1. Health Promotion of infant and Family Chapter 9

2. Objectives By the end of this topic the students will be able to:
Identify the major biologic, psychosocial, cognitive development during the first year.
Out line developmental recommendations that related to infant nutrition, sleep and rest, and immunization
Provide anticipatory guidance to parents regarding common concerns during infancy.
Provide anticipatory guidance regarding injury prevention based on the infant's developmental achievements.

3. Video links https://www.youtube.com/watch?v=ESexo_zeoS0

4. Biologic Development
Growth is very rapid during the first year, especially during the initial 6 months Major body systems undertake advanced maturation that allows infants to respond to and cope with the world Acquisition of fine and gross motor skills occurs in an orderly head-to-toe and center-to-periphery (cephalocaudal-proximodistal) order.

5. Major body systems undertake advanced maturation that allows
infants to respond to and cope with the world
Acquisition of fine and gross motor skills occurs in an orderly
head-to-toe and center-to-periphery (cephalocaudal-proximodistal) order.

6. Proportional Changes Weight: At birth 2.7 to 4.0 kg 2.5-3.5Kg
Weight gain = 150 to 210 g /week for 5 to 6 months
Birth weight doubles by 5 to 6 months
Triples by 1 year.

7. Infants who are breast-fed beyond 4 to 6 months of age gain less weight than those who are Formula -fed.
Why???
The breast-fed infants may have weight loss due to self-regulation of energy intake
Evidence-Based Practice (EBP): breast fed infant has less incidence to have child-adulthood obesity( Fewtrell, 2011)

8. Physical Development Length:
At birth average length about 50 cm, female babies are smaller than male babies.
During the first 6 month increase the length 2.5 cm (one inch) monthly.
By one year the birth length has increased by almost 50% mainly in the trunk
Average length is 65 cm (25.5 inches) at 6 months and 74 cm (29 inches) at 12 months.

9. Physical Development Head circumference:
Normal head circumference (HC) (Normocephaly).
At birth the average HC is 35 cm
During the first 3 month HC increase 2 cm per month.
From 4-6 month, HC increases 1cm per month

10. Physical Development Head circumference:
During the second 6 month increase 0.5 cm per month.
Average HC on 6 month is 43cm
Average HC on 12 months is 46 cm
Head size is increased about 33% by 1 year 10

11. Closure of the cranial sutures occurs with the posterior fontanel fusing
by 6- 8 weeks of age
The anterior fontanel closed by months of age ( an average of 14month)

12. Expanding head size reflects the growth and differentiation of the nervous system.
By the end of the first year the brain has increased in weight about two and one half times.
Maturation of the brain is exhibited in the dramatic developmental achievements of infancy

13. Increasing in the head size reflects the growth and differentiation of the nervous system.
The brain has increased in weight about two and one half times by the end of the first year
Maturation of the brain is shown in the intense developmental accomplishments of during infancy

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15. Chest Circumference
The chest circumference approximately equals the head circumference by the end of the first year.
The chest assumes an adult contour, with the lateral diameter becoming larger than the anteroposterior diameter

16. Physical Development Heart
It grows less rapidly than the rest of the body
Its weight is usually doubled by 1 year of age
Its width is approximately 55% of the chest width

17. The nurse should use an appropriate growth charts Example about Growth Chart

18. Physical Development Motor development:
(ability to move and to control the body)
Fine motor: includes the use of the hands and fingers in the grasp of an object.
Grasping occurs during the first 2 to 3 months as a reflex and gradually becomes voluntary

19. Primitive reflexes are replaced by voluntary, purposeful movement
New reflexes appear to influence motor development

20. Infants’ Reflexes

21. Fine Motor Development
At 1 month:
Hands are predominantly closed, by 3 months they are mostly open
Gradually the palmar grasp (using the whole hand) is replaced with a pincer grasp (using the thumb and index finger).
By 5 month
Infant is able to voluntary grasp objects

22. Palmer Grasp

23. Planter Grasp

24. Fine Motor Development
By 6 months:
Infants have increased manipulative skill.
hold bottle
Grasp feet and pull it to mouth
Feed themselves with crackers

25. By 6 months of age grasp their feet and pull them to their mouth

26. Fine motor Development
By 7 months:
They transfer objects from one hand to the other, use one hand for grasping, and hold a cube in each hand simultaneously.
They enjoy banging objects and will explore the movable parts of a toy.

27. Fine Motor Development
By 8 to 9 months infant uses a crude pincer grasp By 10 months: Pincer grasp is sufficiently established to enable infants to pick up a raisin and other finger foods (Neat Pincer Grap) Can deliberately let go of an object and will offer it to someone

28. Pincer Grasp

29. Fine Motor Development
By 11 months:
Put objects into a container and like to remove them.
By age 1 year, infants try to build a tower of two blocks but fail.

