NCM109 Lesson 3 Infancy (Part 1)
already reaches a 2/3 of its adult-
• Physical Growth
- in normal-term infants increases about 30% by age
5 months and more than 50% by age 12 months
A. Weight
▪ Infants double their birth weight by 4
to 6 months and triple it by 1 year.
▪ During the first 6 months, infants
typically average a weight gain of
2lbs per month.
▪ During the second 6 months, weight
gain is approx. 1lb per month.
▪ Average 1-year old male weighs =
10kg (22lbs)
▪ Average 1-year old female weighs =
9.5kg (21lbs)
▪ According to the 2020 National Vital
Statistics Reports, full-term babies
tend, on average, to weigh between
3,000 and 3,499 grams (6 pounds,
9 ounces, and 7 pounds, 11
ounces).
B. Height
▪ the height of infancy they’re usually
between 19 and 21 inches long
▪ An infant increase in length during the
first year by 50%, or grows from the
average birth length to 20in to about
30in (50.8 to 76.2cm).
▪ For accuracy, measure infants lying in
supine on a measuring board even if
they are beginning to be able to
stand.
C. Head Circumference
▪ The average head circumference at
birth is about 13.5 in. (34.5 cm).
▪ By the end of the first month, it
increases to about 15 in. (37.6 cm).
▪By the end of the first year, the brain
size.
D. Body Proportions
▪ Body proportions changes during the
first year from that of a newborn to a
more typical infant appearance.
▪ By the end of the infant period, the
lower jaw is definitely prominent and
remains the way throughout life.
▪ Circumference of the chest is
generally less than that of the head of
birth by about 2cm.
▪ It is even with the head circumference
in some infants as early as 6 months
and most by 12 months.
▪ The abdomen remains protuberant
until the child has been walking well
into the toddler period.
▪ Cervical, thoracic, and lumbar
vertebral curves developed as infants
hold up their head, sit and walk.
▪ Lengthening of lower extremities
during the last 6 months of infancy
readies the child for walking and
often is the final growth that changes
the appearance from "BABY-LIKE" to
"TODDLER-LIKE".
E. Body System
In the Cardiovascular System
▪ Heart rate slows from 120 to 160
beats per minute to 100 to 200
beats per minute by the end of the
first year
▪ Pulse rate may slow with inhalation
(sinus arrhythmia), this does not
become mark until preschool age.
▪ That the heart is becoming more
efficient is shown by a decreasing
pulse rate and slightly elevated blood
pressure (from an average of 80/40
to 100/60 mm Hg).
▪ Infants are prone to develop a
physiologic anemia at two to three
months of age.
▪ This occurs because of the life of a
typical red cell is 4 months, so the
cells the child’s had at birth begin to
disintegrate at that time, yet new cells
are not being produced at adequate
replacement number.
▪ The Hemoglobin in an infant
becomes totally converter from fetal
NCM109 LEC Notes 1
 to adult hemoglobin at 5 to 6 months
of age.
▪ Infants may experience a decrease in
serum iron levels at 6 to 9 months
old as the remaining iron stores
established in utero are used.
The Respiratory Rate
▪ of an infant slows from 30 to 60
breath per minute to 20 to 30 breath
per minute by the end of the first
year.
▪ Because the lumens of the
respiratory tract remain small and
mucus production by the tract to clear
