THE INFANT

DR. Lina Mrayan

OBJECTIVES

• Discuss the motor development of infant
• Discuss autonomy about infant
• Discuss a sleep patterns of them
• Identify the role of play in fostering growth and development.
• Discuss the nutritional need of infant.
• Describe the eruption and purpose of teeth.
• Discuss immunization and accident prevention for the infant.

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Motor Development

• The development of motor skills is closely related to the development of perception, emotion ,and cognition.

تطور المهارات الحركية يرتبط ارتباطا وثيقا في تطوير الإدراك و العاطفة، والإدراك

• Reaching out and touching what they see enable infant to establish visual –motor skills.

• Many motor skills are dependent on the disappearance of newborn reflexes .

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• With the disappearance of the tonic neck reflex (the arm extends when the head turns to the side) .
• The infant is able to bring both hands to the midline of the body into prayer position.

At the three month, the infant attempts to grasp whatever he or she touches .

At 6 month, the infant shapes the hand to prepare to touch and grasp on observed object .

By 9 month, the pincer action enables the infant to grasp with the thumb and forefinger .

By 2 year, wrist action enables the use of spoons during feeding .

As posture and balance develop

• Learn to left there heads

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• Sit and stand

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• Take their first steps around 1 year of age

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Infant start to walk about 4-5 month after they are able to pull themselves up to a standing position .

The development of locomotion , prehension , and perception

تطوير الحركة و الإمساك والإدراك

1 Month …

• Locomotion : chin –up .
• Prehension: hand held closed, fingers move without coordination from mind.

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• Perception : able to focus or sharply contrasted angled mobile above.

focus or sharply contrasted angled mobile above.

2 Month …

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• Locomotion : chest up, elevates self with arm .
• Prehension : hand hold open most of the time .

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• Perception: selectively responds to patterns, colors. Imitates expressions. Is self –centered. Prefers to look at familiar sights .

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4 Month …

• Locomotion : rolls over at will.

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• Prehension : reach for overhead objects with fingers,

with hit- and- miss action .

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• Perception: perceives differences in facial expressions .

5 Month …

• Locomotion : sits alone momentarily .
• Prehension: picks up toy with squeeze action .

6 Month …

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Locomotion: sits alone steadily with hands forward for support

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Prehension: grasps with thumb on one side and 3 fingers on other.

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Perception: can distinguish between familiar and unfamiliar sight. Separation anxiety begins. Sees self and parent as one.

Grasps with thumb and 3 fingers.

8 Month…

• Locomotion: sits with support. Pulls to standing position.

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• Prehension: thumb and index finger can hold object with out pressing it into palm. Can transfer from one hand to the other

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• perception: can distinguish happy

From fearful face.

thumb and index finger can hold object with out pressing it into palm

9 Month …

• Locomotion: creeps.
• Prehension: use fingers to explore what eye sees. Has hand–mouth coordination
• Perception: fears strangers. Recognizes self as separate from parent .

10 Month …

• Locomotion: walks when led .
• Prehension: can let 1 toy go at a time.
• Perception: separation anxiety peaks.

11 Month…

• Locomotion : Stand a lone and can sit from standing position.

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• Prehension : pincer action enables infant to pick up small object .

12 Month …

• Locomotion: walk 3 steps .
• Prehension: hand obeys direction from mind. Aim is poor but can place toy in pan. Can attempt to feed self .
• Perception: Goal corrected partnership. Enable infant to grasp onto parent because he or she anticipates being left with stranger .

15 Month …

• Locomotion: can walk up stairs with support.

• Prehension: mind is 100% is control of hands. Places round peg in round hole. Builds tower of 2 cubes.

AUTONOMY

• Refers to independence. Striving for independence starts early in infancy.
• Self-consoling behavior is an early sign from of independence.

• At 6- 10 month of age , body rocking is used to achieve self – comforting.
• Nine month olds with newly developed pincer ability will insist on self-finger feeding and will resist the attempts of parents to feed them at mealtime .

AUTONOMY

SLEEP PATTERNS

• A maturing central nervous system combined with parental responses aids in the development of sleep patterns .
• By 3 month ,most infants develop a pattern of sustained sleep between midnight and 5:00 am, but a few do not develop this pattern before 1 year of age.
• In the first year, waking at night is considered normal. The goal is to help infants develop self-regulatory skill so that they return to sleep with out prompting. This can occur more quickly if parents wait until there is evidence that infants are fully a wake before picking them up .

CONT…

• In a semi wakened state, gentle body patting or use of a pacifier should be enough consolation to help the infant return to sleep.
• The establishment of a pre-bedtime routine of quiet activity (e.g. rocking or reading to the infant )helps with the acceptance of bedtime during the first years of life.

The establishment of an appropriate sleep pattern is important because adequate sleep is related to memory, attention, learning and general behavior

ROLE OF PLAY IN FOSTERING GROWTH AND DEVELOPMENT

• Piaget sensorimotor theory of development of the infant is: evident in the infant play activities, which are activated by sensations and relate to the infant directly.
• Play is the work of a child.
• Age- appropriate play activities can effectively foster growth and development.
• For example : newborn must learn to focus and follow with the eyes .

