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Growth and Development
INFANT (1 month to 1 year)
•Infancy most rapid period of growth; especially during the
first 6 months
•Growth monitored by plotting on standardized growth chart
•Gains 150-210 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
•Birth weight triples by 1 year
•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
•Beginning signs of tooth eruption by 5–6 months
•Chewing and biting 5–6 months
•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
•Most newborn infants sleep when not eating, being changed or
•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
•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
•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
—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
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
—May show aggressiveness by occasional biting
—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.
—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
—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 breastfeeding 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
—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
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