Nursing Care of the Infant

and Family
 INFANCY
I - Iron supplements begins at 4-6 months
N - No choking hazards
F - Fear of strangers peak at 8 months
A - Allow use of pacifiers if on NPO
N - Note: weight ( doubles at 6 month, triples at 12
months, quadruples at 2 ½ years )
T - Trust vs. mistrust
S - Solitary play
 INFANCY
100 – 120 beats/min by
end of 1st year
-
Abdominal respirations
20 – 30 breaths/min by
end of year

Temperature
BP 90/60 mmHg by 1 st
taken axillary
year
 Physical Growth
AGE WEIGHT HEIGHT

First 6 • double their birth At birth-

months weight
The average birth length:
• average weight gain
of 2 lb. per month ( 50th percentile ) of a
mature female -53 cm
mature male -54 cm
2nd 6 months • average weight gain • Early months – infant growth is most
of 1 lb. per month apparent in the trunk
• 2nd half of first year– it becomes more
apparent as lengthening of the legs
12 month • tripled birth weight; • 12 months – increases by 50%
 male- 10 kg (22 compared to its birth length
lb. );
 Body Proportion
Head
 In a mature baby , the average head circumference is
usually 34-35 cm.
 Increases rapidly during infancy
 End of first year – brain has reached 2/3 of its adult size
Body
• Chest circumference – 2 cm less than the head at birth
• 2nd 6 months- lengthening of the lower extremities, readies
the child for walking
• End of infant period – lower jaw is prominent
 Body Systems
Physiologic Changes

Cardiovascular  Second 6 months : HR slows

from 120-160 bpm to 100-120
bpm, heart becomes more
efficient by decreasing pulse
rate
Respiratory  Slows from 30-60 breaths/min to
20-30 breaths/min
 Body Systems
Physiologic Changes

Gastrointestinal  Immature in its ability to digest food,

amylase is deficient until approximately
the 3rd month,
 lipase decrease in amount during the
entire 1st year,
 3-4 months: extrusion reflex;
Immune system  Functional at least 2 months of age;
 6 months: ability to adjust to cold (shiver)
Teeth
 6 months – 1st baby tooth
(lower incisors)
 Monthly – new one
 Natal teeth – babies born with
teeth
 Deciduous teeth – temporary
or baby teeth essential for
protecting the growth of the
dental arch
 Deciduous Teeth
Deciduous teeth is the official term for baby teeth, milk teeth, or primary teeth. Deciduous teeth start
developing during the embryonic stage and then commonly begin to come in about 6 months after
birth. There are typically 20 primary teeth — 10 upper and 10 lower
 Motor Development
AGE GROSS MOTOR POSITION-
PRONE
1 Month  lifts their head  child lifts the head momentarily,
then drops it again; may flex the
and turn them elbows, extend the hips, and flex
easily to the side, the knees
keep their knees
tucked under the
abdomen

Ventral Suspension
2 Month  raise their heads
and maintain the
position but
cannot raise their
chest high
enough to look
 Motor Development
AGE GROSS MOTOR POSITION-
PRONE
3 • lifts the head and  child lifts and maintains the head
Month well above the plane of the rest
shoulders well off of the body; landau reflex
the table and
looks around

Landau Reflex
4 • lift their chest
Month
around the bed
and look around
actively, turning
their heads from
side to side, can
 Motor Development
AGE GROSS MOTOR POSITION-
PRONE
5 • Can turn completely over
Month from front to back and
back to front, rest their
weight on their hands
with extended arms,
raise their chest and the
upper part of their
abdomen on the table

9 • able to creep
Month

Parachute Reaction
6-9 months
 Motor Development
AGE GROSS MOTOR- GROSS MOTOR-
Sitting Standing
1 Month  has gross head lag  Stepping reflex, knees
when pulled to a and hips flex rather
sitting position than support more than
momentary weight
1-2 month
2 Month  can hold his or her
head fairly steady,
although it does tend
to bob forward, still
has head lag
3 Month  slight head lag when  begins to try to support
pulled to a sitting part of their weight;
position stepping reflex begins
to fade.
 Motor Development
AGE GROSS MOTOR- Standing
Sitting
4 Month  no longer
demonstrates
head lag