30. Gross Motor Development
1. Head Control
The newborn can temporarily hold the head in midline and parallel when the body is suspended ventrally
In prone position, newborn can lift and turn the head from side to side
When infant from a lying to sitting position, Head Lag is evident

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32. Head Lag

33. (sudden infant death syndrome) (SIDS).
Alarm!!!!!!!!
!!!!!!!When put prone on soft object or below!!!!!!
Infants do not have the head control to lift their head out of the depression of the object risk suffocation
(sudden infant death syndrome) (SIDS).
When infant is pulled from a lying to a sitting position, head lag is evident

34. Head Control
By 3 months
Hold their head well beyond the plane of the body.
By 4 months
can lift the head and front portion of the chest approximately 90 degrees above the table, bearing their weight on the forearms.
Slight head lag is evident when the infant is pulled from a lying to a sitting position

35. Head Control 4 to 6 months head control is well established Newborn
Age 6 months

36. Gross Motor development
2. Rolling over:
Newborn may roll over by accidentally because of their rounded back.
By 5 month
Infant can turn from the abdomen to the back.
By 6 month
Infant can turn from back to the abdomen 36

37. Infant can turn from the abdomen to the back.
By 5 month
Infant can turn from the abdomen to the back.

38. Infant can turn from back to the abdomen
By 6 month
Infant can turn from back to the abdomen

39. !!!!!!!!! Alarm Do not put infants to sleep on side position
Risk for SIDS
Put infant on supine position to sleep
Before infant can roll over, alternate the head position to prevent plagiocephaly

40. Gross Motor Development
3. Sitting
Infant ability to sit follows progressive head control and straightening of the back
At age of 2 to 3 months
The back is uniformly rounded
At age of 3 to 4 months
The convex cervical curve of back forms (when head control is established).

41. Gross Motor Development
3. Sitting
At age 4 months
The convex lumbar curve appears when the child begins to sit,
Can be propped in a sitting position (the spinal column straightens)

42. Gross Motor Development
By age 7 months
can sit alone, leaning forward on their hands for support
By age 8 months
can sit well while unsupported
begin to explore their surroundings in this position rather than in a lying position.
By 10 months
can maneuver from a prone to a sitting position.

43. By age 7 months infant can sit alone, leaning forward on their hands for support

44. By age 8 months infant can sit well while unsupported

45. Gross Motor Development
4. Locomotion:
Locomotion skill involves:
acquiring the ability to bear weight
propel forward on all four extremities
stand upright with support
finally, walk alone
By 4 to 6 months:
Infant have increasing coordination in their arms (a cephalocaudal pattern)

46. Gross Motor Development
4. Locomotion:
Initial locomotion
Infants propelling themselves backward by pushing with the arms
By 6 to 7 months
Able to bear all their weight on the legs with assistance

47. Gross Motor Development
Crawling : propelling forward with belly on floor.
By 9 months.
Progresses to creeping on hands and knees with belly off floor

48. Infant's Crawling

49. Infant’s Creeping

50. Gross Motor Development
4. Locomotion:
By 11 months
Walk while holding onto furniture or with both hands held
At 12 months
Walk with assistance one hand held.
First independent steps by their first birthday.

51. Psychosocial Development
Developing a Sense of Trust (Erikson)
Erikson's phase I Trust vs. Mistrust (birth to 1 year)
Infant acquires a sense of trust, while overcoming a sense of mistrust.
A trust of self, of others, and of the world.
Infants "trust" that their comfort, feeding, stimulation, and caring needs will be met.
The provision of food, warmth, and shelter by itself is insufficient for the development of a strong sense of self

52. Psychosocial Development
Erikson's phase I (Trust vs. Mistrust)
The critical elements for the achievement of trust are:
The quality of both the parent (caregiver)-child relationship
The consistency care the infant receives.
Tactile stimulation is extremely important in the total process of acquiring trust

53. Psychosocial Development
Mistrust can develop from either too much or too little frustration.
During 3-4 months (The first social stage)
Food intake is the most important social activity
Infant use more advanced behaviors to interact with others by bodily process such as vision, motor movement
Example : rather than cry, infants may put their arms up to signify a desire to be held.

54. Psychosocial Development
Grasping ( The second social stage)
Reaching out to others through grasping. Grasping is initially reflexive, but, it has a powerful social meaning for the parents.
The reciprocal response to the infant's grasping is the parents' holding on and touching.

