INTRODUCTION

Traditionally, infancy is designated as the period of time from 1 month to 1 year of age.
In these important months, an infant undergoes such rapid development that parents
sometimes believe their baby looks different and demonstrates new abilities every day.
During this time, an infant triples birth weight and increases length by 50%.

Infant’s reflexes develop and senses sharpen and, with the process of attachment to
primary caregivers, they form a first social rela- tionship.

Because of the growth and learning potential that occurs, this first year is a crucial one.
Without proper nutrition, a baby will not grow and physically thrive, and without proper
stimulation and nurturing care by consistent caregivers, an infant may not develop a
healthy interest in life or a feeling of security essential for future development.

As a result, infant health promotion is the subject of much concern.

 Infants grow rapidly both in size and in their ability to perform tasks. Although
development follows set patterns, some of it is dependent on cultural factors. One
difference is in the way mothers carry their infants. Many mothers tend to carry infants
in their arms, while other women carry their infant in a shoulder sling or on their hip or in
a forward-facing harness, positions that allow a woman to continue to work or walk
while holding an infant close.

This last case study of Belle is focused on the growth and development of her Babygirl.
Her infant is rapidly growing and learning such things. It is important to give attention to
physiologic and psychological changes that occur during this stage of development.

OBJECTIVES

General Objectives

At the end of this case presentation, the participants and the audience will be:
● Integrate knowledge of infant growth and development with the nursing process to
achieve quality maternal and child health nursing care.

Specific Objectives

Knowledge
● Describe normal infant growth and development associated with parental concerns.
● Identify health goals related to infant growth and development that nurses can help
achieve.
● Use critical thinking to analyze methods of care for an infant to be certain care is
family centered.

Skills
● Assess an infant for normal growth and development milestones.
● Formulate nursing diagnoses based on infant growth and development and
associated parental outcomes.
● Plan nursing care to meet an infant’s growth and development needs such as
teaching parents to childproof their home.

NURSING HEALTH HISTORY

A. Biographic Data

Patient’s Name: Belle’s Baby Girl

Address: NA
Age: NA
Sex: Female
Marital Status: Single
Occupation: NA
Religion: NA
Source of Information: Belle
Attending Physician: NA
Date of Admission:NA
Time of Admission:NA
Chief Complaint:

ANATOMY AND PHYSIOLOGY

The physiologic changes that occur in the infant year reflect both the increasing maturity
and growth of body organs. The following sections will discuss the changes that are
typically seen in the first year of life.

Weight
As a rule, most infants double their birth weight by 6 months of age and triple it by 1
year. During the first 6 months, infants typically average a weight gain of 2 lb per month.
During the second 6 months, weight gain is approximately 1 lb per month. The average
1-year-old boy weighs 10 kg (22 lb); the average girl weighs 9.5 kg (21 lb). 
Height
An infant increases in height during the first year by 50%, or grows from the average
birth length of 20 inches to about 30 inches (50.8 to 76.2 cm). Height, like weight, is
best assessed if it is plotted on a standard growth chart. Infant growth is most apparent
in the trunk during the early months.
Head Circumference
By the end of the first year, the brain has already reached two thirds of its adult size.
Head circumference increases rapidly during the infant period to reflect that rapid brain
growth.
Some infants’ heads appear asymmetric until the second half of the first year. This may
occur from always being placed in one sleeping position, causing the skull bones to
flatten on that side.
Body Proportion
Body proportion changes during the first year from that of a newborn to a more typical
infant appearance. The mandible becomes more prominent as bone grows. By the end
of the infant period, the lower jaw is prominent and remains that way throughout life.
The circumference of the chest is generally less than that of the head at birth by about 2
cm.
Body Systems
In the cardiovascular system, heart rate slows from 120 to 160 beats per minute to 100
to 120 beats per minute by the end of the first year. The heart continues to occupy a
little over half the width of the chest. Pulse rate may begin to slow with inhalation (sinus
arrhythmia), but this does not become marked until preschool age. That the heart is
becoming more efficient is shown by a decreasing pulse rate and a slightly elevated
blood pressure (from an average of 80/40 to 100/60 mm Hg).

