Chapter 25
Growth and Development of the
Newborn and Infant
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Developmental Changes
Growth
o Increase in physical size
Development
o Sequential process of skill attainment
Maturation
o Increased functionality of body systems or
developmental skills
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Growth #1
Measure:
o Weight
o Length
o Head circumference
Plot each on standardized growth chart
Also plot weight for length
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Growth Charts
 Boy: birth to 24 months
of age
https://www.cdc.gov/growthcharts/data/who/
GrChrt_Boys_24LW_100611.pdf
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Growth #2
 Percentiles
o Measurements usually in approximately the same growth
percentiles over time
 Significant deviations from their previous percentiles
o May indicate that further assessments are indicated
 Specialized growth charts are available
o Children with Down syndrome
o Breastfed infants
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Infant Growth
 Weight—average 3,400 g (7.5 lb) at birth
o Doubles by 4 to 6 months
o Triples by 12 months
 Length—average 50 cm (20 in) at birth
o Increases by 50% by 12 months
 Head circumference 35 cm (13.5 in) at birth
o Increases by about 10 cm by 12 months
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Assessing Developmental Milestones
 Ask the parent if the skill has been attained
 Observe the skill during the assessment
 Screening tools:
o Ages and Stages Questionnaire (ASQ)
o Infant–Toddler Checklist (ITC)
o Infant Development Inventory (IDI)
o Parents’ Evaluation of Developmental StatusDevelopmental Milestones (PEDS-DM)
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Physiologic Changes
 Systems immature at birth, maturing somewhat over first year:
o
Neurologic
o
Respiratory
o
Cardiovascular
o
Gastrointestinal
o
Renal
o
Hematopoietic
o
Immunologic
o
Integumentary
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Neurologic System #1
 Central nervous system not fully myelinated
 Primitive reflexes present at birth
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Neurologic System #2
 As primitive reflexes disappear, protective reflexes develop
 Protective reflexes
 Involuntary motor responses maintaining equilibrium
 Persist throughout life
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Respiratory System
 Compared to the adult, the infant’s
o Nasal passages are narrower
o Larynx is more funnel shaped
o Trachea and chest wall are more compliant
o Bronchi and bronchioles are shorter and narrower
o Alveoli are significantly fewer in number
o Respiratory rate is fast (decreases as the child matures)
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Cardiovascular System
 Heart doubles in size in the first year
 Average pulse rate
o
120 to 140 in the newborn
o
Decreases to about 100 in the 1 year old
 Blood pressure
o
Average of 60/40 in the newborn
o
Steadily increases to 100/50 in the 12 month old
 Peripheral capillaries closer to skin surface
o
Newborn and young infant more susceptible to heat loss
o
Thermoregulation becomes more effective over first few months
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Gastrointestinal System
 Tongue large relative to oral cavity size
o
Allows for nipple latch so infant can feed
 Stomach capacity increases as the infant grows
 Teeth emerge in a predictable pattern
o
First primary teeth (incisors) erupt at age 6 and 8 months
 Consistency and frequency of stools
o
Meconium as newborn
o
Change over the first year of life based on intake (breast or
bottle, then solid foods)
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Genitourinary System
Frequent urination
Low specific gravity
All renal functions reduced as compared to adult
More susceptible to dehydration
o Poorer urine concentration ability
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Integumentary System
Newborns
o Lanugo and vernix may be present
o Acrocyanosis is normal; decreases over the first
few days of life
Infant’s skin relatively thinner than adults
o Peripheral capillaries more superficial
o Increased absorption of topical medications
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Hematopoietic and Immunologic Systems
 High hemoglobin level at birth
o Decreases over first 2 to 3 months
o Stabilizes by 6 to 9 months
 With adequate iron intake
 Maternal IgG stores transmitted to infant
o Protect infant in first 3 to 6 months of life
 Infant IgM level reaches adult level by 9 months of age
 Infant IgG level reaches adult level by 12 months of age
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Developmental Theories
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Social and Emotional Development
 Stranger anxiety
o
Develops around 8 months of age
o
Infant recognizes self as separate from others
 Separation anxiety
o
Develops in later infancy
o
Infant becomes distressed when parent leaves
 Temperament ranges between
o
Low to moderately active, regular, and predictable
o
Highly active, more intense, and less adaptable
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Motor Skills
 Gross motor skills develop
in cephalocaudal fashion
 Fine motor skills develop
in proximodistal fashion
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Gross Motor Skill Progression #1
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Gross Motor Skill Progression #2
 Adapted from Centers for Disease Control and Prevention. (2018b).
Developmental milestones. Retrieved March 11, 2019, from
http://www.cdc.gov/ncbddd/actearly/milestones/index.html
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Fine Motor Skill Progression #1
Age
Fine Motor Skills
1 month
3 months
Fists mostly clenched, involuntary hand
movements
Holds hand in front of face, hands open
4 months
Bats at objects
5 months
Grasps rattle
6 months
Releases object in hand to take another
7 months
Transfers object from one hand to the
other
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Fine Motor Skill Progression #2
 Adapted from Centers for Disease Control and Prevention. (2018b).