invading microorganisms is still
inefficient, upper respiratory
infections occur to be more often and
tend to be more severe than in adults.
At birth Gastrointestinal Tract
▪ Is immature in its ability to digest food
and mechanically move it along. This
function gradually during the infant
year.
▪ Although the ability to digest protein
is present and effective at birth the
amount of amylase, which is
necessary for digestion of complex
carbohydrates, is deficient until
approximately the 3rd month.
▪ Lipase, necessary for the digestion of
saturated fats, is decreased during
the amount of the entire first year.
The Liver
▪ Of an infant remains immature,
possibly causing an inadequate
conjugation of drugs and the efficient
formulation of carbohydrates, protein
and vitamins for storage.
▪ Until age 3 or 4 months, an
EXTRUSION REFLEX (food placed
on the infant’s tongue is thrust
forward and out of the mouth)
prevents form infants form eating
effectively if they are offered solid
food this early.
▪ Newborns can drink from a cup as
long as parent control the fluid flow.
▪ An infant can independently drink by
a cup from age of 8 to 10 months.
The Kidney
▪ Remains immature and not as
efficient at eliminating as in an adult.
▪ The ENDOCRINE SYSTEM remains
particularly immature in response to
pituitary stimulation,
adrenocorticotropic hormone, or
insulin production form the pancreas.
Without these hormones functioning
effectively, an infant may not be able
to respond to stress.
An Infant’s Immune System
▪ Becomes functional by at least 2
months of age
▪ An infant actively both
immunoglobulin (iG) and IgM anti
bodies by 1 year. The level's of other
Igs (IgA , IgE, IgD) are not plentiful
until preschool age, which is the
reason why infants continue to need
protection from infection.
▪ The ability to ADJUST TO COLD IS
MATURE by age 6 months, infants
already can shiver in response to cold
(which increase muscle activity and
provides warmth) and has developed
additional adipose tissue to serve a
insulation.
▪ The amount of Brown Fat, which
protected the newborn from cold,
DECREASES during the First year as
Subcutaneous fat INCREASES.
F. Teeth
▪ First baby tooth (typically a central
incisor) usually erupts at age of 6
MONTHS,
▪ Followed by a new tooth monthly
until all 20 deciduous teeth has
erupted by age 2 to 3 years.
▪ Fluoride supplementation should be
administered at 6months of age.
▪ However teething patterns can vary
greatly among children.
▪ Some newborns (about 2,000)
maybe born with teeth (NATAL
TEETH) have teeth erupt in the first
4 weeks of life (NEONATAL TEETH).
▪ THE LOWER CENTRAL INCISORS -
teeth frequently involved in this early
growth. If they are loosely attached,
they are usually removed before they
NCM109 LEC Notes 2
 are loosened spontaneously and are
aspirated by the infant.
▪ In most infants, NATAL OR
NEONATAL TEETH are deciduous or
are fixed firmly. These should not be
removed because no others teeth will
grow to replace them until the
permanent teeth erupt at age 6 or 7
years.
▪ DECIDUOUS TEETH - essential for
allowing proper growth of dental
arch. If they are injured, children
need a dental evaluation to be certain
their space for permanent teeth to
erupt effectively or that permanent (1-month-old)
teeth are not discolored.

