CHAPTER 10: HEALTH PROMOTION OF THE INFANT
AND FAMILY
WONG’S NURSING CARE OF INFANTS AND CHILDREN
BIOLOGIC DEVELOPMENT OR
PROPORTIONAL CHANGES
- Growth is rapid
Weight:
- Doubles at 6 months
- Triples at 1 year
- 1.5 lb weight gain per month
- Infants who are breastfeed
beyond 4-6 months gain less
weight than those who are
formula fed
Height:
- At 1 year there should be a
50% increased
- 1st six months there should
be a 1 inch or 2.5 cm
increase
- Increase should occur on the
trunk
Head:
- 0.75 inch (2cm) increase per
month
- Sagigital & lambdoidal
sutures meet (6-8 weeks)
- Coronal, frontal & sagittal
suture meet (12-18 months)
Nervous System:
- Primitive reflexes replaced by
voluntary and purposeful
movements
Chest:
- End of 1st year chest
circumference should equal
the head circumference
Sensory Movement:
- Binocular fixation/binocularity
well established at 4 months;
lack of binocular vision →
strabismus → permanent
blindness
Depth Perception/Stereopsis:
- Begin to developed
by age 7-9 months
- At 7 months
parachute reflex
appears and may be
a protective response
to fall
Visual preference
- At 6 months infants
responds to facial
expressions →
separation anxiety
begins to occur
Auditory Acuity
- Tear gland functions
at 4 weeks
MATURATION OF SYSTEMS
1. Respiratory
- Abdominal breathers
Factors that predispose the
infants to respiratory problems:
● Close proximity of the
trachea to bronchi
● Small airways
● Inability to produce IgA
● Volume of dead space is
large → infants breaths twice
as fast as adults
2. Cardiovascular
- Sinus Arrhythmia
- Systolic pressure ↑ during
first 2 months
- Diastolic pressure ↓ during
first 3 months
- Fetal Hemoglobin causes
shortened survival of RBC –
Physiologic Anemia &
depresses production of
erythropoietin
- Maternal Iron Store is
necessary for formation of
Hgb
 3. Digestive
- Immature at birth
- Prone to dehydration, fluid
and electrolyte imbalance, &
malabsorption
- Drooling is common because
of the in coordinated
swallowing reflex
- Ptyalin/Amylase in small
amounts
- Lipase is also limited
- Gastric Digestion consist
primarily of the action of HCI
and Rennin
- Digestion takes place in the
duodenum
- Stomach is more enlarged
- At birth the size of a marble
after 10 days about the size
of a pingpong
- Esophageal Valve: is
immature
4. Immunologic System
- Immunoglobulins are
insufficient
- Have high proportion of ECF
- Has a maternal supply of
immunoglobulin G
FINE MOTOR DEVELOPMENT
- Includes the use of hands and
fingers in the prehension of objects
- Grasping occurs as a reflex at 2-3
months and occurs voluntary at 5
months
- Plamar → Pincer → Crude Pincer →
Neat Pincer
- At 6 months can hold bottle
- 7 months can able transfer form one
hand to another
- 10 months: Pincer Grasp
GROSS MOTOR SKILLS
- Includes development maturation in
posture, head balance, sitting,
creeping, standing, and walking
- First to develop is head control
- Crawl → Creep
- SIDS
❖ Locomotion
- Involve acquiring ability to
bear weight, propel forward
on all four extremities, stand
upright with support, and
walk alone
- 11 months: Cruise, walking
while holding onto furniture
with both hands
PSYCHOSOCIAL DEVELOPMENT: Trust
vs Mistrust
- Food intake is the most important
social activity at first 3 months
- Delayed gratification → mistrust
- Tactile stimulation is very important
in the process of acquiring trust
- Biting occurs to bring relief from
teething discomfort
- Pacifiers has negative effects on the
baby
COGNITIVE DEVELOPMENT:
Preoperational (Sensorimotor)
- Reflex behaviors → simple repetitive
acts → imitative activity
- Three Crucial Activities: Separation,
Object Permanence, and Symbol or
Mental Representation
SOCIAL DEVELOPMENT
- Factors that can influence social
development:
1. Reflex Behavior
2. Attachment
- Reactive Attachment Disorder is a
psychologic and developmental
problem that stems from
maladaptive or absent attachment
between infant and parent
- Separation Anxiety (4-8 months)
- Stranger Anxiety (6-8 months)
LANGUAGE DEVELOPMENT
- Crying is the first language
- 5-6 weeks: small throaty sounds
- 8 months: able to imitate sounds
- 9 months: can comprehend meaning
of NO and obeys simple commands
PERSONAL SOCIAL BEHAVIOR
- Includes the child’s personal
responses to the
environment
- Area most influenced by
external stimuli
- Social smile: 6-8 weeks
- Interest in environment is
more evident in 3 months
- Second half of infancy can
understand simple discipline
- Play is solitary
- Media is not encouraged for
18 months and younger
- Temperament is a behavior
style. May have a biologic
influence, but mostly
environmental
COPING WITH CONCERNS RELATED TO
NORMAL GROWTH AND DEVELOPMENT
1. Separation and Stranger Anxiety
- Encourage parents to have
close friends or relatives visit
often
- Infants need opportunities to
safely experience strangers
2. Limit Setting and Discipline
- Begin with a negative voice
and stern eye contact
- Time Out
