Chapter 31 The Infant and Family All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Promoting Optimal Growth and Development Biologic development Proportional changes 5- to 7-oz weight gain per week Doubling of birth weight by age 6 months Tripling of birth weight by age 1 year Height increases by 1 inch per month x 6 months Growth in “spurts” rather than gradual pattern All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Maturation of Systems Slowing of respiratory rate Slowing of heart rate Hematopoietic changes Head growth Differentiation of the nervous system Maturation of digestive processes Maturation of immunologic system Thermoregulation Maturation of renal function Increase in auditory acuity and perception All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Fine Motor Development Grasping object: ages 2 to 3 months Transferring object between hands: age 7 months Pincer grasp: age 10 months Removing objects from container: age 11 months Building tower of two blocks: age 1 year All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Fine Motor Development (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Gross Motor Development Head control Rolling over Age 5 months: abdomen to back Age 6 months: back to abdomen Sitting: age 7 months Move from prone to sitting position: age 10 months All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Gross Motor Development (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Gross Motor Development (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Gross Motor Development (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Gross Motor Development (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Gross Motor Development (Cont.) Locomotion Cephalocaudal direction of development Crawling: ages 6 to 7 months Creeping: age 9 months Walking with assistance: age 11 months Walking alone: age 1 year All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Gross Motor Development (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Psychosocial Development Developing a sense of trust (Erikson) Infants trust that their comfort needs will be met Feeding Stimulation Mistrust Occurs when gratification of needs is delayed Social modifications Grasping Biting All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Cognitive Development Sensorimotor phase (Piaget) Birth to age 1 month: use of reflexes Ages 1 to 4 months: primary circular reactions Ages 4 to 8 months: secondary circular reactions Imitation Play Affect Coordination of second schemas All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Development of Body Image Concept of object permanence is acquired Development of body image parallels sensory motor development Anesthetic and tactile experiences are children’s first perceptions of their bodies By end of first year, children recognize that they are distinct from parents All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Development of Body Image (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Development of Body Image (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Social Development Attachment Reactive attachment disorder (RAD) Separation anxiety Stranger fear Language development Play All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Social Development (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Temperament Infants’ behavioral style Strong biologic component May be modified by the environment and family Revised infant temperament questionnaire Difficult Intense Less predictable All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Coping with Concerns Related to Normal Growth and Development Fear of separation and strangers Alternative child care arrangements Setting limits and discipline Thumb-sucking and use of a pacifier Teething Infant shoes All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Promoting Optimum Health During Infancy Nutrition First 6 months of life: human milk should be the only food Second 6 months Selection and preparation of solid foods Introduction of solid foods Weaning from breast or bottle All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Promoting Optimum Health During Infancy (Cont.) Sleep and activity Sleep patterns vary among infants By ages 3-4 months, nocturnal sleep lasts 9-11 hours Breastfed infants awakened more often Napping Infants are naturally active Walkers, swings, and playpens are not necessary All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Promoting Optimum Health During Infancy (Cont.) Dental health Maternal dental health Cleaning: begins when primary teeth erupt Fluoride at 6 months Prevention of dental caries No bottle propping No milk in bed No fruit juices All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Promoting Optimum Health During Infancy (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Immunizations Schedule for immunizations Recommendations for routine immunization Hepatitis A and B viruses Diphtheria Tetanus Pertussis Polio All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Immunizations (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Immunizations (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Immunizations (Cont.) Routine immunizations Measles, mumps, rubella Pneumococcus Haemophilus influenzae B Varicella (chickenpox) Influenza All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Immunizations (Cont.) Recommendations for selected immunizations Selected groups of children Rotavirus and human papillomavirus Reactions Contraindications and precautions Administration All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Immunizations (Cont.) Vaccine Adverse Event Reporting System (VAERS) To report any adverse reactions after administration of any vaccine Vaccine Information Statements (VIS) Information statements that must be given to parents before administration of given vaccines Updated information that must be given to parent/guardian of child being vaccinated All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Safety Promotion and Injury Prevention Motor vehicle safety Motor vehicle accidents: the leading cause of accidental death Car seats: in the back seat of the car Hyperthermia: can result from overdressing Nurse’s role in injury prevention Ensuring safety in the home Teaching infant CPR All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Safety Promotion and Injury Prevention (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Special Health Problems Colic (paroxysmal abdominal pain) 15%-40% of all infants Therapeutic management Failure to thrive (growth failure) Diagnostic evaluation Prognosis Care management All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Special Health Problems (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Special Health Problems (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Special Health Problems (Cont.) Sudden infant death syndrome (SIDS) Risk factors for SIDS Protective factors for SIDS Infant risk factors Care of the family after a sudden death All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Special Health Problems (Cont.) Positional plagiocephaly “Back to Sleep” since 1992 Front to play Diagnostic evaluation Therapeutic management Care management All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Special Health Problems (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Special Health Problems (Cont.) Apparent life-threatening event (ALTE) Aborted or near-miss SIDS Diagnostic evaluation of ALTEs Therapeutic management Theophylline/caffeine Home apnea monitors Family support CPR training All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Special Health Problems (Cont.) All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.

Question Latasha is a breastfed infant being seen in the clinic for her 6-month checkup. Her mother tells the nurse that Latasha recently began to suck her thumb. Which of the following is the best nursing intervention? A. Recommend that the mother substitute a pacifier for Latasha’s thumb. B. Assess Latasha for other signs of sensory deprivation. C. Reassure the mother that thumbsucking is normal at this age. D. Suggest that the mother breastfeed Latasha more often to satisfy sucking needs. All Elsevier items and derived items © 2014, 2010, 2006, 2002, Mosby, Inc., an imprint of Elsevier Inc.