Dr/ Sara Galal

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Introduction

The first year of life is often called the infant period. The infant needs your
love, attention, and care as he adjusts to the world around him. The infant has his
own special personality and with time will develop into his own person. You can
help the infant grow up happy, healthy, confident, and help him have positive self-
esteem (think good about himself).

Normal Infant
Infancy period starts at the end of the first month up to the end of the first
year of age. Infant's growth and development during this period are characterized
by being rapid.

1- Physical Growth:
A) Weight: the infant gains:
Birth to 4 months ——-> ¾ kg/month.
5 to 8 months ——-> ½ kg/month.
9 to 12 months ——> ¼ kg/month.
 The infant will double his birth weight by (4-5) months and triple it by (12)
months of age.
 Another way of calculating the weight for infant age 3 to 12 months
 Weight = age in month + 9
———————
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 For example, the weight of 7 months old infant= 7+9 / 2 = 16/2 = 8 kg.
b. Length:

 Length increases about 3 cm/month during the first 3 months of age.

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  It increases 2 cm/ month at age of 4-6 months.

 It increases 1 ½ cm / month at 7 to12 months.

c. Head Circumference:

 It increases about 2 cm / month during the first 3 months, then ½ cm /month

during the second 9 months of age.
 Posterior fontanel closes by 2 to 6 weeks of age.
 Anterior fontanel closes by 12 – 18 months of age
d. Chest Circumference:
 By the end of the first year, it will be equal to head circumference.

Physiological Growth of Infant

 Temperature: 36.5-37.5 °c
 Pulse: 110- 150 beats / minute.
 Respiration: 35+ l0 c/minute.
 Blood Pressure: 80/50 ± 20/10 mmHg.
Dentition:
 Eruption of teeth starts by 5- 6 months of age. It is called "Milky teeth‖ or
"Deciduous teeth‖ or ―temporary teeth‖.

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 N.B: Infant will have (10) teeth at the end of one year, Four upper and lower
central incisors Four upper and lower lateral incisors, second lower first molar
Normal range for Dentition:

Name of Teeth Mandibular (Lower Jaw) Maxillary (Upper jaw)

Central incisors 5-7 months 6-8 months

Lateral incisors 7-10 months 8-11 months

Cuspids (canines) 16-20 months 16-20 months

First molars 15-16 months 10-16 months

Second molars 10-16 months 20-30 months

Development of the infant

Nurse can assess development of infant through assessment. Special senses
development (visual, taste, hearing, touch, smell)
2 months • When on back, follow a moving object beyond the midline of vision.
• Eyes follow moving persons nearby.
3 months • When on back, turn eyes to a moving light or dangling objects.
• When he can follow an object moving from left to right; up and down.
4 months • Starts at rattle in his hand grasp.
• Follow moving object well with eyes.
• Beginning hand-eye coordination.
5 months • Visual acuity 6/6
• Inspect objects visually for lengthening period.
9 months • Follow objects through transition from one place to another.
Taste • By 6 months he has preferences in taste for foods.

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1- Motor Development of Infant
2 months:
Gross motor
 In prone position, left head aside.
 Holds head erect in mid- position.
 Turn from side to back.
Fine motor
 Holds a rattle briefly when placed in his hand.
3 months:
Gross
 Raises chest, usually supported on forearm when prone position.
 Holds head erect and steady.
Fine
 Holds hands in front of face.
 Reaches for bright objects but misses them.
 Holds objects put in hand.
4 months:
Gross
 Sits with adequate support.
 Rolls over head erect and steady while in sitting position.
 Holds head erect and steady while in sitting position.
Fine
 Bring hands together in midline and plays with fingers.
 Grasps object held near hand but cannot pick it up when dropped.
 Grasps objects with both hands.
 Carry objects to mouth.
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5 months:
Gross
 Site with slight support.
 Rolls from back to front.
 Pulls feet up to mouth when supine.
Fine
 Uses thumb in picking up objects.
 Grasps objects with whole hand (Rt or Lt).
 Tries to obtain objects beyond reach.
6 months:
Gross
 Sits alone briefly.
 Pulls to a sitting position
 Turns completely over (abdomen to abdomen).
Fine
 Begins to transfer object from one hand to another
 Holds own bottle.
7 months:
Gross • Sits alone.
Fine • Transfers a toy from one hand to the other successfully.
• Holds cup.
8 months:
Gross
 Sits alone steadily.
 Pulls himself to standing position with help
 Hand-eye coordination is perfect.
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Fine
 Holds two objects
 Reaches for objects beyond range of grasp.
 Drink from cup with assistance
 Eats fingers food that can be held in one hand.
9 months:
Gross • Raises to a sitting position alone.
• Crawls (i.e. pull body while in prone position).
• Begins to pull self to standing position alone while holding on to
furniture.
Fine • Brings two objects together.
• Holds own bottle with good hand- mouth coordination.
10 months:
Gross • Moves from prone to sitting position.
• Creeps well (use hands and legs).
• Walk but with help
Fine • Picks small objects up with index finger and thumb ( i.e. pincer grasp )
• Brings the hands together.
11 months:
Gross • Walks holding on furniture.
• Stands erect with minimal support.
Fine • Removes covers from boxes.
• Takes a toy out and put it inside box or cup
12 months:
Gross • Stands alone for variable length of time.
• Sits down from standing position alone.
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Fine • Picks up small bits of food and transfers them to his mouth.
• Drinks from a cup and eats from a spoon, but still requires some help
2- Vocalization and socialization
 Nurses can assess mental development through socialization and language
development. So, nurse can observe infant during:
2 months: Responds to caregiver's voice "ah", "eh", "uh"
3 months: Laugh loudly.
6 months: Vocalizes several well-defined syllables.
7 months: Vocalizes da, ma, ba.
9 months: Associates words with persons or objects, says "ma ma", "da da".
10 months: May speak one "word no" or "hi".
12 months: May speak two or more words beside "ma ma", "da da", "ba ba".

