1. INFANCY

2. The First Year of Life Time of rapid growth and development.
Growth in the first year is extremely rapid.
It occurs in spurts, called saltatory growth.

3. Infant Weight At birth: 2.7 – 4.0 kg At 5 months: 2X birth weight.
At 2 years: 4 X birth weight.
At 3 years: 5 X birth weight.
At 5 years: 6 X birth weight.
At 7 years: 7 X birth weight.
At 8 years: 8 X birth weight.
At 9 years: 9 X birth weight.
At 10 years: 10 X birth weight.

4. Weight Gain (per day) AGE WEIGHT GAIN 0-3 months: 30 g/day
1-3 years: 8 g/day (2.8kg/yr)
3-6 years: 6 g/day (2 kg/yr)

5. Weight Gain (per month)
AGE WEIGHT GAIN
0-3 months: 900 g
3-6 months: 600 g
6-9 months: 450 g
9-12 months: 360 g
1-3 years: 240 g/month(2.8 kg/yr)
4-6 years: 180 g/month (2 kg/yr)

6. Formula For Weight During Infancy WT (Kg) = [ Age (months) +9] /2.
During 2-6 Years
WT (Kg) = Age (yrs) X 2+ 8.
During 7-12 Years
WT (Kg) = [Age (yrs) X 7-5] /2.

7. Length/ Height
Supine length is measured for children of less than two years of age.
After two years of age, standing height is taken as a measure of stature.

8. Length At Birth: At birth: 48 – 53 cm At one year = 75 cm.
At two years = 87.5 cm.
At four years = 100 cm.

9. Length Gain AGE GAIN 0-3 months: 3.5 cm/ month
1-3 years: 1 cm/month(12 cm/yr)
3-6 years: cm/month (3 cm/yr)

10. Gain In Length 1st year = 25 cm 2nd year = 12 cm 3rd year = 10 cm
4th year = 3 cm
At puberty:
Girls = 6-11 cm
Boys= 7-12 cm

11. Formula for Calculating Height
From 1- 6 Years
Height (cm) = Age (Yrs) X

12. Head Circumference At birth: 35.3 ± 1.2 cm.
Increases by 6 cm during the first 3 months.
Further increases by another 6 cm during months.

13. Gain in head circumference
During 1st year = 12 cm.
During 2nd year = 2 cm.
During 3rd year = 1.5 cm.
From 3 to 14 years = 2.5 cm

14. Changes in head circumference
AGE GAIN
0-3 months: 2 cm/ month
3-6 months: 1 cm / month
6-12 months: 0.5 cm/ month
1-3 years: cm/month
3-6 years: 1 cm/year

15. VISION
An infants vision is at first, visual acuity 20/100-20/400
Within a week they can focus on objects that are cm away
Binocularity: fixation of two ocular images into one cerebral picture begins to develop by 6 weeks and established by 4 months.
Lack of binocular vision results in strabismus
Have visual preference for looking at the human face
blurry

16. Vision
Depth perception (stereopsis) begins in the 2nd – 3rd month, well developed by age 7 months.
What is Depth Perception?
Recognizing that an object is three-dimensional, not flat.
With this improved vision they develop hand-eye coordination.
Why is the development of hand eye coordination important?
Important for skills such as eating, catching, coloring, tying shoes, etc

17. Hearing Birth: 8-12 weeks: >12 weeks: 24-32 weeks:
Responds to loud noise by startle or Moro
Responds to sound of human voice more readily than to any other sound
8-12 weeks:
Turns head to side when sound is made at level of ear
>12 weeks:
Locates sound by turning head to side and then looking up or down
24-32 weeks:
Responds to own name

18. Smell and Taste
The sense of smell does not develop much before birth because baby is surrounded by amniotic fluid until birth.
Within 10 days they can distinguish the smell of their mother from another person.
The sense of taste develops rapidly.
During the 1st year, babies learn about the world through their mouth, putting everything in sight in it.
Parents need to make sure the objects are clean, not too small, and without edges.

19. Development During the First Year
Teeth
Development of the baby’s teeth usually begin about the 6th week of pregnancy
The first baby teeth appear at about 6 or 7 months (primary teeth).
Teething often causes pain and swelling and makes for a cranky baby

20. Language Acquisition Cooing: Repetition of vowel sounds by infants
Babbling: Repetition of meaningless language sounds (e.g., babababa)
Single-Word Stage: The child says one word at a time
Telegraphic Speech: Two word sentences that communicate a single idea (e.g., Want yogurt)

21. Language development 12 weeks cooing, smiles when talked to
16 weeks turns head in response to human voice
20 weeks makes vowels and consonant sounds
6 months babbling (all sounds)
8 months repeat certain syllables (ma-ma)
12 months understands and says some words

22. Psychosocial development
Erik Erikson: First Psychosocial Stage: Trust vs. Mistrust
Consistent loving care by a mothering person is essential to build a trust relationship.
Mistrust develops when basic needs are inconsistently met.