- Shaken Baby Syndrome, a
fussy or irritable infant is a
potential victim of this
traumatic brain injury
- Spoiled Child Syndrome,
excessive self-centered and
immature behavior
3. Thumbsucking
- If it persist for 4-6 years it
may developed
malocclusion, which is a
condition in which the upper
and lower teeth are
abnormally related
4. Pacifiers
- Should wean after second 6
months of life
5. Teething
- Lower Central Incisors are
the first to erupt (6-8
months)
Interventions for pain that
is due to Inflammation:
➢ Frozen teething ring
➢ Baby Ora-Jel
➢ Acetaminophen,
Ibuprofen
➢ Aspirin is
CONTRAINDICATED
➢ Do NOT give hard
candy
PROMOTING OPTIMUM HEALTH
DURING INFANCY
1. Nutrition
- Breastmilk: most desirable
- Biggest threat to successful
breastfeeding is Maternal
Fatigue
- Iron supplement for infants
4-6 months due to decreased
maternal iron
- Vitamin D and Vitamin B12
(Cobalamin): if mother’s
intake of these vitamins is
inadequate
- Cobalamin is important for
maintaining nerve cells & it
helps in the production of
DNA & RNA
- Tap water may cause LEAD
POISONING
- Cow’s Whole Milk is not
recommended because it
has high renal solute load
- Amount of formula per day
should not exceed 960mL or
32 ounces
- Excessive intake of water in
infants → WATER
INTOXICATION &
HYPONATREMIA
 Selection and introduction of
Solid Foods:
➔ New foods should be
introduced once at a time
with 4-7 days interval
➔ Infant Cereal is the first to be
introduced
➔ Fruit juices should not be
given in large amounts
Weaning
➔ Giving up one method of
feeding to another
➔ Breast → Bottle → Cup
Aspiration
➔ Leading cause of death
Cereals → Vegetables → Fruits → Egg
(yolk - white) → Meats (chicken should be
last) → Fruits (rich in Vitamin C)
2. Sleep and Activity
- 15 hrs of sleep
3. Dental Health
- Initially wipe teeth and gums
with damp cloth
- Fluoride should not be given
in excess because it can
cause fluorosis
- Do not coat pacifiers with
honey
- Coating pacifiers with honey
can cause Botulism, a rare
but potentially fatal illness
caused by a toxin, produced
by the bacteria Clostridium
Botulinum
Infant Botulism
- also known as Floppy Baby
Syndrome
- Characterized by
constipation, lethargy,
difficulty feeding
- Avoid foods with
concentrated sugar (sucrose)
- Do NOT allow Candy Pacifier
because it can be aspirated
SAFETY PROMOTION AND INJURY
PREVENTION
1. Falls
- Leading cause of neonatal
injuries
- Commonly associated with
furnitures
2. Motor Vehicle Accident
- Major factor is lack of proper
child restraint
- Rear-facing car seat
minimizes stress on the neck
HEALTH PROBLEMS OF INFANTS
NUTRITIONAL DISTURBANCES
1. Vitamin D Deficiency
- Rickets, defective
mineralization or calcification
of bones before epiphyseal
closure
2. Folic Acid Deficiency
- Neural tube defects
3. Hypervitaminosis
- Too large amounts of
vitamins A & D
PROTEIN & ENERGY MALNUTRITION
(PEM)
1. Kwashiorkor
- Deficient CHON
- thin , wasted extremity,
prominent abdomen
2. Marasmus
- CHON & Calorie Deficiency
- Child appears old
3. Food Sensitivity
- Due to allergens
- Onset: 5-30 minutes after
ingestion
- May be mistaken as an
asthma attack
- Medication: Epinephrine
 4. Cow’s Milk Allergy
- Onset: 45 mins to several
days after ingestion
- Casein Hydrolysate Milk
Formula & Neocate (Amino
Acid Base Formula) may be
given
5. Lactose Intolerance
- Due to absence of the
enzyme lactase
FEEDING DIFFICULTIES
1. Regurgitation & Spitting Up
- d/t GERD
- Complications include
excoriation of the corners of
the mouth, chin, and neck
2. Colic (Paroxysmal Abdominal
Pain)
- Cramping
- Potential Causes: too rapid
feeding, overeating, improper
feeding technique, & parental
smoking
3. Failure to Thrive
- Sign of inadequate growth d/t
inability to obtain and/use
calories required for growth
- A weight that falls below the
fifth percentile for child’s age
DISORDERS OF UNKNOWN ORIGIN
1. SIDS
- Sudden Infant Death
Syndrome
- Unexplained death, usually
during sleep
- Sometimes known as crib
death
- Although the cause is
unknown, it appears that it
may be associated with
abnormalities in the portion
of an infant’s brain
2. Apnea of Infancy
- Unexplained episode of
cessation of breathing for 20
seconds or longer or shorter
- Sign of developmental
immaturity and it subsides as
the baby grows older
3. Autism
- Mental condition,
characterized by difficulty in
communicating and forming
relationships
Infants with Autism may:
➔ Does not smile often
➔ Rarely imitate expression
➔ Delayed babbling
➔ Does not respond to his/her
name
➔ Poor eye contact
➔ Unusual body movements
Children or Adults with Autism
Spectrum Disorder (ASD):
➔ Not point at objects to show
interest
➔ Not point at object when
another person points at
them
➔ Have trouble relating to
others
➔ Have trouble understanding
other people
➔ Don't play “pretend” games
➔ Repetitive behaviors
➔ Have a trouble adapting
when a routine changes
➔ Have unusual reactions to
the way things smell, look,
taste, feel, or sound