The respiratory rate of an infant slows from 30 to 60 breaths per minute to 20 to 30

breaths per minute by the end of the first year.
 
At birth, the gastrointestinal tract is immature in its ability to digest food and
mechanically move it along. These functions mature gradually during the infant year.
 
The liver of an infant remains immature, possibly causing inadequate conjugation of
drugs (if a drug should be necessary for treatment of illness) and inefficient formation of
car- bohydrate, protein, and vitamins for storage.
 
The kidneys remain immature and not as efficient at eliminating body wastes as in an
adult. The infant is also unable to concentrate urine as much as an adult, which causes
them to be more prone to dehydration.
 
An infant’s immune system becomes functional by at least 2 months of age; an infant
can actively produce both IgG and IgM antibodies by 1 year.
 
Teeth
The first baby tooth (typically a central incisor) usually erupts at age 6 months, followed
by a new one monthly.

Motor Development
An average infant progresses through systematic motor growth during the first year that
strongly reflects the principles of cephalocaudal and gross to fine motor development.

To assess motor development, both gross motor development (ability to accomplish

large body movements) and fine motor development, which is measured by observing
or testing prehensile ability (ability to coordinate hand movements), should be
evaluated.
Gross Motor Development
To assess gross motor development, an infant is observed in four positions: ventral
suspension, prone, sitting, and standing.
Ventral Suspension Position.
Ventral suspension refers to an infant’s appearance when held in midair on a horizontal
plane, supported by a hand under the abdomen. In this position, the newborn allows the
head to hang down with little effort at control.

 A 1-month-old child lifts the head momentarily, then drops it again.

 Two-month-old children hold their heads in the same plane as the rest of their
body, a major advance in muscle control.
 A 3-month-old child lifts and maintains the head well above the plane of the rest
of the body in ventral suspension. A Landau reflex develops at 3 months. When
held in ventral suspension, an infant’s head, legs, and spine extend. When the
head is depressed, the hips, knees, and elbows flex. This reflex continues to be
present in most infants during the second 6 months of life.
 At 6 to 9 months, an infant also demonstrates a parachute reaction from a ventral
suspension position. When infants are suddenly lowered toward an examining
table from ventral suspension, the arms extend as if to protect themselves from
falling.
Prone Position.
When lying on their stomach, newborns can turn their heads to move them out of a
position where breathing is impaired, but they cannot hold them raised.
 
 By 1 month of age, infants lift their heads and turn them easily to the side. They
still tend to keep their knees tucked under the abdomen as they did as a
newborn.
 Two-month-old infants can raise their heads and maintain the position, but they
cannot raise their chests high enough to look around yet. Their head is still held
facing downward
A 3-month-old child lifts the head and shoulders well off the table and looks around
when prone. The pelvis is flat on the table, no longer elevated.
 Four-month-old children lift their chests off the bed and look around actively,
turning their heads from side to side. They can turn from front to back. Neck-
righting reflex begins at this age. When an infant turns the head to the side, the
shoulders, trunk, and pelvis turn in that direction, too. This reflex causes babies
to lose their balance and roll sideways when lifting the head up. Five-month-old
children rest weight on their forearms when prone. They can turn completely
over, front to back and back to front.
 At 6 months, infants rest their weight on their hands with extended arms. They
can raise their chests and the upper part of their abdomens off the table.
 By 9 months, a child can creep from the prone position. Creeping is a new skill,
advanced from hitching.
Sitting Position.
When placed on the back and then pulled to a sitting position.
 