Developmental milestones. Retrieved March 11, 2019, from
http://www.cdc.gov/ncbddd/actearly/milestones/index.html
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Question #1
Is the following statement true or false?
o Fine motor skills develop in a cephalocaudal
fashion (from the head to tail).
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Answer to Question #1
False.
Fine motor skills develop in a proximodistal fashion (from
the center to the periphery).
Rationale: Gross motor skills develop in a cephalocaudal
fashion (from the head to the tail).
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Premature Infants
 Infant born at <36 weeks’ gestation
 Problems:
o
Significantly immature respiratory and nervous systems
o
Lack of adequate iron stores
o
Lack of adequate immunoglobulins
o
Immature gastrointestinal system
 May not be capable of oral feeding
 May not tolerate enteral feeding
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Growth and Development
of a Premature Infant
 Must adjust for prematurity
o
Use the infant’s adjusted age to determine expected outcomes
o
Plot growth parameters and assess developmental milestones based on
adjusted age
 To calculate adjusted age:
o
Subtract number of weeks infant was premature from infant’s
chronologic age
o
Example 6 month old born at 32 weeks’ gestation
 6 months minus 8 weeks—4 months
 This infant’s growth and developmental skills should be that of a 4month-old
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Question #2
The nurse is assessing a 7-month-old premature infant born at 28
weeks’ gestation. What would be the adjusted age upon which the
nurse would base assessment of the infant growth and
developmental milestones?
a. 2 months
b. 3 months
c. 4 months
d. 5 months
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Answer to Question #2
c. 4 months. The nurse assessing developmental milestones
for a 7-month-old premature infant born at 28 weeks’
gestation would adjust the age to 4 months.
Rationale: The infant was born 12 weeks early (3
months); therefore, the nurse would subtract 3 months
from the chronologic age of 7 months to obtain an adjusted
age of 4 months. Healthy growth would be demonstrated if
the infant were the size of a 4‐month‐old and achieved the
developmental milestones of a 4‐month‐old.
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Early Warning Signs: Hearing or Vision
Hearing
Vision
Does not respond to loud noises
Crosses eyes most of the time at
age 6 months
Does make sounds or babble by 4
months of age
Does not turn to locate sound at
age 4 months
Does not track (follow) an
interesting item
Does not try to study an object in
the visual field
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Warning Signs: Problems with Language
Development
Does not make sounds at 4 months of age
Does not laugh or squeal by 6 months of age
Does not babble by 8 months of age
Does not use single words with meaning at
12 months of age (mama, dada)
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Breastfeeding
Decision to breastfeed heavily influenced by cultural
expectations
Best type of nutrition for newborns and infants
Health benefits for both mother and infant
Requires correct use of breastfeeding techniques for
success
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Breastfeeding Benefits for Infants
 Increased bonding with
mother
 Decreased incidence
o
Diarrheal diseases
o
Asthma
 Possible enhancement of
cognitive development
o
Otitis media
 Decreased incidence of
obesity later in life
o
Bacterial meningitis
o
Botulism
o
Urinary tract infections
 Immunologic protection
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Breastfeeding Benefits for Mothers
Increased bonding with infant
Lessens maternal blood loss postpartum
Decreases risk of ovarian and premenopausal breast
cancers
Possible delay of ovulation
Economic advantage, convenience of use
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Exceptions to Recommended
Breastfeeding
Infants with galactosemia
Maternal use of illicit drugs and a few prescription
medications
Maternal untreated active tuberculosis
Maternal HIV infection in developed countries
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Bottle Feeding
Multiple types of formula available
o Accommodate various nutritional needs
Most contain adequate essential vitamins and
minerals
Prepare according to package directions
o Use correct volume of water (varies with type)
Clean bottles and nipples between feedings
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Promoting Healthy Eating Habits
 Breast- and bottlefed infants feed “on demand”
 Adding solids:
o
When tongue extrusion reflex disappears
o
Soft or mashed until teeth erupt
o
1 new food every 3 to 4 days (observe for allergy)
o
May require 20 exposures to accept the food
 Introduce the cup early (~6 months)
 Family models acceptable eating behaviors
 Parent provides the food, the child will decide how much to eat
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Cultural Influences
Cultural practices
o Can have a direct impact on growth and
development of children
Parenting styles and health promotion behaviors
including infant nutrition, sleep locations, and
activity levels often influenced by culture
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Common Developmental Concerns in
Infancy
Colic
Spitting up
Thumb sucking, pacifiers, security items
Teething
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Promoting Healthy Sleep and Rest
 Place newborns and young infants on their back to sleep
o
To decrease risk of SIDS
 Newborns sleep up to 20 hours per day (waking only to feed)
 By 3 months:
o
Infants sleep 7 to 8 hours per night
o
Take 2 to 3 naps per day
 Around 4 months, establish a bedtime routine
o
Facilitates relaxation and predictable sleep time
 By 12 months
o
Infants sleep 8 to 12 hours per night
o
Take 2 naps per day
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Promoting Safety
 Car seat
o
Correct: type, positioning of infant in set, securing of seat in vehicle
 Safe crib and changing table use
 Avoid use of baby walkers
 Safety in the home, use:
o
Safety gates
o
Outlet covers
 Identify and avoid choking hazards (small toys, foods)
 Water safety (bathrooms, buckets, and tubs)
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