3- Social Development
 Shows a social smile in response to another smile and learn that by crying,
he will get attention. Recognize stranger.

4- Emotional Development
 The infant expresses his emotions through crying, laugh and body
movements. His emotions are unstable where it is rapidly changes from
crying to laughter.
Psychosocial development according to "Erikson"
 Erikson terms the crisis of infancy as "trust versus mistrust".
 In this stage, developing a sense of trust in infant is the central focus of
caregivers.

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  Infant who receive attentive care learn that life is predictable and that their
needs will be met promptly, which fosters trust. Also, infant develop self-
trust when his/her care is effective, comfort and consistent.
 Infant whose needs are unmet or who experience significant delays in having
their needs will develop a sense "of uncertainty, leading to mistrust of
caregivers and the environment also he develops mistrust when he receives
inadequate and inconsistent care.
Psychosexual development according to "Freud"
 The oral stage of development extends from birth to 18 months.
 During this stage, infant learning to deal with anxiety by mouth and tongue.
 Infant libidinal pleasure center about the gratification from using his mouth
for sucking, swallowing, chewing and biting.
Cognitive development according to "Piaget"
 During the sensorimotor stage "between birth and 18 months", intellect
develops and the infant gains knowledge of the environment through the
senses.
Infants' needs
 Infant needs five basic emotional needs, which are: -

1 - Love and security.

2- Feeding.
3- Sucking pleasure.
4- Warmth and comfortable.
5- Sensory stimulation.

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Daily care of the infant
 There is no set pattern of daily care for all children since their needs vary
from month to month and the family situation of each differs from that of the
others.
1- Care of (eye, nose, ears, and mouth)

 Eyes: Any secretion should be washed out with soft subject and clean water,
stating from inner to outer on one direction and then dry it.
 Nose and Ears: Nose and ears can be cleaned externally by using twisted
cotton can be moistened in water. Oil should never be used because of the
danger of aspiration when cause harm to respiratory tract.
 Mouth: The mouth should be cleaned after each feeding by clean water or
by introduces sterile gauze with glycerin.
2- Diaper Care: frequent change of diaper after each maturation and
defecation then clean the genitalia and buttocks very gently and dry it.
3- Carrying the infant: The technique of carrying the infant is based on his
anatomical structure and motor ability. Infant head is large in proportion to
his body and he is unable to hold erect without support until he is about 3
months old. The shoulder and back must support at first because of
weakness.
There are different techniques/or carrying infant such as
1- Cradle technique. 2- Upright technique. 3-Football hold
 Each of them has its special use.
 The cradle technique is commonly used in lifting, turning and carrying the
infant & breast-feeding
 Upright technique is usually in eructation the infant &IM injection.

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 The football hold: Is usually in washing the infant's head over a basin or
making the crib while holding the infant.
4- Bathing: The purpose of bath is not only cleanliness but also:
 To make the infant exercise without clothing.
 To provides the time of play with him.
 To provides an opportunity to note his growth and development.
 To observe his body for evidence of rash.
 There are many types of bathing. The infant may have sponge bath in bed or,
bathed in a tub.
 The bath time must be suitable according to facilities.
 Safety factors must be kept in mind when bathing the infant must not be left
alone in sitting position in tub.
 The mother can give chance for the father to give him the bath to know him
better and to give him the sense of being loved and cared for.
5- Clothing: Infant's clothes must be simple, bright color and loose especially
when he starts to creep or move around freely. Shoes should be soft until the
child walks. Fresh air and sunshine is important for infant.
6- Exercise: An infant get exercise in several ways; he is active at bath time.
His clothes should not restrict his movement. When he is old enough to turn
over, he should have toys to encourage activity.
7- Sleep: infant needs rest for his rapid growth and his energy output. Infant
needs more than 15-18 hours a sleep a day in the first few months of life. At
3 months, he usually sleeps in 24hr about (15-l6) hours. At 6 months the
average amount of sleep 12 hours at night and 3-4 hours during day. He
needs one or two naps a day.
 Before bedtime, over stimulation should be avoided.
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 Infant should be dry and comfortable.
 He should not be put to bed immediately or left alone in the dark.
 He may need to keep his favorite toy with them so they can feel secure while
going to sleep.
 He should lie on a flat surface as this will be best for his bone development.
 It is preferred to put infant lying on his side for comfortable and safety. As
on his back, he may vomit and aspirate fluid

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