A Typical Eruption Pattern of Deciduous Teeth

(3-month-old)

a) Landaux Reflex
✓ Develops at 3 months
✓ When held at a ventral suspension, the infant’s
head, legs, and spine extend; when the head
is depressed, the knees, hips, and elbows flex.
• Motor Development
✓ This reflex continues to be present in most
- An average infant progress through systematic
infants during 6 months of life, but then it
motor growth during the first year, strongly
becomes increasingly difficult to demonstrate.
reflecting the principles of cephalocaudal (head to
✓ Important reflex to assess because a child with
toe) and gross-to-fine motor development.
motor weakness, cerebral palsy, or other
a. Gross Motor Development
neuromuscular defects will not be able to
b. Fine Motor Development
demonstrate that reflex
• Gross Motor Development
- Four things to assess:
1. Ventral Suspension
Refers to an infant’s appearance when
held midair on a horizontal plane and
supported by a hand under the abdomen.

NCM109 LEC Notes 3

 b) Parachute Reaction
✓ 6 to 9 months
✓ Happens when an infant is suddenly lowered
toward an examining table – they extend their
arms as if to protect themselves from falling.
✓ Children with cerebral palsy do not
demonstrate this response because they flex
their extremities too tightly
2. Prone
Prone Position
Newborns turn their head to move it out
of a position where breathing
is impaired, but cannot hold
their head raised for an
extended time
1 month old lift their head and easily turn
it to the side
2 month old infants can now raise their
head and maintain the
position, but cannot raise
their chest high enough to
look around yet
3 month old lift their head and shoulder
well off the table and look
around when prone; some
children can turn from a prone
to a side-lying position at this
age
4 month old lift their chests off the bed
and look around actively,
turning their head from side
to side, turn from front to
back.
Neck-righting reflex (this
reflex causes babies to lose
their balance and roll
sideways when lifting the
head up) begins at this age
5 month old rest weight on their forearms
when prone, can turn
completely over
6 month old raise their chest and upper
part of their abdomens off the
table
9 month old a child can creep from the
prone position
3. Sitting
Sitting Position
Newborn extreme head lag; present
until about 1 month. In a
sitting position the back
appears rounded and an
infant demonstrates only
momentary head control.
2 month old hold their head fairly steady;
although their head does tend
to bob forward and will still
show head lag when pulled to
a sitting position
4 month old child reaches an important
milestone by no longer
demonstrating head lag when
pulled to a sitting position
5 month old straighten their back when
held or propped in a sitting
position
6 month old sit momentarily without
support
7 month old can sit alone but only when
the hands are held forward for
balance
8 month old can sit securely without any
additional support; a major
milestone in development
that should always be
considered in an assessment
9 month old can sit so steadily that they
can lean forward and regain
their balance; they may still
lose their balance if they lean
sideways, which is a skill not
achieved for another month
4. Standing
Standing Position
Newborn to 1 month old infants knees and hips flex
rather than support more
than momentary weight on
their feet.
3 month old support part of their weight
on their feet
4 month old support their weight on their
legs; stepping reflex has
faded
NCM109 LEC Notes 4
5 month old tonic neck reflex should be
extinguished, and the moro
reflex should be fading
6 month old nearly support their full
weight when in a standing
position
7 month old bounces with enjoyment in a
standing position
9 month old an stand holding onto a
coffee table if they are placed
in that position
10 month old pull themselves to a standing
position by holding onto
objects but cannot let
themselves down again just
yet
11 month old infant learns to “cruise” or
move by holding onto objects
within their reach
12 month old can stand alone at least
momentarily
• Fine Motor Development
- Finger and hand skills such as writing, cutting,
opening lunch boxes, and tying shoelaces.
Fine Motor Development
1 month old strong grasp reflex – hold
their hands in fists so tightly
that it is difficult to extend
their fingers
2 month old as grasp reflex fades, a 2-
month-old infant can hold an
object for a few minutes
before dropping it; hands are
held open, not closed in fists
3 month old reach for attractive objects in
front of them. Their grasp is
unpracticed so they usually
miss them
4 month old bring their hands together
and pull their clothes. Thumb
opposition (ability to bring
the thumb and fingers
together) begins, but the
motion is a scooping or raking
one, not a picking up one, and
is not very accurate
5 month old can accept objects that are
handed to them by grasping
with the whole hand. Fisting
that persists beyond 5
months suggests a delay in
motor development
6 month old grasping has advanced to a
point where a child can hold
objects in both hands. Can
now hold a spoon and start to
feed themselves
The Moro, the palmar grasp,
and the tonic neck reflex have
completely faded.
The Moro reflex that persists
beyond this point should
arouse suspicion of
neurologic disease.
7 month old transfer toys from one hand
to the other
8 month old random reaching and
ineffective grasping disappear
as a result of advanced eye-
hand coordination
10 month old major milestone at this age is
the ability to bring the thumb
and fist together in a pincer
grasp. This enables children
to pick up small objects such
as crumbs or pieces of cereal
from a high chair tray
12 month old hold a crayon well enough to
draw a semi straight line.
They can hold a spoon and
cup to feed themselves fairly
well and can take off socks
and push their hands into
sleeves if they have been
allowed to practice
• Growth and Development Milestones
- In addition to the gross and fine motor skills
developing at this time, language and play behavior
also reach major milestones.
A. Language Development