• At 3 months an interactive mobile that is activated by kicking helps develop the cause effect understanding.
• At 6 to 7 months playing peek-a- boo helps solidify the object permanence concept.

• In the young infant all toys are explored by taste and touch , but by 1 year infant typically understands the function of the toy. (a car will be pushed a telephone will be put on the ear )
• Egocentric behavior is evidenced by 1 year olds who drink from a toy cup or place a toy telephone to their ear,
• The 1 year old enjoys push toys that foster the newly mastered walking abilities.

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• The infant explores with the mouth according to Freud. Oral sucking, biting, and chewing toys are appropriate for this stage of development.

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• The nurse or health care worker needs to reassure parents that picking up everything from the floor and placing it into his or her mouth and intentionally dropping food from the highchair tray onto the floor are developmentally normal behaviors and definitely not signs of badly behaved child.

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HEALTH MAINTENANCE:�Nutrition

• In the first year of life, the brain and the body grow and develop rapidly. proper nutritional intake is essential to support optimum development.
• the newborn has a rooting reflex that seeks out the nipple and
• sucking reflex that elicited when the nipple touches the lips.

A tongue extrusion reflex prevents ingestion of solid food.

• The best nutrition for the newborn is the breast milk, which contain antibodies and easy-to-digest fats.
• For mothers who cannot breastfeed, most commercial formulas provide adequate nutrition, although the extra benefits of the antibodies ingredients are not provided.

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• Newborns are usually fed on demand at 2 to 3 hours intervals and by 4 to 6 months of age may skip a nighttime feeding.
• Infant should be fed formula or breast milk for 1 full year.
• At 1 year of age the infant can be placed on whole milk.
• low-fat milk should not be given to children under age 2 , because the fats are necessary for development of the nervous system.

• At 6 months: the tongue extrusion

reflex has disappeared;

• the infant will no longer spit out solid foods and is therefore ready for strained rice cereal.
• gradually, fruits and vegetables are added, but only one at time to help the parents determine what food may upset the stomach and to identify a food allergy response.

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• By 11 months: meat and eggs are added to the diet.
• by 1 year: the infant typically eats table food three time a day and can join the family meal schedule.
• Introduction of foods before 6 months of age is not for nutritional value, because the infant may not have the digestive enzymes necessary for complete digestion and utilization of the nutrients.

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• foods such as nuts, jellied candy, and large piece of solid food, should not be offered to the infant because they present of choking hazard.
• honey should not be given to children under 2 years of age because of the risk of botulism poisoning.
• Commercially prepared foods such as beets, turnips, spinach, celery , and collard green are high in nitrates and should be used sparingly (carefully) for infants under 1 year of age.

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• Commercially prepared baby food in jars are vacuum packed, and parents should check the safety seals and expiration dates before purchase.
• the development of autonomy dictates the need for finger foods by 9 to 10 months, when the infant can be expected to prefer self-feeding.

• The temperament of the infant will influence the development of mealtime challenges.

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• For example: infants with a high activity level should not be expected to sit for long period at the family meal table. Infants who are highly distractible may not even finish a meal. Infants who are slow to adapt may not easily try new foods.

• The nurse can help the parent develop strategies to deal with temperament as it relates to feeding, so that conflicts will not arise.
• The nurse or health care workers can provide parents with information regarding feeding concerns during the first year.

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Teeth

• The eruption of the first 20 deciduous teeth, which are also known as primary or baby teeth, usually begins at 5 to 7 months of age .

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The number of primary tooth that should be present in the mouth of an infant or toddler can be anticipated by use of the following formula:

Age in months - 6

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• the upper and lower central incisors are usually the first to erupt .
• the primary teeth serve the purpose of helping the intake of nutrition by allowing the chewing of foods and they also help in the formation of the jaw.

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• Nursing caries: the most common type of dental caries. occur when the infant is put to bed while sucking on a bottle of milk or juice. the sugars in the milk or juice coat the teeth and promote tooth decay.

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• If infant insists on a bottle at bedtime, it should be a bottle of water to prevent the development of nursing caries.

immunizations:

• well child visits should be scheduled before the newborn is discharged.

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• the growth, development, health, and nutrition of the infant should be checked every 2months and appropriate immunization scheduled.

Accident Prevention

• Accidents are a major cause of morbidity (illness) and mortality (death). The first injury prevention activity for the newborn, is the use of car seats for infants and children.

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• Falls are common cause of injury to infants under 1 year. keeping the side rails up prevent the infant from rolling out of the crib. the use of safety straps when infants are placed in highchairs or strollers also prevent falls .

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• Placing infants supine on the back to sleep and not using pillows in the crib can aid in prevention accidental suffocation and sudden infant death syndrome (SIDS).

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• Choking becomes a high risk because small objects picked up from the floor are typically placed in the mouth.

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• Infants can drown in a shallow tub bath if left unattended even for a minute.

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• Burns can be a risk for infants who pull on the cord of a hot iron, reach for the handle of a pot on the stove, or stick their finger into an exposed and inviting electrical outlet.

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THANK YOU