Hockenberry: Wongs Nursing Care of Infants and Children, 10th Edition

Chapter 10: Health Promotion of the Infant and Family

Key Points - Print
Biologic development of the child encompasses proportional changes; sensory changes,
including binocularity, depth perception, and visual preference; maturation of biologic
systems; fine motor development; and gross motor development.
Physical growth occurs at a rapid rate during the first year of life. Infant birth weight should
double by 6 months of age and triple by 12 months of age. Head growth is also rapid and an
important determinant of brain growth. 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 approximately 2.5 times. By 1 year of age, head size has increased by almost 33%.
Closure of the cranial sutures occurs, with the posterior fontanel fusing by 6 to 8 weeks of age
and the anterior fontanel closing by 12 to 18 months of age (the average age being 14
months).
Height increases by 2.5 cm (1 inch) per month during the first 6 months and by half that
amount per month during the second 6 months. Increases in length occur in sudden spurts
rather than in a slow, gradual pattern. By 1 year, birth length has increased by almost 50%.
This increase occurs mainly in the trunk rather than the legs and contributes to the
characteristic physique of older infants.
Gross motor development is demonstrated throughout the first 12 months of life by
increasing ability to control head movement, sit without support, crawl, and stand holding on
to an object.
Eriksons theory of psychosocial development (birth to 1 year) is concerned with acquiring a
sense of trust while overcoming a sense of mistrust. The crucial element for the achievement
of this task is the quality of both the parent (caregiver)child relationship and the care the
infant receives.
Piagets theory of cognitive development, as it applies to the infant, focuses on the
sensorimotor phase, which includes the use of reflexes, primary circular reactions, secondary
circular reactions, and coordination or secondary schemata and their application to new
situations. A major accomplishment is achieving the concept of object permanence, or the
realization that objects that leave the visual field still exist.
Development of body image begins in infancy, and by 1 year of age, infants recognize that
they are distinct from their parents. As motor skills develop, infants learn that parts of the
body are useful; for example, the hands bring objects to the mouth, and the legs help them
move to different locations.
Social development of the infant is guided by attachment, language development, personalsocial behavior, and participation in play. Play is a major socializing agent and provides
stimulation needed to learn from and interact with the environment. Play in infancy is
considered to be solitary play, or one sided; infants choose with whom they will interact. At 6
to 8 months, they usually refuse to play with strangers. Parents are definite favorites, and
infants know how to attract their attention.
Copyright 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Key Points - Print

10-2

Separation anxiety develops between ages 4 and 8 months and is manifested through a
predictable sequence of behaviors. Infants protest the physical separation from the mother
through crying. Between ages 6 and 8 months, fear of strangers and stranger anxiety become
prominent and are related to infants ability to discriminate between familiar and unfamiliar
people. Behaviors such as clinging to the parent, crying, and turning away from the stranger
are common.
Temperament influences the type of interaction that occurs between the child and parents and
siblings. With knowledge of the infants temperament, nurses are better able to (1) provide
parents with background information that will help them see their child in a better perspective,
(2) offer a more organized picture of the childs behavior and possibly reveal distortions in the
parents perceptions of the behavior, and (3) guide parents regarding appropriate childrearing
techniques.
Parents are faced with many concerns, including infant fears, day care, limit setting and
discipline, thumb sucking and pacifier use, teething, and choice of infant shoes. Providing the
parents information regarding infant behavior and appropriate childrearing practices helps
parents cope with the tasks of childrearing.
A fussy or irritable infant is a potential victim of traumatic brain injury or shaken baby
syndrome (or other bodily harm) because adults and caretakers may not understand the nature
of the infants crying. It must be reiterated continually that infants cry because a need is not
being met, not to intentionally irritate an adult.
Parents may need assistance choosing an appropriate child care arrangement if the mother
returns to work.
Breast milk is the most desirable food for infants during the first 6 months. Exclusively
breastfed infants should receive a daily supplement of 400 international units of vitamin D
beginning in the first few days of life to prevent rickets and vitamin D deficiency. Commercial
iron-fortified formula is an acceptable alternative to breast milk followed by gradual
introduction of solid food during the period of 4 to 6 months. Iron-fortified rice cereal is
recommended as the first solid food. Whole milk is not recommended until after 12 months.
Infants, whether breastfed or bottle fed, do not require additional fluids, especially water or
juice, during the first 4 to 6 months of life. Honey should be avoided in the first 12 months
because of the risk of infant botulism.
The order of introduction of other solid foods is arbitrary. A common sequence is strained
fruits followed by vegetables and, finally, meats. Some clinicians prefer to add vegetables
before fruit. Only one solid is introduced every 5 to 7 days so that a reaction to a particular
food can be distinguished.
One of the more difficult periods in the infants (and parents) life is the eruption of the
deciduous (primary) teeth, often referred to as teething. The age of tooth eruption shows
considerable variation among children, but the order of their appearance is fairly regular and
predictable. The first primary teeth to erupt are the lower central incisors, which appear at
approximately 6 to 10 months of age (average 8 months).
Cleaning the teeth regularly and appropriate dietary intake promote good dental health.
Fluoride, an essential mineral for building caries-resistant teeth, is needed beginning at 6
months of age if the infant does not receive water with adequate fluoride content.

Copyright 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Key Points - Print

10-3

Effective teaching for injury prevention optimally begins in infancy by helping parents
understand their childs normal development. Because injuries are a major cause of death
during infancy, parents should be alerted to aspiration of foreign objects, suffocation, falls,
poisoning, burns, motor vehicle injuries, and bodily damage, as well as preventive actions
needed to make the environment safe for infants. The three leading causes of accidental death
in infants are suffocation, motor vehiclerelated injuries, and drowning.
A significant number of infants are injured or die from improper restraint within the vehicle,
most often from riding on the lap of another occupant. For infants and toddlers up to 24
months of age, a rear-facing car seat in the back seat of the vehicle provides the best
protection.

Copyright 2015, 2011, 2007, 2003, 1999 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.