 1-month-old child has gross head lag as in the first days of life. In a sitting
position, the back appears rounded and an infant demonstrates only momentary
head control.
 Two-month-olds can hold their head fairly steady when sitting up, although it
does tend to bob forward. An infant at this age still has head lag when pulled to a
sitting position.
 A 3-month-old child has only slight head lag when pulled to a sitting position.
 A 4-month-old child reaches an important milestone by no longer demonstrating
head lag when pulled to a sitting position.
 A 5-month-old infant can be seen to straighten the back when held or propped in
a sitting position.
 By 6 months, children sit momentarily without support. They anticipate being
picked up and reach up with their hands from this position.
 A 7-month-old child sits alone, but only when the hands are held forward for
balance.
 An 8-month-old child can sit securely without any additional support. This is a
major milestone in development that should always be considered in
assessment. Children with delayed cognitive or motor development may not
accomplish this step at this time.
 At 9 months, infants sit so steadily they can lean forward and regain their
balance.
 Standing Position.
 A newborn stepping reflex can still be demonstrated at 1 month of age. In a
standing position, an infant’s knees and hips flex rather than support more than
momentary weight.
 Two-month-old children, when held in a standing position, hold their head up with
the same show of support as in a sitting position.
 At 3 months, infants begin to try to support part of their weight.
 At 4 months, infants begin to be able to support their weight on their legs. They
are successful at doing this because the stepping reflex has faded.
 A 5-month-old child continues the ability to sustain a portion of weight. The tonic
neck reflex should be extinguished, and the Moro reflex is fading.
 By 6 months, infants support nearly their full weight when in a standing position.
 A 7-month-old child bounces with enjoyment in a standing position.
 Nine-month-old children can stand holding onto a coffee table if they are placed
in that position.
 Ten-month-old children can pull themselves to a standing position by holding
onto the side of a playpen or a low table, but they cannot let themselves down
again as yet.

Fine Motor Development

 
 One-month-old infants still have a strong grasp reflex, and they hold their hands
in fists so tightly it is difficult to extend the fingers.
 As the grasp reflex begins to fade, a 2-month-old child will hold an object for a
few minutes before dropping it. The hands are held open, not closed in fists.
 At 3 months, infants reach for attractive objects in front of them. Their grasp is
unpracticed, however, so they usually miss them.
 By 4 months, infants bring their hands together and pull at their clothes. They will
shake a rattle placed in their hand. Thumb opposition (ability to bring the thumb
and fingers together) is beginning, but the motion is a scooping or raking one, not
a picking-up one, and is not very accurate. Palmar and plantar grasp reflexes
have disappeared.
 Five-month-old children can accept objects that are handed to them by grasping
with the whole hand.
 By 6 months, grasping has advanced to a point where a child can hold objects in
both hands.
 Seven-month-old children can transfer toys from one hand to the other. They
hold a first object when a second one is offered.
 By 8 months, random reaching and ineffective grasping have disappeared as a
result of advanced eye–hand coordination.
 A major milestone of 10 months is the ability to bring the thumb and first finger
together in a pincer grasp.
 At 12 months, infants can draw a semistraight line with a crayon. They enjoy
putting objects such as small blocks in containers and taking them out again.
 
Developmental Milestones
In addition to the gross and fine motor skills developing at this time, language and
play behavior also reach major mile- stones. Motor and cognitive development and
play throughout this year.
 
Language Development
 A child begins to make small, cooing (dovelike) sounds by the end of the first
month.
 A 2-month-old child differentiates a cry.
 In response to a nodding, smiling face or a friendly tone of voice, a 3-month-old
child will squeal with pleasure.
 By 4 months, infants are very “talkative,” cooing, babbling, and gurgling when
spoken to. They definitely laugh out loud.
 By 5 months, an infant says some simple vowel sounds (for example, “goo-goo”
and “gah-gah”).
 At 6 months, infants learn the art of imitating. They may imitatea parent’s cough,
for example, or say “Oh!” as a way of attracting attention.
 The amount of talking infants do increases at 7 months. They can imitate vowel
sounds well.
 By 9 months, an infant usually speaks a first word: “da-da” or “ba-ba.”
 By 10 months, an infant masters another word such as “bye-bye” or “no.” By 12
months, infants can gener- ally say two words besides “ma-ma” and “da-da”; they
use those two words with meaning.
Play
 