5 Month  can be seen to

straighten his or
her back when
propped in a sitting
position
6 Month  sits momentarily
without support, • Supports nearly
can anticipate their full weight
being pick-up
 Motor Development
AGE GROSS MOTOR- GROSS MOTOR-
Sitting Standing
7 Month  sit alone only when  Bounces with
the hands are held enjoyment in a
alone for balance standing position

8 Month  Can sit securely

without additional
support

9 Month  can sit steadily  Can stand holding

they can lean to a table/ couch
forward and regain
their balance, but
may lose their
balance if they lean
 Motor Development
AGE GROSS GROSS MOTOR-
MOTOR- Standing
Sitting
10  sit  Can pull themselves to
Month steadil a standing position by
y holding to the side of a
play pen or a low table
but cannot let
themselves down again
as yet
11  learns to “cruise”
Month
12  stands alone at
Mont least momentarily
 Motor Development
AGE FINE MOTOR

1 Month strong grasp

reflex

2 Month grasp reflex

begins to
disappear
3 Month reach for
attractive objects
in front of them
 Motor Development
AGE FINE MOTOR
4 Month  bring their hands together and pull at their clothes,
shake a rattle placed in their hands for a long time,
thumb position begins but the motion is as scooping
rather than a picking-up one, palmar and plantar grasp
have disappeared

5 Month  accept objects that are handed to them and grasp with
the whole hand, can reach and pick-up object without
being offered and play with their toes as objects
6 Month  grasping has advanced to a point where a child can
hold object in both hands, drops one toy when a second
one is offered on the same hand, can hold a spoon and
start to feed themselves; moro, palmar and tonic neck
have completely faded
 Motor Development
AGE FINE MOTOR
7 Month • transfer a toy from one hand to the other

10 Month • pincer grasp, enables a child to pick up small object

or pieces of cereal .
• The pincer grasp is the ability to hold something
between the thumb and first finger.

12 Month • can draw a semi-straight line with a crayon, enjoy

putting objects such as small blocks in containers
and taking them out again, can hold a cup and spoon
to feed themselves fairly well, can take off socks and
push their hands into sleeves, can offer toys and
release them
 Developmental Milestones
AGE LANGUAGE PLAY
1 Month  By end of 1st  Fix their eyes on an object, interested in watching a
month start to mobile over their crib or playpen, spend a great
make small deal of time watching the parent’s face, listens to
cooing sounds the sound of music box or a musical rattle
 Enjoy watching faces of primary care giver
2 Month  Makes cooing  Infant will hold light, small rattles for a short period
sounds of time but then drop them, very attuned to mobiles
 differentiates a or cradle gyms strung across their crib.
cry  Enjoys bright-colored mobiles
 “Social smile”

3 Month  Laughs out loud  Spends time looking at hands or using them as toys
 response to a  “ Hand regard”
nodding, smiling
face, or friendly
 Developmental Milestones
AGE LANGUAGE PLAY
4 Month  very talkative;  need a playpen or a sheet spread on the
cooing, babbling floor to exercise their new skill of rolling
and gurgling once over
spoken to, laughs  Needs space to turn
out loud
5 Month  says some simple  ready for a variety of objects to handle,
vowel sounds such as plastic rings, blocks, squeeze
(goo-goo, gah- toys,
gah)  Handles rattles well
6 Month  May say bowel  Enjoys bathtub toys such as rubber
sound ( oh-oh ) ducks or plastic boats, starting to teethe
 Developmental Milestones
AGE LANGUAGE/ PLAY
Socialization
7 Month  imitates vowel sounds  Likes objects that are good that are good size for
well transferring
 Shows beginning fear of  begin to be more interested in brightly-colored balls
strangers or toys
8 Month  Has peak fear of  Enjoys manipulation, rattles and toys
strangers ( ability to tell  sensitive to differences in texture
known from unknown
people )
9 Month  usually speaks a first  needs the experience of creeping, begin to enjoy
words (dada, baba) toys that go inside one another such as nest of
blocks or rings of different sizes
10  masters another word  ready for peek-a-boo, spend long time playing the
Month such as “bye-bye” or game with their hands or with a cloth over their
“no” head, can clap, ready to play patty-cake, can
participate in active games
 Developmental Milestones
AGE LANGUAGE PLAY

