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Newborn, Infant & Toddler Growth & Development Study Guide
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Chapter 25 Study Guide: Growth and Development of the Newborn and Infant 1. Normal Physical Growth, Physiologic Changes, Sensory Development, and Psychosocial Development in the Newborn and Infant Physical Growth ● Weight: Newborns average 3.4 kg (7.5 lbs); lose 5–10% of body weight in the first week, regain by day 10. Double birth weight by 4–6 months; triple by 12 months. ● Length: Avg. 50 cm (20 in) at birth; increases by 50% by 12 months. ● Head Circumference: Avg. 35 cm at birth; increases about 10 cm in the first year. Physiologic Changes ● Neurologic: Brain growth rapid; myelination ongoing. Reflexes shift from primitive to protective. ● Respiratory: RR decreases from 30–60 (newborn) to 20–30 (1 year). ● Cardiovascular: Heart size doubles; HR decreases, BP increases. ● GI: Immature at birth; enzymes for digestion mature around 5 months. Teeth usually erupt at 6–8 months. ● Renal: Immature kidneys; risk of dehydration. ● Hematologic: Physiologic anemia at 2–3 months; iron stores deplete by 6 months. ● Immune: IgG from mother lasts 3–6 months; infant makes IgM (by 9 mo), IgG (60% of adult by 12 mo), IgA later. Sensory Development ● Vision: Nearsighted; binocularity by 4 months, full color vision by 7 months. ● Hearing: Intact at birth. ● Smell/Taste: Can distinguish mother’s scent by 7 days; prefers sweet tastes. ● Touch: Most developed; essential for bonding. Psychosocial Development of the Newborn and Infant Erikson’s Stage: Trust vs. Mistrust (Birth to 1 Year) ● Core Task: Developing a sense of trust when basic needs are consistently met by caregivers. ● Positive Outcome: Infants who are fed, comforted, and cared for promptly and lovingly develop trust in their environment and caregivers. ● Negative Outcome: Inconsistent or neglectful caregiving leads to mistrust, insecurity, and difficulty forming future relationships. Caregiver Actions that Promote Trust Effects on the Infant Prompt feeding when hungry Builds emotional security Soothing when upset Fosters attachment and self-regulation Holding, cuddling, and face-to-face interaction Encourages social bonding Talking and singing to infant Enhances communication and emotional connection Social and Emotional Milestones Age Milestone 2 months First social smile appears 3–4 months Smiles, coos, mimics facial expressions 6–8 months Enjoys games like peek-a-boo, shows preference for caregivers 8 months Stranger anxiety begins—infant becomes cautious or fearful around unfamiliar people 9–12 months Separation anxiety begins—infant becomes distressed when parent leaves 12 months Shows affection, enjoys interactive play, may test caregiver reactions for social learning Temperament ● Definition: Innate personality traits that influence how infants interact with their environment. ● Types of Temperament: ○ Easy: Adapts well, predictable, generally happy. ○ Difficult: Intense reactions, less adaptable, irregular patterns. ○ Slow to warm up: Initially hesitant, gradually adjusts. Nursing Role: ● Educate parents on recognizing and adapting to their infant’s temperament. ● Encourage responsive caregiving tailored to the infant’s cues and needs. Red Flags in Psychosocial Development ● Lack of smiling or eye contact by 3 months ● Does not enjoy people or seems indifferent to caregivers ● No interest in social games (e.g., peek-a-boo) by 8 months ● Refuses to cuddle or does not seek comfort when distressed 2. Gross and Fine Motor Milestones of the Newborn and Infant Gross Motor (Cephalocaudal) Age Milestone 1 month Lifts head briefly when prone 4 months Rolls prone to supine 6 months Tripod sits 8 months Sits unsupported 9 months Crawls (abdomen off floor) 10 months Pulls to stand, cruises 12 months Walks independently Fine Motor (Proximodistal) Age Milestone 3 months Hands open; holds hands in front of face 5 months Grasps