 1-month-olds can fix their eyes on an object, they are interested in watching a
mobile over their crib or playpen. Hearing is a second sense that is a source of
pleasure for children in early infancy. Even newborns “listen” to the sound of a
music box or a musical rattle.
 Two-month-old infants will hold light, small rattles for a short period of time but
then drop them.
 Three-month-old children can handle small blocks or small rattles.
 The 9-month-old infant needs the experience of creeping. This means time out of
a crib or playpen so there is room to maneuver.
 By 10 months, infants are ready for peek-a-boo and will spend a long time
playing the game with their hands or with a cloth over their head that they can
reach and remove.
 At 11 months, children have learned to cruise or walk along low tables by holding
on. They often find this so absorbing they spend little time doing anything else
during the month.
 Twelve-month-old infants enjoy putting things in and taking things out of
containers. They like little boxes that fit inside one another or dropping small
blocks into a cardboard box.

DISCHARGE PLAN/HEALTH TEACHINGS

Evaluation
 
The baby was assessed and given nursing care and treatment.
 
As the newborn was assessed it shows that all of the reflexes disappeared at the
right time. The baby shows good physiological, social and emotional development.
On the other hand, the baby was diagnosed of having some behavioral problem as
evidenced by banging of head, grinds her teeth and pulling the hair of anyone near
her which indicates of developmental delay.
 
The goals are met as evidenced by no injury noted to the infant as assessed by the
physician.
 
Discharged plan:
 
Inform the client of the following:
• Position the child upright during feeding and raise the head of the crib 30°
thereafter.
• After feeding, place the infant in a sitting posture for 30 minutes.
• Secure a raised cushion beneath the baby's head to keep her comfortable and
avoid milk backflow.
• To ensure a good night's sleep for the infant, follow the typical bedtime rituals.
 • To establish an effective sleeping pattern, keep the surroundings calm when the
infant is sleeping.
• Never leave the infant alone in or around a certain location without a caregiver.
• To satisfy the demands of a developing full-term newborn, infant formula must
contain glucose, protein, fat, as well as vitamins and minerals.
• Starting with iron-fortified newborn cereals and proceeding to pureed vegetables,
fruits, and meats, early meals should be simple and presented one at a time.
• If you're not paying attention, your infant might choke, especially if you're traveling.
• Hot dogs, grapes, fresh fruits and vegetables, raisins, seeds, popcorn, and peanut
butter are among foods that might cause your kid to choke.
• Your infant should not be given liquids other than breast milk or formula in a bottle.
• Make sure the environment is safe and healthy.
• Advise the patient to keep sharp and breakable things out of reach of the infant.
• Because babies under the age of one-year-old crawl quickly, avoid placing the
infant in a high area or near the stairs.
• Choking hazards exist when offering little toys that can fit into a child's mouth.
Instead, give the infant a variety of soft and large toys.
• Keep the infant away from cable lines and electrical outlets.
• Allow the infant to play in a soft, open area.
• To minimize infection, all equipment should be cleaned on a regular basis.
• Give them their own space, such as a corner or a room, with a soft carpet on
which they may crawl and play with their toys. Choose toys with fascinating
shapes or that can be crushed, squeezed, or grasped to help them develop their
motor abilities.
• Put safety locks on any doors and cabinets you don't want your child to open,
and cover all outlets so they can't poke about with their fingers.
• Tablecloths should be removed to prevent the infant from dragging items down.
To avoid asphyxia, keep plastic bags out of reach.
• Keep all cleaning supplies and other potentially hazardous items out of reach of
youngsters and/ or in a locked cabinet.
• Allowing youngsters to be alone in the kitchen is never a good idea.
• Matches, lighters, curling irons, candles, and hot foods and drinks should all be
kept out of reach of children.
• Never leave your youngster unsupervised near or in water. Even in extremely
shallow water, such as a bathtub or a wading pool, little children can drown