11 Month  learned to cruise or walk along low tables be holding on

12 Month  can generally  enjoy putting things in and taking things out of the
say 2 words containers, like little boxes that fit inside one another
besides “mama” and dropping objects such as blocks into a cardboard
and “dada”, use box, as soon as they can walk, they will be interested in
those 2 words pull toys, listen to someone saying nursery rhymes or
with meanings listening to music
Developmental Milestones- Development of
Senses
AGE Vision-Sight Hearing
1 Month  Regard object in the midline of their  Quiets momentarily at a
vision-something directly in front of distinctive sound such as
themselves as soon as it is brought in as bell
close as 18 inches
2 Month  Focus well follow objects with the eyes  Hearing awareness
 Achieve” binocular vision” becomes so acute
 Infant will stop activity at
the sound of spoken
words
3 Month  Follow objects across their midline  3-4 month
 Hold their hands in front of their face  Turns head to attempt to
and study their fingers for a long period locate the sound, and
of time “ hand regard” look in that direction
Developmental Milestones- Development of
Senses
AGE Vision-Sight Hearing
4 Month  Recognize familiar objects  3-4 month
 Follow parents movements with  Turns head to attempt to locate the
their eyes eagerly sound, and look in that direction

5 Month  5-6 month

 Can localize sounds downward
and to the side

6 Month  Capable of organized depth  6 month-being able to locate sound

perception above them
 Increases accuracy of their
reach of objects
Developmental Milestones- Development of
Senses
AGE Vision-Sight Hearing
7  Pat their image in the mirror
Month  Depth perception has matured
to the extend they can perform
task such as transferring toys
from hand to hand

10  Looks under the towel or around  Recognize their name and listen
Month the corner for concealed objects acutely when spoken to
 Beginning of object permanence

12  Easily locate sounds in any

Month direction
 Vocabulary of two word “ ma-ma,
da-da”
Developmental Milestones
AGE Emotional Development
1 Month  differentiate between faces and other objects
by studying a face or the picture;
 quiet best and eat best with their primary
caregiver

2 Months  social smile

3 Months  demonstrates increased social awareness by

readily smiling at the sight of a parent’s face,
 laugh out loud at the site of funny face
Developmental Milestones
AGE Emotional Development
4 Months  Cries or smiles to show they enjoyed interaction,
 recognize their primary caregiver
5 Months  show displeasure when an object is taken away
from them
6 Months  aware of the difference between people who
regularly care for them,
 begin to draw back from unfamiliar faces
7 Months  begin to show obvious fear of strangers,
 cry when taken form parents,
 attempt to cling when taken from parents
Developmental Milestones
AGE Emotional Development
8 Month  fear of strangers reaches its height,
 eight-month anxiety or stranger anxiety
9 Month  very aware of changes in tone of voice,
 cry when scolded
12 Month  overcome their fear of strangers,
 alert and responsive again when approached,
 like to play interactive nursery rhymes
 like being at the table for meals
 Developmental Milestones
AGE Cognitive Development
Jean Piaget: Cognitive Development Theory
1st month  Mainly uses simple reflex activity
of life
3 Months  The infant enters a cognitive stage as identified by Piaget.
“Primary Circular Reaction.”
 Infant identify objects by grasping them with the hands or by
putting them in their mouth.
 Unaware of what actions they can cause
6 Months  Infants can grasp the idea of their action
 Can initiate pleasurable sensation
 The infant enter the stage as identified by Piaget.
“Secondary Circular Reaction.”
Developmental Milestones
AGE Cognitive Development
10 Month  Discover “ Object Permanence”, or become
aware that object exists even if it is out of sight.
 If a baby drops a spoon from a high chair, infant
knows it exist and try to reach for it, Piaget
called this stage of cognitive development “
coordination of secondary schema”

12 Month  Capable of reproducing interesting events-

deliberately hit a mobile, once it moves; they hit
it again.
 Developmental Milestones
Infancy Oral
Sigmund Freud: Psychosexual Theory

Birth to 1 year  Mouth is the center of gratification through

old sucking, chewing, swallowing, breastfeeding, and
biting.