Language develop step by step the same as
motor development.
(Kindly refer to Table 29.2 attached at the last page for the
summarizes developments per milestone)
B. Development of Senses
Sense of Vision
0-1 month old able to regard an object in the
midline of their vision
(something directly in front of
them) as soon as it is brought
in as close as about 18 in.
(46 cm).
2 mos. old focus well (from about 6
weeks) and able to follow
moving objects with the eyes.
NCM109 LEC Notes 5
 The ability to follow and focus
in this way is a major
milestone in development,
indication that an infant has
achieved a binocular vision
or the ability to fuse two
images into one.
3 mos. old can follow an object across
their midline
They typically hold their hands
in front of their face and study
their fingers for a long time
(hand regard).
4-5 mos. old able to recognize familiar
objects.
6 mos. old capable of organized depth
perception. This increases the
accuracy of their reach for
objects as they begin to
perceive distances correctly.
7-9 mos. old pat their own image in a
mirror.
10 mos. old an infant look under a towel
or around a corner for a
concealed object (the
beginning of object
permanence, or an
awareness that an object
out of sight still exists.)
Sense of Hearing
1 month Hearing tests are required
Reactions are even more
marked
2 month old Hearing awareness becomes
acute
Infants will stop activity at the
sound of spoken words
3 month old Infants turn their heads to
attempt to locate a sound
4 month old Infants hear a distinctive
sound, they turn and look in
that direction
5 month old Infants demonstrate they can
localize sounds downward
and to the side, by turning
their head and looking down.
6 month old Progressed from being able
to locate sounds above them
10 month old Can recognize their name and
when spoken to, listen
intently
12 month old Can easily locate sounds in
any direction and turn toward
them.
A vocabulary of four words
also demonstrates that an
infant can hear.
Sense of Touch
Infants need to be touched so they can experience skin-to-skin
contact. Clothes should feel comfortable and soft rather than
rough; diapers should be dry rather than wet.
Sense of Taste
Infants demonstrate they have an acute sense of taste by
turning away from or spitting out a taste they do not enjoy.
When infants are introduced to solid food at about 6 months,
urge caregiver to make mealtime a time for fostering trust as
well as supplying nutrition by being certain that feedings are
done at an infant’s pace and the amount offered fits the child’s
needs and not the adult’s idea of how much should be eaten.
Sense of Smell
Infants have highly developed sense of smell within 1 or 2
hours of birth. They respond to an irritating smell by turning
their head away from it. They appear to enjoy pleasant odors
and learn early in life to identify the familiar smell of breast milk.
• Emotional Development
- Your baby is also growing in other ways that aren’t
as easy to spot, but are just as important.
- During this first year, your baby will form special
bonds with caring adults, explore the world around
them by touching, looking and engaging within safe
spaces with caregivers. They will also learn more
about emotions by watching you, sharing a smile
and calming with your help.
- It’s also important for your baby to be healthy
emotionally. These skills help them make friends as
they get older, learn how to express emotions in
safe ways, and take initiative to problem-solve and
succeed in school and life.
- When an interested person nods and smiles at a 6-
week-old infant, the infant smiles in return.
- This is a social smile and is a definite response to
the interaction, not the faint, quick smile that
younger infants, even newborns, demonstrate.
Infant Emotional Checklists
Birth to 2 months When your baby is fussy or
crying, respond with warmth
and kindness so your baby
learns their needs will be met
consistently and with care.
You’ll show them how to
safely get their needs met,
how a loving relationship
NCM109 LEC Notes 6
 works, and how to get along - At about 6 months of age, infants pass into a new
with others. stage Piaget (1952) called secondary circular
4 - 6 months Your baby will enjoy trying to reaction.
copy your expressions and - By 10 months, infants discover objects
learn how to respond to permanence. Infants are ready for a peek-a-boo
people this way. Make a silly once they have gained this concept.
face, give a big smile, or raise - As infants reach 1 year of age, they are capable of
your eyebrows and
reproducing new events.
encourage your baby to do
the same.
7 to 9 months You may notice that your
baby is fearful of strangers, or
loud noises, or new
situations. Offer comfort and
explore slowly together,
letting your baby know you
are there. They will develop
curiosity and learn to explore
in safe ways, which will help
them do the same in new
situations as they develop
and grow.
9 to 12 months Now your baby is starting to
recognize some words, even
if they can’t say them yet. This
lays a foundation for learning
to express themselves and
you can help them make the
connection between words
and feelings. When your baby
laughs, talk about being
happy. When your baby cries
because the toys are being
put away, talk about being
sad that play time is over.

• Cognitive Development
- In the first month of life, an infant mainly uses
simple reflex activities.
- A reflex that is still present after the age when it
would normally disappear can be a sign of brain or
nervous system damage.
- There are little evidence infants at this early age see
themselves as separate from their environment.
- However, this does not mean they cannot respond
actively or interact with people.
- They demonstrate they are very people-oriented
moments after birth by cuddling against an adult's
chest.
• Primary and Secondary Circular Reaction
- By the third month of life a child enters a cognitive
stage identified by Piaget (1952) as a primary
circular reaction.
- Infants appear to be unaware of what actions they
can use or what actions occur independently.

NCM109 LEC Notes 7

NCM109 LEC Notes 8