 
QUESTIONS:
1. What is a primitive reflex?
Ans. Primitive reflexes are involuntary motor responses originating in the brainstem that
are present after birth in the early child development that facilitate survival.
Several reflexes are important in the assessment of newborns and young infants.
These central Nervous system motor responses are eventually inhibited by 4 to 6
months of age as the brain matures and replaces them with voluntary motor
activities but may return with the presence of neurological diseases.
 
2. What are the primitive reflexes?
Ans. 1. Blink Reflex. It serves the same purpose as it does in adult – it is to protect
the eye from any object coming near it by rapid eyelid closure.
How to initiate: elicited by shining a strong light such as a flashlight or otoscope into an
eye. A sudden movement toward the eye sometimes can elicit the blink reflex.
2. Rooting Reflex. This reflex helps the newborn to find food. Must disappear at
about the sixth week of life.
How to initiate: When the newborn’s cheek is brushed or stroked near the corner of the
mouth, the infant will turn the head in that direction. When the mother would brush her
nipple to the cheek of her newborn, the newborn would turn toward the breast and suck.
3.Sucking Reflex. Like the rooting, this reflex helps the newborn find food. Begins
to disappear at about six months of age.
How to initiate: when the newborn’s lips are touched, the newborn makes a sucking
motion.
4.Swallowing Reflex. Is the same as in adults. Food that reaches the posterior
portion of the tongue is automatically swallowed. Gag, cough and sneeze reflexes also
are present in newborns to maintain clear airway in the event that normal swallowing
does not keep the pharynx free of obstructing mucus.
5.Extrusion Reflex. In order to prevent the swallowing of inedible substances, a
newborn extrudes any substance that is placed on the anterior portion of the tongue.
Disappears or fades at 4 months.
6.Palmar Grasp Reflex. Newborns grasp an object placed in their palm by quickly
closing their fingers on it. Disappears at about 6 weeks to 3 months of age.
7. Step (Walk)-In-Place Reflex. Newborn held in a vertical position with their feet
touching a hard surface will take a few quick alternating steps. Disappears by 3 months
of age so that by 4 months, they can bear good portion of their weight unhindered by
this reflex.
8.Placing Reflex. Similar as Step in Place, except it is elicited by touching the
anterior surface of the lower part of a newborn’s leg against a hard surface such as the
edge of the bassinet or table, the newborn makes a few quick lifting motions.
9.Plantar Grasp Reflex. When an object touches the sole of a newborn’s foot at
the base, the toes grasp in the same manner as the fingers. Disappears at about 8 to 9
months of age in preparation for walking.
10.Tonic Neck Reflex. When newborn lies on their back, their head usually turn
to one side or the other side. The arm and the leg on the side toward which the head
turns extend and the opposite arm and leg contract. Also called the “BOXER” or fencing
reflex. As to similar to a boxer position and or getting stab by a sword.
 11.Moro Reflex. STARTLE REFLEX. Can be initiated when a newborn hears a
loud sound or noise, arms form a C. it is strong for the first 8 weeks of life then fades by
the end of 4th and 5th month. This is a protective response to the abrupt disruption of
body balance.
12.Babinski Reflex. When the sole of a newborn’s foot is stroked in an inverted
“J” curve from the heel upward, a newborn fan his toes. Fades until 3 months of age.
13.Magnet Reflex. If pressure is applied to the soles of the feet of a newborn
lying in a supine position, the newborn pushes his back against the pressure. A test for
spinal integrity.
14.Crossed Extension Reflex. When a newborn is lying supine, if one leg is
extended and the sole of that foot is irritated by being rubbed with a sharp object, such
as a thumbnail, the infant raises to the leg and extends it as if trying to push away the
hand irritating the first leg.
15. Trunk Incurvation Reflex. Newborn lies in prone position and is touched along
the paravertebral area on the back by a probing finger, the newborn flexes the trunk and
swings the pelvis toward the touch.
16.Landau Reflex : Newborn is supported in a prone position by a hand, the
newborn should demonstrate some muscle tone. A newborn may not be able to lift the
head or arch the back in this position (as will be possible at 3 months of age), but
neither should the infant sag into an inverted “U” position. The latter response indicates
extremely poor muscle tone, the cause of which to be investigated.
17.Deep Tendon Reflex. Both patellar and a Biceps reflex are intact in a newborn
. biceps is to test spinal nerves C5 and C6. Patellar is to test spinal nerves L2 through
L4.