rattle 7 months Transfers objects hand-to-hand 9 months Bangs objects together 10 months Fine pincer grasp 12 months Feeds self with cup/spoon; pokes with index finger 3. Normal Language Development in the First Year Age Milestone 1–3 months Coos, differentiated cries 4–5 months Vowel sounds, laughs, raspberries 6 months Babbles, responds to name 7–10 months Strings syllables (e.g., "mama") without meaning 9–12 months Uses 2–3 words meaningfully, imitates sounds, understands simple commands 4. Nursing Care Plan for Common Issues Related to Growth and Development Examples of Diagnoses & Interventions: ● Breastfeeding difficulty: Teach latch techniques, hunger cues, monitor weight gain and diapers. ● Desire for improved nutrition: Provide feeding education, introduce age-appropriate solids after 6 months. ● Altered nutrition: Evaluate intake, increase caloric density/formula concentration if needed. ● Attachment risk: Promote bonding through eye contact, holding, responsiveness. ● Caregiver fatigue risk: Educate, encourage respite, provide anticipatory guidance. ● Injury risk: Teach safety measures (car seat, choking hazards, supervision). 5. Nutritional Requirements of the Newborn and Infant Age Calories Fluids Newborn 105–108 kcal/kg/day 140–160 mL/kg/day 1–6 months 108 kcal/kg/day 100 mL/kg/day 6–12 months 98 kcal/kg/day Add solids + continued breast/formula ● Breastfeeding: Preferred. Contains antibodies, easily digestible. Exclusively for 6 months. ● Formula: Nutritionally adequate alternative. ● Iron: Needed after 4–6 months; supplementation may be necessary. 6. Nutritional Plan for the First Year of Life Birth–6 months: ● Exclusive breastfeeding or iron-fortified formula. ● No solids or juice. 6–12 months: ● Introduce solids (iron-fortified cereal first), then fruits, vegetables, proteins. ● Introduce cup. ● Avoid honey, cow's milk, and choking hazards (e.g., grapes, nuts). 7. Common Issues Related to Growth and Development in Infancy ● Colic: Unexplained crying in infants <3 months; comfort measures and reassurance. ● Teething: Begins around 6 months; may cause fussiness. ● Stranger/Separation Anxiety: Begins ~8 months; normal part of social development. ● Delayed milestones: Monitor and refer if necessary. ● Failure to thrive: Requires nutritional/medical evaluation. 8. Anticipatory Guidance for Common Developmental Issues ● Nutrition: Exclusive breastfeeding for 6 months; introduce solids gradually. ● Sleep: Establish bedtime routines; safe sleep practices (on back, firm mattress). ● Safety: Car seat use, childproofing, CPR education, choking prevention. ● Immunizations: Follow CDC schedule. ● Play: Encourage age-appropriate toys and interactions (e.g., peek-a-boo). ● Social/Emotional: Respond to cues, allow safe exploration, model emotional regulation. Chapter 26 Study Guide: Growth and Development of the Toddler (1–3 Years) 1. Normal Physical Growth, Physiologic Changes, and Sensory Development Physical Growth ● Slows compared to infancy. ● Weight gain: 3–5 lb (1.36–2.27 kg) per year. ● Height increase: ~3 in (7.62 cm) per year. ● Toddlers reach approximately 50% of adult height by 2 years. Physiologic Changes ● Brain growth slows; myelination of the spinal cord completes by 2 years. ● GI and GU systems mature; bowel/bladder control improves. ● Immune system improves; fewer infections over time. ● Respiratory and cardiovascular systems mature further. Sensory Development ● Vision: Improves to 20/50 to 20/40 by toddler years. ● Hearing: Fully developed; essential for language development. ● Taste and Smell: Developing but still immature—toddlers may reject unfamiliar foods. ● Touch: Integral to exploration; toddlers mouth objects often. 