
7-9 months
10-12 months
increases vowels and consonants
uses 2 syllable sounds (dada)
talks along with others
associates words with activity
responds to simple commands
("no no")
understands familiar words
means "mama" and "dada"
repeats sounds made by others
makes intentional gestures
learns 3-5 words
recognizes family member names
recognizes objects by name
understands simple commands
("bye bye")
Expressive
Receptive
12-18 months
18-24 months
24-36 months
starts to combine 2 words
mixes real and jargon words/gestures
uses words more than gestures
familiar objects by name
18-22 word vocabulary
refers to self by name
2 and 3 word phrases
articulation lags behind
270-300 word vacabulary
recognizes names of body parts
identifies pictures of familiar
objects when named
follows 2 consecutive related
directions
understands more complex
sentences
learns concepts such as hot/cold
listens to and identifies sounds
short complete phrases
inverts subject and verbs
answers simple yes/no questions
uses consonants and pronouns
begins to use ord endings
900 word vocabulary
Developmental Concerns
Play
Play is parallel
Toddler
Play is solitary
Infant

1 month = watch caregivers face
2 months = mobiles or cradle gyms
3 months = small blocks or small rattles
4 months = playpen for rolling over
5 months = objects to handle (plastic rings,
blocks, squeeze toys, rattles)
6 months = bathtub toys, teething rings
7 months = transfer toys (blocks, rattles,
plastic keys)
8 months = textured cloth books
9 months = room to crawl
10 months = peek-a-boo games
11 months = cruising along tables, furniture
12 months = dropping objects into
containers
15 month old = stacking boxes or balls that fit inside
each other, wooden puzzles, bath toys
18 month old = pull toys, riding toys, large crayons, play
dough, finger paint
24 month old = imitating adult behaviors (household
items: bowls, pots, purses, hats)
Toddler
Infant
Paraoxysmal abdominal pain and severe, uncontrollable crying
Cries intensely for >3 hours, >3 days/week, >3 weeks/month
Worsens in the late afternoon and early evening
Lift their head, draw their legs up to their tummy, become red in the face, and pass gas
Peak incidence is 6 weeks of age and generally resolve by 3-4 months
Potential causes
Feeding too rapidly, swallowing large amounts of air
Solutions - The 5 S's
Cuddle cure - Swaddle
Put on their side
Swing
Make the shhhh sound
Something to suck on
Colic
Sudden and unexplained death of an apparently healthy infant aged one month to one year
Peak incidence between 2-4 months of age
Reduce the risk
Back to sleep
No co-bedding
Firm mattress with fitted sheet
No pillows or toys in the bed
Keep crib away from heat vent and set temperature between 68 and 75 degrees
Sudden Infant Death Syndrome - SIDS
Falls -Mobility increases in first year of life, progressing from squirming movements to crawling, rolling and standing
Burns - Infant is dependent on caretakers for environmental control
Increased mobility - Objects are explored by touching and placing in mouth
Motor vehicle accidents - Infant is dependent on caretakers for placement in car
Drowning - Infant cannot swim and is unable to lift head
Poisoning - Infant is dependent on caretakers to keep harmful substances out of reach
Choking/suffocation/strangulation - Infant has minimal head control and can get head into crib slats but cannot remove it
Safety
Begin at about 1 year of age
Peak around age 2-3 years
Rules of engagement
Stay calm
Separate child from others
Ignore the child but be sure child is safe
Do not bribe, give in, or reward the behavior
Talk calmly to child
Temper Tantrums
need sphincter control
stays dry for at least 2 hours at a time
has regular bowel movements
able to follow simple instructions
uncomfortable with dirty diapers and wanting them to be changed
asks to use the potty chair
asks to wear regular underwear
RELAX! - punishment and coercion can lead to shame and feelings of inferiority
Toilet Training
Falls - Gross motor skills improve and are able to move chairs to counters and climb up ladders
Poisoning - Gross motor skills enable toddler to get into cabinets
Medicines, cosmetics, and other poisonous substances are easily reached
Burns - Toddler is tall enough to reach stove top
Toddler can walk to fireplace and reach into fire
Drowning
Toddler can walk onto docks or pool decks
Can stand on or climb seats on boat
Can fall into buckets, toilets, and fish tanks and be unable to get top of body out
Motor vehicle accidents
Toddler is unpredictable
Safety
You are at Vine clinic seeing a 2-year-old child, brought by his father for a well child examination. In providing age appropriate information, you should tell him which of the following?

A. He should set his water heater to 71o C (160o F) to ensure the sterility of dishes and clothes, thereby decreasing the risk of infections
B. Milk should be switched from whole to skim or low fat
C. Continue rear facing car seats
D. Purchase a bed alarm to assist with the child’s nocturnal enuresis
E. Teach the child to swim so that the parents have the ability to allow the child to be alone in pools
B. Milk should be switched from whole to skim or low fat
Full transcript