23. Piaget’s Cognitive Stages

24. Sensorimotor Stage (0-2)
Stage One (birth-1 mo.)
Use of reflexes
Stage Two (1 - 4 mos.)
Primary circular reactions: Actions that are at first random and activate a reflex are attempted again to try and induce the experience again (recognition of causality). The interesting events are occurring within the body (plays with hands, fingers, feet).
Stage Three (4 - 8 mos.)
Secondary circular reactions: The interesting events in this case are located in the external world (Making Interesting Sights Last)
Beginning of object permanence: shows separation anxiety
Able to imitate selective activity

25. Infants’ imitation of facial expressions

26. Sensorimotor Stage, Cont’d
Stage Four ( mos.)
Coordination of secondary schemata
New Adaptations and Anticipation
Intentionality occurs in interactions with the environment and the infant is moving towards goal directed behavior: works to get toy that is out of reach
Fully developed object permanence

27. Moral development (Kohlberg)
Level 1: Preconventional morality (0-9y)
Stage 1: the punishment-and-obedience orientation.
Children determine the goodness or badness of an action in terms of its consequences.
They avoid punishment and obey unquestioningly those who have the power to determine and enforce the rules
They have no concept of the underlying moral order

28. Play
Solitary Play: When a child plays alone even when with other children

29. Principles of Motor Development
Gross movements before fine movements
Pattern of development is usually the same, but the rate differs greatly from child to child and from culture to culture.

30. 2-3 months

31. Gross Motor Development
First Month
Turns head to clear nose from bed
Keeps hands fisted or slightly open
Head lag when pulled from lying to sitting
Second month
Holds head up while on tummy almost 45 degrees
Third month
Lift head and chest of the bed
Turns head to sounds
Reaches for objects with both hands

32. Fourth month Fifth month Sixth month Rolls from back to side
Able to raise head and chest off surface to angle of 90 degrees
Fifth month
Rolls from abdomen to back
May sit if supported
When supine, puts feet to mouth
Sixth month
Transfer toy from one hand to next
army crawl on tummy
Rolls from back to abdomen

33. Seventh month Eighth month Ninth month Pushes up on hands and knees
Sits w/ little support
When held in standing position bounces actively
Eighth month
Sit without support
Creeps
Stands leaning against something
Ninth month
May crawl upstairs

34. Tenth month Eleventh month Twelfth month Stands w/ little support
Cruises the room.
Eleventh month
Stands alone
Twelfth month
Walks

35. Fine Motor Behavior
At 4 month: brings hands together and shake rattle.
At 6 month: palmer grasp.
At 7 month: pass object from hand to another.
At 8 month: advanced eye-hand coordination.
At 10 month: pincer grasp.
at 12 month: holds cup or spoon

37. Hematologic System
Hgb A production largely replaces Hgb F by 4 months (physiologic anemia due to fetal RBCs destruction)

38. Respiratory System RR slows.
Upper respiratory infections tend to be more severe due to small lumen of respiratory tract and inefficient mucus production.

39. Immune System Become functioning at 2 months.
Produce both IgG & IgM antibodies by the first year.

40. Emotional At 6 weeks: social smile.
At 4 months: recognize his primary caregiver.
At 7-8 months: stranger anxiety, continue until 12 months.
At 8 months: separation anxiety, continue until preschool period.
Both are related to infant’s ability to discriminate between familiar and nonfamiliar people

41. Dentation First tooth erupt 5-7 months
Has 6-8 deciduous teeth by the first year of age.
The sequence of eruption is:
At 6 months: lower central incisors.
At 7 months: lower lateral incisors.
At 8 months: upper central incisors.
At 9 months: upper lateral incisors.

43. GI System Can digest protein at birth.
Amylase deficiency until 3rd month of age ( cannot digest complex CHO)
Lipase deficiency during entire 1st year.
Infant needs frequent feedings.
Extrusion reflex exists until 3-4 months.
Introduction of solid food 4-6 months.

44. Energy Requirement Age Energy requirement
< 6 months Wt (kg) x 108/ day
6mo-1 year Wt (kg) x 98/ day

45. Water requirements = amt in foods + fluids
Age Amount
3 days ml/kg/day
10 days ml/kg/day
3 mo ml/kg/day
6 mo 130/155 ml/kg/day
9 mo ml/kg/day
With BF and formula: none additionally needed in first 4 to 6 months

46. Infant Nutrition Birth through 4-6 months Breast milk OR
Iron-Fortified infant formula

47. Breast- Versus Bottle-Feeding
Debate focused on whether breast-feeding is better for the infant than bottle-feeding
American Pediatric Association strongly endorses breast-feeding throughout the first year of life
Benefits
Appropriate weight gain
Fewer allergies
Fewer illnesses
Reduced childhood cancer and reduced incidence of breast cancer in mothers and their female offspring
Lower incidence of SIDS
Stronger attachment bond

48. Infant Nutrition 4 through 7 months Breast milk OR
Iron-Fortified infant formula
Iron-Fortified infant cereal
Vegetables
Fruit

49. Infant Nutrition 8 through 11 months Same as 4 through 7 months PLUS
Meat
Egg yolks

50. Infant Nutrition
11 months
Finger foods
Cup

51. Tips for Introduction of Solid Foods
Start slowly
Only 1 new food every 4-5 days
Hold baby during feeding
First food: Iron-Fortified infant rice cereal

52. Tips for Introduction of Solid Foods
Use single-ingredient foods
Read food labels
Avoid desserts
Avoid foods that can choke infants

53. Feeding Problems Colic (<3months): gas production, and bloating
Cause? Not always known: formula fed! (high in carbohydrate)
Overfeeding : swallowing too much air.
Breastfeeding?
Foods in the mother’s diet
Cow’s milk, or other items
Spitting up
Normal occurrence: after meals, mouthful of milk.
Unless projectile vomiting: Organic problem: pyloric sphincter closure

54. Common Health Concerns
Teething: gum sore, tender can lead to decreased intake and cry.
Thumb sucking: does not deform the jaw as long as it stops by school-age.
Diaper dermatitis: prolong contact with urine or feces.
Constipation: increased with formula fed.
Sleep problems: as a result of colic or other health problems.