2. Psychosocial, Cognitive, Social/Emotional, and Moral/Spiritual Development Psychosocial (Erikson’s Stage: Autonomy vs. Shame and Doubt) ● Age: 1–3 years. ● Toddlers strive for independence: "I do it myself!" ● Development of autonomy through tasks like dressing and feeding. ● Excessive criticism leads to shame and doubt. Cognitive (Piaget) ● Sensorimotor → Preoperational (begins ~2 years) ○ Symbolic thought emerges. ○ Toddlers exhibit animism (giving lifelike qualities to inanimate objects). ○ Begin problem-solving through trial and error and symbolic play. Social/Emotional Development ● Strong egocentrism; difficulty seeing others’ perspectives. ● Parallel play is common. ● May exhibit separation anxiety, temper tantrums, and regression under stress. ● Temperament (easy, difficult, slow-to-warm-up) affects social adjustment. Moral/Spiritual (Kohlberg) ● Preconventional morality: understands “right” and “wrong” based on punishment or reward. ● Basic empathy may begin to emerge. ● Spirituality: finds comfort in routine, like prayers, but lacks deeper understanding. 3. Gross and Fine Motor Milestones Age Gross Motor Fine Motor 12–15 months Walks independently Feeds self finger foods; points with index finger 18 months Climbs stairs w/ help; pulls toys Stacks 4 cubes; turns book pages; removes shoes/socks 24 months Runs, kicks ball, tiptoes Builds 6–7 cube tower; scribbles; uses knobs 36 months Pedals tricycle, stairs with alternate feet Copies circle; turns pages; uses writing utensils 4. Language Development in Toddlerhood ● Receptive language > Expressive language ● 15 months: Understands 100+ words; uses 5–20. ● 2 years: Uses 2–3 word phrases; 50-word vocabulary. ● 3 years: 3–4 word sentences; 900-word vocabulary. ● Echolalia and telegraphic speech are common ("want milk"). 5. Nursing Care Plan: Common Growth/Development Issues Problem Nursing Interventions Language delay Screen with tools; refer for early intervention Gross motor delay Encourage safe play; refer to PT/OT Attachment issues Encourage routine, comfort objects Regression Educate parents: normal under stress; praise appropriate behavior Behavioral outbursts Encourage consistent limit-setting; offer controlled choices 6. Safety Teaching Plan for Toddlers Focus Areas ● Falls: Use gates, supervise on stairs/playgrounds. ● Poisoning: Lock up meds, cleaning agents. ● Choking: Avoid small objects/foods (nuts, grapes). ● Burns: Cover outlets, keep hot items out of reach. ● Drowning: Never leave unsupervised near water—even tubs. 7. Common Developmental Issues ● Negativism ("no!" stage) ● Temper tantrums: common when frustrated. ● Toilet training: readiness around 2 years; avoid pressure. ● Sibling rivalry: encourage involvement in baby care. ● Regression during stress (e.g., birth of sibling). 8. Nutritional Plan Based on Requirements Nutrient Recommendation Calories ~102 kcal/kg/day Calcium 700 mg/day Fiber 19 g/day Milk Limit to 16–24 oz/day to avoid iron-deficiency Iron Include iron-rich foods (meats, cereals, beans); watch for anemia Fluids Encourage water; limit juice to 4–6 oz/day ● Avoid high-fat restrictions under age 2. ● Meals should be small, frequent, and nutrient-dense. 9. Discipline in Toddlerhood ● Use positive reinforcement and clear, consistent boundaries. ● Offer limited choices ("Do you want the red or blue shirt?"). ● Time-outs may be used sparingly (1 min per year of age). ● Avoid physical punishment; model calm behavior. 10. Anticipatory Guidance Topic Guidance Toilet Training Look for readiness signs; avoid pressure Nutrition Encourage variety, avoid force feeding Play Provide safe, exploratory opportunities Language Read aloud daily; name objects, respond to speech Behavior Expect tantrums; maintain routine Health Supervision Maintain immunizations and well-child checks Chapter 27 Study Guide: Growth and Development of the Preschooler (3–6 Years) 1. Physical Growth, Physiologic Changes, and Sensory Development Physical Growth ● Age range: 3 to 6 years. ● Growth slows compared to earlier years. ● Height: Increases 2.5–3 in/year (avg. 6.5–7.8 cm). ● Weight: Increases ~4–5 lb/year (avg. 2.3 kg). ● Loss of baby fat; appearance becomes leaner and more muscular. Physiologic Changes ● Myelination completes → improved bowel and bladder control. ● Respiratory system matures: fewer infections. ● Gastrointestinal system matures: can handle a wider range of foods. ● Full set of primary teeth by age 5 or 6. Sensory Development ● Visual acuity ~20/30 to 20/40 by age 5. ● Full color vision established. ● Taste remains immature → picky eating and ingestion risks remain. ● Smell and touch continue developing. 