Growth and Development AHMAD AYDI

INFANT (1 month to 1 year) Growth Infancy most rapid period of growth; especially during the first 6 months Growth monitored by plotting on standardized growth chart

Weight Gains gm per week for first 6 months Birth weight doubles at 5–6 months Weight gain slows during the second 6 months Gains 85–150 g weekly for next 6 months Birth weight triples by 1 year

Length Grows 2.5 cm (1 inch) per month for the first 6 months Slows during the second 6 months Grows 1.25 cm (1⁄2 inch) for second 6 months Birth length increases by 50%, mainly in the trunk, by 1 year

Head Growth Posterior fontanel closes Increases by 1.5 cm (1/2 inch) per month for the first 6 months and by 1.25 cm per month during the second 6 months

Chest Circumference Increases by 2–3 cm. for the first 6 months (1 inch less than head circumference) Chest and head circumferences equal at 1 year

Vital Signs Heart rate 80–130 Respiratory rate 30–50 up till 6 months; 20–30 till 2 years B/P 90/50 on average

Dentition Beginning signs of tooth eruption by 5–6 months Chewing and biting 5–6 months

Sensory Rudimentary fixation on light or objects; ability to follow light to midline; and differentiates light and dark at birth Hearing and touch are well developed at birth Rudimentary color vision begins at 2 months and improves throughout the first year Able to fixate on moving object 8–10 inches away, 45 degrees range at 1 month.

Follows objects 180 degrees at 3 months Beginning hand eye coordination at 4 months Can fixate on very small objects at 7 months Begins to develop depth perception 7–9 months Able to discriminate simple geometric forms at 12 months Able to follow rapidly moving objects at 12 months Locates sound by turning head to side, looking in same direction at 3 months

Sleep Most newborn infants sleep when not eating, being changed or bathed Most infants sleep 9–11 hours a night by 3–4 months Total daily sleep is approximately 15 hours Nighttime sleep hours and amount and length of naps vary among infants Most infants take routine morning and afternoon naps by 12 months

Gross Motor Developmental Milestones Lifts head 90 degrees when prone, sits with support at 3 months Good head control at 5 months Rolls completely over, good head control in sitting position, crawls on abdomen with arms at 6 months

Attains sitting position independently, creeps on all four extremities, pulls self to standing position at 9 months Walks holding on to furniture cruising at 11 months Stands alone, takes one to two steps at 12 months Walks alone at 15 months

Fine Motor Developmental Milestones Grasps and briefly holds objects and takes them to mouth at 3 months Uses palm grasp with fingers encircling object, transfers cube from hand to hand at 6 months Crude thumb-finger pincer grasp, bangs hand held cubes together at 9 months Places tiny object, such as raisin into container, makes marks with crayon at 12 months Builds tower of two cubes, scribbles with crayon at 15 Months

Cognitive Development (Piaget) —Sensorimotor (birth to 2 years) —Learning takes place through the child's developing sensory and motor skills —The child progresses from reflexive activity to purposeful acts

—Initially the infant focuses on own body; discovers own body parts at 2–4 months; gradually shifts attention to objects in the environment —Learning by simple repetitive behaviors: repeating pleasing actions; learning that sucking gives pleasure, leads to generalized sucking of fingers, rattle

—Prolonging interesting actions for reasons that result; grasping and holding becomes shaking, banging, and pulling. Shaking makes one noise, shaking more or less makes a different noise —Imitates simple acts and noises

—Beginning understanding of object permanence, searches for dropped objects Can find partially hidden object at 6 months Briefly searches for dropped object; begins to understand object permanence 7–9 months Develops sense of object permanence at 10 months Searches for objects where seen last, even if not hidden at 12 months

Language Development —Vocalization is distinct from crying at 2 months —Vocalizes to show pleasure; squeals at 3 months —Laughs at 4 months —Begins to imitate sounds at 6 months

—One syllable utterances ma, da, mu, hi at 6 months —Chained syllables baba, dada at 7 months —Dada, mama with meaning at 10 months —Five word vocabulary at 12 months

Psychosocial Development (Erikson) —Trust vs. Mistrust (birth to 1 year) —Infants whose needs for warmth, comfort, love, security, and food are met learn to trust. Infant’s whose needs are significantly delayed or unmet, learn to mistrust —Erikson reasons that the quality of parent–infant interactions determines development of trust or mistrust

Psychosocial Behaviors —Parents and infants develop a strong bond that grows into deep attachment as the parent cares for the newborn —Stares at parents' face when parent talks to infant at 1 month —Smiles socially at 2 months —Recognizes familiar faces at 3 months —Demands attention, enjoys social interaction with people at 4 months —May show aggressiveness by occasional biting

Fears —Begins to express fear; anticipates fear of mutilation, animal noises, the dark —Stranger anxiety begins at around 6 months and intensifies in the following months, consistent stranger anxiety at 8 months

Psychosexual Development (Freud) —Oral stage (birth to 1 year) —Actions center on oral activities. The infant sucks, tastes, bites, chews, swallows, and vocalizes for pleasure.

Safety: —Use approved infant car seat, teach proper installation facing rear, place in back seat, not in a seat with an air bag. —Check bathing water temperature/formula temperature —Ensure crib mattress fits snugly; no pillow or comforter in the crib

—Position supine or supported on side for sleep until infant can turn over because prone position may increase sudden infant death syndrome (SIDS). SIDS— sudden unexpected unexplained death of a seemingly healthy infant —Only use pacifier with one-piece construction and loop handle

—Do not warm frozen breast milk in the microwave causing uneven warming and risk for burns; defrost in refrigerator, then run under warm water —Never leave infant on raised, unguarded surface (may roll) —Restrain in infant seat —Remove bib before putting infant in crib —Inspect toys for small removable parts

Older infant: —Keep phone number of poison control center posted near telephones or programmed in speed dial —Be sure paint on furniture does not contain lead —Teach danger of latex balloons —Restrain in high chair —Keep crib away from windows or other furniture

Infant nutrition: Breast milk is a complete and healthful diet for the first 6 months; importance of breast-feeding mother being well nourished Support choice to use commercial iron fortified formula if breast- feeding not desirable to mother or not a feasible option; recommend mixing powdered formula with bottled water, if water supply has lead or other impurities

No additional fluids needed during first 4–6 months, will fill infant up, not allowing for adequate nutritional calories Cow's milk, imitation milks are not acceptable Breast milk or formula primary source of nutrition in second 6 months as well Gradual introduction of solid foods during second 6 months; starting with cereals, fruits, vegetables, and meats

Do not feed nuts, food with pits, hot dogs, or any foods that could block the airway or have risk of choking Honey not given in first year, a source of botulism Supplements include: vitamin D, iron by 4–6 months (fetal iron stores are depleted), vitamin B12 may be needed if mother's intake is inadequate —Fluoride beginning at 6 months

Discipline: —Consistently and promptly meeting infant's needs builds trust; does not “spoil” infant. —Setting limits is appropriate and will be required in establishing nighttime routine. —Corporal punishment is unacceptable