3. Why do primitive reflexes disappear? Explain briefly.

ANSWER: Because these reflexes are suppressed by the development of the frontal
lobes as a child transitions normally into child development.
 
4. What is a parachute reflex?
ANSWER: This reflex occurs in slightly older infants when the child is held upright and
the baby's body is rotated quickly to face forward (as in falling). The baby will extend his
arms forward as if to break a fall, even though this reflex appears long before the baby
walks.

5. What are the 5 reflexes that persist throughout life?

ANSWER:
• Blink Reflex. It serves the same purpose as it does in adult – it is to protect the
eye from any object coming near it by rapid eyelid closure. How to initiate:
elicited by shining a strong light such as a flashlight or otoscope into an eye. A
sudden movement toward the eye sometimes can elicit the blink reflex.
• Swallowing Reflex. Is the same as in adults. Food that reaches the posterior
portion of the tongue is automatically swallowed. Gag, cough and sneeze
reflexes also are present in newborns to maintain clear airway in the event that
normal swallowing does not keep the pharynx free of obstructing mucus.
 • Cough Reflex - an expulsive reflex initiated when the respiratory tract is irritated
by infection, noxious fumes, dust, or other types of foreign bodies. The reflex
results in a sudden expulsion of air from the lungs that carries with it excessive
secretions or foreign material from the respiratory tract.
• Sneeze Reflex - sneezing is a protective reflex response, little else is known
about it. A sneeze (or sternutation) is expulsion of air from the lungs through the
nose and mouth, most commonly caused by the irritation of the nasal mucosa.
• Gag Reflex -The gag reflex, also called the pharyngeal reflex, is a contraction of
the throat that happens when something touches the roof of your mouth, the
back of your tongue or throat, or the area around your tonsils. This reflexive
action helps to prevent choking and keeps us from swallowing potentially harmful
substance

6. What is a developmental milestone?

ANSWER:
Developmental milestones are behaviors or skills that illustrate a child's growth
in a number of areas. The milestones have been established based on what
most children can do at a certain age. Examples are the age at which a child
smiles for the first time, takes his first steps, or says his first words.
7. Why is it important to know the different developmental milestones?
ANSWER:
it is important because it offer clues about a child's developmental health. Where
in Doctors and nurses use developmental screening to tell if children are learning
basic skills when they should, or if they might have problems.
8. What is play and why is it important?
ANSWER: Play allows children to use their creativity while developing their
imagination, dexterity, and physical, cognitive, and emotional strength. Play is important
to healthy brain development. It also allows children the chance to emulate what they
see and practice skills.
9. Why is talking and communicating to an infant important?
ANSWER: It is important because Talking with your baby or toddler can help his
language and communication development. Wherein from birth, warm, gentle and
responsive communication helps babies and children feel safe and secure in their
worlds. It also builds and strengthens relationships between children and their parents
and carers.
10. Is baby Belles developmental milestone within normal? What does it indicate if it is
not within normal
Baby Belle’s milestones are within normal range because her reflexes falls into the
normal age wherein it should start and it should diminish. It would indicate abnormality if
the baby is delayed and/or her primitive reflexes doesn’t decrease within the age that it
should decrease