55. Cognitive Development
Piaget:
The Sensorimotor phase
Use reflexes (birth -1 month) most action is reflexive.
perception of event is centered on the body.
By 6 months they respond to new stimuli.
4-8 months, activity makes changes in the environment.

56. Three critical events during this phase
Three critical events during this phase. A- The separation: infants learn to separate themselves from other objects in the environment. They realize that others besides themselves control the environment and this is important for mutual satisfaction to occur.

57. B- object permanence: the realization that objects that leave the visual field still exist. Example: Infants are able to pursue objects they observe being hidden under a pillow or behind a chair This skill develops at 9 to 10 months of age

58. C- Symbols, or mental representation:
The use of symbols allows the infant to think of an object or situation without actually experiencing it.
It is the beginning of the understanding of time and space.
They can experience an event by observing it
They begin to associate symbols with events (e.g., "bye-bye" with "Mommy/Daddy goes to work"),

59. Development of Body Image
The development of body image parallels sensorimotor development. Infants' kinesthetic and tactile experiences are the first perceptions of their body, and the mouth is the principal area of pleasurable sensations The hands and fingers to suck and the feet to play with are objects of pleasure They feel comfort and satisfaction with their body when their physical needs are met

60. Development of Body Image
As physical needs are met, they feel comfort and satisfaction with their body.
When infants smile, they receive emotional satisfaction from others who smile back.
Object permanence is basic to the development of self-image.
By the end of the first year infants recognize that they are distinct from their parents.

61. Development of Body Image
As their motor skills develop, they learn that parts of the body are useful It is important to transmit positive messages to infants about their bodies. There is increasing interest in their image, especially in the mirror

62. Social Development
Initially, Social development is influenced by infant's reflexive behavior, such as grasping. By age of 2 months The social smile is an early step of communication By second half of the first year. Attachment to the parent is increasingly evident By 4 months Infant lough aloud

63. Social Development Play is the major socializing agent
It provides stimulation needed to learn from and interact with the environment.
By age 6 months
Infants are very personable.
They play peekaboo
They show their desire to be picked up by extending their arms they show displeasure when their face is washed.

64. Attachment

65. Attachment
Human physical contact is very important to infants and cannot be over emphasized
Parenting is not instinctual ability but a learned acquired process
The attachment of parent and child begins before birth and assumes even more importance after birth and continue over first year of life

66. Attachment
The mother is a term that used in the broad context of the consistent caregiver with whom the child relates more than anyone else. The father or a grandparent may very well be that person (a mother)

67. EBP
When First- time father hold their infants: They develops strong close attachment They verbalize positive feeling of affection and love to their infants (Feeley, Sherrard, Whaitzer et al.,2013

68. Attachment
Two components of cognitive development are needed for attachment
The ability to discriminate the mother from other individuals
2) The attainment of object permanence

69. Attachment
Infant progresses through four overlapping stages 1- In the first few weeks of life: Infants respond indiscriminately to any one 2- By age 8-12 weeks of age Infants cry, smile, and vocalize more to the mother than any one else but continue to responds to others

70. Attachment
3- By 6 months of age Infants show a distinct preference for the mother 4- By 7 month of age showing attachment to mother and other members of the family, most often the father

71. Attachment
Other developmental behaviors that influence the attachment process:
(1) differential crying, smiling, and vocalization (more to the mother than to anyone else)
(2) visual-motor orientation (looking more at the mother, even if she is not close
(3) crying when the mother leaves the room

72. Attachment
(4) approaching through locomotion (crawling, creeping, or walking)
(5) clinging (especially in the presence of a stranger)
(6) exploring away from the mother while using her as a secure base.

73. Language Development
First weeks of life: Crying = verbal communication a biologic sign that conveys a message about displeasure, such as hunger. Crying tends to decrease by 12 weeks The increase in crying for no apparent reason during the first few months may be related to the discharge of energy and the maturational changes in the central nervous system

74. Language Development
By the end of the first year: Infants cry for seeking attention They cry from fear (especially stranger fear) They cry from frustration By 5 to 6 weeks Vocalizations during crying (making throaty sounds). By 2 months They make single vowel sounds such as ah, eh, and uh.

75. Language Development
By 3 to 4 months The consonants n, k, g, p, and b are added, and the infants coo, gurgle, and laugh aloud. By 8 months imitate sounds, add the consonants t, d, and w, and combine syllables (e.g., "dada"), but they do not ascribe meaning to the word until 10 to 11 months of age . By 9 to 10 months comprehend the meaning of the word "no" and obey simple commands. By age 1 year can say three to five words with meaning.

76. References
Hockenberry, M. J.,Wilson, D. & Rodgers, C., (2017). Wong's Essentials of Pediatric Nursing (10th ed.). St. Louis, MO: Elsevier Mosby