2. Psychosocial, Cognitive, Social/Emotional, and Moral/Spiritual Development Psychosocial (Erikson: Initiative vs. Guilt) ● Ages 3–6. ● Children assert power through directing play and social interactions. ● Success: Initiative, purpose, leadership. ● Failure: Guilt, inhibition. ● Conscience (superego) begins to develop. Cognitive (Piaget: Preoperational Stage) ● Preconceptual phase (2–4 years): egocentrism, animism, magical thinking. ● Intuitive phase (4–7 years): reasoning through transduction, improved classification, time concepts forming. ● Imaginary friends are common and healthy. ● Cannot yet understand conservation or logic. Social/Emotional Development ● Increased emotional regulation and expression. ● Gains skills: sharing, cooperation, conversation, showing affection. ● Identity and gender roles become more pronounced. ● Fears common (e.g., monsters, dark). ● Friendships grow in importance. Moral (Kohlberg: Preconventional Stage) ● Morality based on avoiding punishment and gaining rewards. ● Views rules as fixed; influenced by adults. ● Developing conscience and guilt when misbehaving. Spiritual ● Concept of faith is intuitive and imaginative. ● Children may personify God based on adult behavior (e.g., “angry God”). ● Religious rituals can provide structure and comfort. 3. Gross and Fine Motor Milestones Age Gross Motor Fine Motor 3 yrs Climbs well, pedals tricycle, stairs with alternate feet Copies circle, builds tower, undresses self 4 yrs Throws ball overhead, hops on one foot Uses scissors, draws person with 2–4 parts 5 yrs Skips, swings, somersaults Ties shoes, prints letters, draws full person 4. Language Development ● Vocabulary: ○ 3 years: ~900–1000 words. ○ 5 years: ~2,100 words. ● Sentence structure becomes adult-like. ● Understands tenses, opposites, and can follow multi-step commands. ● Stuttering or dysfluency is common but usually resolves. ● Language enables pretend play and storytelling. 5. Nursing Care Plan: Addressing Common Concerns Concern Nursing Interventions Delayed speech Refer to speech-language therapy; engage in reading and speaking activities. Behavioral issues Educate parents on positive discipline, consistency, and redirection. Sleep disturbances Encourage bedtime routines, discuss nightmares and night terrors. Nutritional concerns Offer education on portion sizes, food groups, and limiting sweets. Social delays Recommend structured group play or early education programs. 6. Nutrition Plan ● Calories: ~85 kcal/kg/day. ● Fiber: 19 mg/day. ● Calcium: 700–1,000 mg/day. ● Iron: 7–10 mg/day. ● Fat: 20–30% of total calories. ● Fluids: Encourage water, limit juice to 4–6 oz/day. ● Continue small portions (⅓–½ adult size); offer variety across all food groups. ● Promote family meals and healthy food modeling. 7. Anticipatory Guidance Topic Guidance Sleep Needs 10–13 hours/day; establish bedtime routine. Safety Teach pedestrian rules, water safety, fire safety, car seats. Behavior Expect imaginary play, fears, and emotional highs/lows. Use praise and redirection. Toileting Most are toilet-trained, but setbacks can occur. Be supportive. Dental Care Brush twice daily; regular dental visits. Screen Time Limit to <1 hour/day of high-quality programming. Play Encourage creative, interactive, and physical play. Chapter 28 Study Guide: Growth and Development of the School-Age Child (6-12 Years) 1. Normal Physiologic, Cognitive, and Moral Changes Physiologic Growth ● Ages: 6–12 years. ● Growth is slow and steady: ○ Height: 2.5 in/year (6–7 cm). ○ Weight: ~7 lb/year (3–3.5 kg). ● Girls may surpass boys in height and weight