Unsuccessful  may lead to oral fixation habits such as nail-biting,

Outcome thumb sucking, smoking, and excessive drinking.
Developmental Milestones
Infancy Developmental Task
Erik Ericson: Psychosocial Theory
Task  keep the parents involve with trust-
attachment to the mother/caregiver
 trust develops when the infants needs are met

 “learning to love & be loved”

Successful  Feeling of trust
Outcome

Unsuccessful  Mistrust, Suspicion, Uncertainty of the future

Outcome
The Nursing Role in Health Promotion of
the Infant and Family
1. Immunizations / Promoting Infant Safety
2. Promoting Nutritional Health of Infant
3. Promoting Infant Development in Daily Activities
4. Parental Concerns and Problems related to
Normal Development
5. Concerns of the Family with a Cognitive or
Physically challenged or Chronologically Ill Infant
Immunization Requirements
(0-1 year old)
 Shortly after birth, baby should receive the first
dose of the vaccine to help protect against the
following disease:
• - Hepatitis B (HepB) (1st dose)
. BCG
At 1 to 2 months, your baby should receive
vaccines to protect them from the following
diseases:
- Hepatitis B (HepB) (2nd dose)
- Diphtheria, tetanus, and whooping cough (pertussis)
(DTaP) (1st dose)
- Haemophilus influenzae type b disease (Hib) (1st dose)
- Polio (IPV) (1st dose)
- Pneumococcal vaccine (PCV13) (1st dose)
- Rotavirus (RV) (1st dose)
 At 4 months, your baby should receive
vaccines to help protect against the
following diseases:

- Diphtheria, tetanus, and whooping cough (pertussis)

(DTaP) (2nd dose)
- Haemophilus influenzae type b disease (Hib) (2nd
dose)
- Polio (IPV) (2nd dose)
- Pneumococcal vaccine (PCV13) (2nd dose)
- Rotavirus (RV) (2nd dose)
At 6 months of age, your baby should receive vaccines
to protect them from the following diseases:
- Diphtheria, tetanus, and whooping cough (pertussis) (DTaP)
(3rd dose)
- Haemophilus influenzae type b disease (Hib) (3rd dose)
- Polio (IPV) (3rd dose)
- Pneumococcal vaccine (PCV13) (3rd dose)
- Rotavirus (RV) (3rd dose)
- Influenza (Flu) (every year)