in later school years. ● Body systems mature: ○ GI system matures → fewer stomach upsets. ○ The immune system improves → fewer infections. ○ Vision reaches 20/20; may detect refractive errors. Cognitive Development (Piaget: Concrete Operational) ● Age 7–11: ○ Thinks logically about concrete events. ○ Understands conservation, classification, serialization, and reversibility. ○ Understands others’ perspectives. ○ Begins to use inductive logic (specific to general). Moral Development (Kohlberg) ● 7–10 years: Stage 3 – “Good child/bad child” ○ Focus on pleasing others and following rules to be seen as “good.” ● 10–12 years: Stage 4 – “Law and order” ○ Behavior judged by intent, not just outcome. ○ Begins applying the “Golden Rule”. Psychosocial Development (Erikson: Industry vs. Inferiority) ● Task: Mastery of skills, accomplishments, and peer relationships. ● Success = industry: competence, self-worth. ● Failure = inferiority: insecurity, low motivation. ● Role of caregivers and teachers is crucial in building confidence through positive reinforcement. 2. Role of Peers and Schools in Socialization Peers ● Shift from family-centric to peer-centric relationships. ● Same-sex peer groups dominate. ● Peer approval and norms influence self-worth and identity. ● Peer interaction promotes conflict resolution, cooperation, and social skill development. School ● Major force in shaping behavior and intellect. ● Facilitates development of industry (Erikson). ● Teachers reinforce effort and help prevent inferiority. ● Teaches societal values and appropriate conduct. 3. Developmental Milestones Gross Motor ● Coordination, rhythm, and balance improve. ● Activities include: ○ Riding a bike, jumping rope, playing sports. ○ Older children may experience awkwardness due to growth spurts. Fine Motor ● Precision improves: ○ Writing neatly, playing instruments, creating models or crafts. ○ Interest in hobbies like collecting, drawing, or building. 4. Nurse's Role in Safety Promotion Injury Prevention ● Increased independence = increased risk. ● Safety teaching: ○ Helmet use for biking/skating. ○ Water safety: swimming lessons and supervision. ○ Fire safety: stop-drop-roll, emergency plans. ○ Stranger safety: distinguish good/bad touch. Nurse Guidance ● Encourage open discussions about fears (e.g., natural disasters, injury). ● Teach coping skills: breathing, positive self-talk. ● Educate about bullying and advocate for prevention programs. 5. Nutritional Requirements Nutrient Needs Calories Varies: ~1,400–2,200/day depending on age/activity Protein ~28–46g/day Calcium 800–1,300 mg/day Iron 8–10 mg/day Fiber 25–31g/day ● Appetite may increase, especially in prepubescent years. ● Emphasize: ○ Balanced meals: lean proteins, whole grains, fruits, veggies. ○ Healthy snacks: yogurt, fruit, whole grain crackers. ○ Limit sugary drinks and processed snacks. ● Nurses should assess family food practices and model healthy behaviors. 6. Common Developmental Concerns ● Bullying: Common, especially at school. Associated with anxiety, sleep issues, and poor academic performance. ● School refusal: May signal fear, bullying, or separation anxiety. ● Obesity: Due to sedentary behavior, poor diet. ● Sleep problems: Insufficient or poor-quality sleep. ● Low self-esteem: May arise from peer comparison or academic challenges. 7. Nursing Guidance for Developmental Concerns Concern Nursing Strategies Bullying Teach assertiveness; collaborate with schools; educate parents and children. Obesity Educate families on balanced diets; promote daily physical activity. Academic Struggles Collaborate with school staff; refer for evaluation if needed. Sleep hygiene Recommend 9–11 hours/night; establish bedtime routines. Self-esteem issues Encourage praise, recognize effort over results, and set achievable goals. Chapter 29 Study Guide: Growth and Development of the Adolescent (11-20 Years) 1. Normal Physiologic Changes Including Puberty ● Adolescence: Ages 11–20 years. Second only to infancy in terms of growth rate. ● Puberty: Initiated by hormonal changes—gonadotropin-releasing hormone (GnRH) from the hypothalamus triggers the pituitary to release FSH and LH, which stimulate the gonads. Females ● Breast development (thelarche): ~9–11 years. ● Menarche: ~12.8 years (range: 9–15). ● Increase in fat distribution and hip widening. Males ● Testicular enlargement is first sign (~10–11 years). ● Penis growth, voice deepening, facial/body hair follows. Other Changes ● Voice changes (more prominent in males). ● Acne due to increased sebaceous activity. ● Ossification continues, muscle mass increases (more in males). 2. Psychosocial, Cognitive, Social, and Moral Development Psychosocial (Erikson: Identity vs. Role Confusion) ● Adolescents explore personal values, beliefs, and goals. ● Success leads to a stable sense of self. ● Failure results in role confusion, insecurity. Cognitive (Piaget: Formal Operational Stage) ● Abstract, logical, and introspective thinking develops. ● Egocentrism common: belief in being unique/invincible. ● Can reason through hypothetical situations and plan ahead. Moral (Kohlberg: Postconventional) ● Begins to form personal moral code based on principles and justice. ● May challenge societal norms and question authority. Spiritual ● May question organized religion and explore spirituality. ● Seek alignment between personal beliefs and spiritual practices. 3. Changes in Relationships Relationshi p Changes Peers Central to identity formation. Provide emotional support, influence behaviors (both positive and negative). Family Shift from dependency to independence. Increased conflict over autonomy; parents’ role shifts to that of a consultant. Teachers Influence values, goals, and academic self-concept. Community Broader influences include cultural, social, and online communities. Teens may align with causes or groups that reinforce identity. 4. Safety Interventions Common Risks ● Motor vehicle accidents: Leading cause of death. ● Substance use, unprotected sex, risky social media use. Nursing Interventions ● Promote seat belt and helmet use. ● Educate on substance abuse, consequences, and refusal skills. ● Teach safe sex practices and STI prevention. ● Discuss gun safety, drowning prevention, and healthy peer interactions. 5. Nutritional Requirements Caloric Needs ● Girls (moderately active): ~2,000 kcal/day. ● Boys (moderately active): 2,200–2,800 kcal/day. Key Nutrients ● Calcium: 1,300 mg/day for bone growth. ● Iron: Girls: 15 mg/day; Boys: 11 mg/day. ● Protein: Girls: 46 g/day; Boys: 52 g/day. ● Zinc: Supports immune and reproductive health. Challenges ● Skipped meals, fast food preference, disordered eating, and body image concerns. 6. Development of Sexuality and Its Influence on Dating ● Sexuality includes identity, behavior, orientation, and intimacy. ● Romantic relationships become emotionally significant. ● Teens may begin exploring gender identity and sexual orientation. Risks ● STIs, pregnancy, dating violence. ● Teens need education on healthy relationships, boundaries, and consent. 7. Common Developmental Concerns Concern Description Body Image Teens may struggle with appearance vs. peer standards. Substance Use Influenced by peer pressure and media. Depression/Anxiety Triggered by academic, peer, or family stress. Academic pressure May lead to burnout or disengagement. Sexual identity confusion May cause emotional distress and social challenges. 8. Nursing Guidance for Developmental Concerns Issue Nursing Guidance Substance Use Assess risk, educate on consequences, refer for counseling if needed. Mental Health Screen for depression/anxiety; encourage open dialogue. Sexual Health Offer confidential counseling; provide resources on STIs and contraception. Peer Pressure Promote resilience, decision-making, and self-esteem. Nutrition Promote healthy eating habits, especially for athletes or those at risk for disordered eating.
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