At 7-11 months of age, your baby should receive the

flu vaccine to protect your baby from the following
disease:
- Influenza (Flu) (every year)
Between 12 and 23 months of age, your baby should
receive vaccines to protect them from the following
diseases:
- Chickenpox (Varicella) (1st dose)
- Diphtheria, tetanus, and whooping cough (pertussis) (DTaP)
(4th dose)
- Haemophilus influenzae type b disease (Hib) (4th dose)
- Measles, mumps, and rubella (MMR) (1st dose)
- Polio (IPV) (3rd dose)
- Pneumococcal disease (PCV13) (4th dose)
- Hepatitis A (HepA) (1st dose)
- Hepatitis B (HepB) (3rd dose between 6 months and 18
months)
- Influenza (Flu) (every year)
Immunizations/Vaccination
1. BCG
 Bacillus Calmette–Guérin (BCG) vaccine is a vaccine
primarily used against tuberculosis (TB).
 It is named after its inventors Albert Calmette and Camille
Guérin. In countries where tuberculosis or leprosy is common,
one dose is recommended in healthy babies as soon after
birth as possible.
2. Hepatitis B vaccine
 Hepatitis B vaccine is a vaccine that prevents hepatitis B
infection.
 The first dose is recommended within 24 hours of birth with
either two or three more doses given after that.
 \
Immunizations/Vaccination
3. Diphtheria, tetanus, and whooping cough (pertussis) (DTaP)
 DTaP is an immunization against Diphtheria, Tetanus, and
Pertussis (whooping cough). There are also DTaP vaccines
that are combined with immunizations against other
diseases, Polio, Hepatitis B, and Hib infections.
4. Hib vaccine
 The Haemophilus influenzae type B vaccine, often called
Hib vaccine, is a vaccine used to prevent Haemophilus
influenzae type b (Hib) infection.
 Hib vaccines are highly effective in preventing Hib disease,
including meningitis (inflammation (swelling) of the lining of
the brain and spinal cord).
Immunizations/Vaccination
5. Oral Polio/ IPV ( 2-4-6 Months, booster )
 Oral polio vaccine (OPV) contains an attenuated
(weakened) vaccine-virus, activating an immune response
in the body.
 IPV stands for inactivated polio vaccine. It is a safe and
effective vaccine that must be given in a series of four shots
to boost protection against the poliomyelitis virus.
6. Pneumococcal vaccine ( 2-4-6 months )
 The pneumococcal vaccine is an injection given to protect
you from pneumococcal disease. Pneumococcal disease
develops from an infection caused by pneumococcal bacteria.
The infection may cause pneumonia or an ear infection.
Pneumococcal disease is spread from person to person
through coughing and sneezing.
Immunizations/Vaccination
7. Rota virus vaccine
 Rotavirus vaccine is a vaccine used to protect
against rotavirus infections, which are the
leading cause of severe diarrhea among
young children.
8. MMR
 The MMR vaccine is a vaccine against
measles, mumps, and rubella (German
measles). The first dose is generally given to
children around 9- 12 months to 15 months of
age, with a second dose at 15 months to 6
 Immunizations/Vaccination
7. Hepatitis A vaccine
 The hepatitis A vaccine is a dose of inactive virus
that stimulates your natural immune system. After
the hepatitis A vaccine is given, your body makes
antibodies that will protect you against the
hepatitis A virus, requires 2 shots, 6 months apart.
( first dose is given between 12-24 months )
8. Varicella vaccine
 The chickenpox (varicella) vaccine can prevent
you or your child from getting chickenpox. The
Promoting Infant Safety
1. Aspiration Prevention
 Infants put everything in the mouth, therefore
choking is a major problem- do not give round,
cylindrical small objects.
 Children under 5 years should not be offered
popcorns or peanuts.
2. Fall Prevention
 Should not be left unattended on a raised
surface
 2 month- roll over, side rails precaution
 Keep safety pins out of reach
Promoting Infant Safety
3. Car Safety
 Car seats- should be placed in rear-facing seats
in the backseat
4. Safety with siblings
 Do not leave older siblings under 5 yo- not
responsible enough about infants
Promoting Infant Safety
5. Bathing and Swimming
 Do not leave unattended in a tub
 Infant swim programs
6. Childproofing
 5-6 months; teething begins, may chew any
object within reach.
 Exposed electrical fixtures- protective caps
 Safety gates
Promoting Infant Safety
5. Bathing and Swimming
 Do not leave unattended in a tub
 Infant swim programs
6. Childproofing
 5-6 months; teething begins, may chew any
object within reach.
 Exposed electrical fixtures- protective caps
 Safety gates
 Promoting Nutritional Health of
Infant ADVANTAGES DISADVANTAGES
Human • No preparation • Lifestyle or illness of mother
Breast Milk needed, may influence availability
nonallergenic,
provides
antibodies
Formula/ Milk • Easy to prepare, • Expensive
powder can prepare • May cause allergic reaction to
( Artificial milk bottle at a time, certain milk product
formula)
easy to feed • Must use accurate proportions
when travelling or measurements
• Safe water supply
• Need to wash/sterilized
Promoting Nutritional Health of
Infant
Introduction to Solid Foods

 Normal full-term infant can thrive on a commercial iron-

fortified formula or breast milk without the addition of any
solid food until 4-6 months.

 Infants are physiologically ready for solid food when they

are taking more than 32 oz (960 ml) of formula a day
and does not seem satisfied.
Promoting Nutritional Health of
Infant
Introduction to Solid Foods

 Offer new foods one at a time

 Allow child to eat the item for about 1 week

before introducing another new food

 First solid food best given when an infant is in the

parent’s arm like that of breast-feeding
Promoting Nutritional Health of
Infant
Promoting Nutritional Health of
Infant
Establishing Healthy Eating Patterns
Weaning

 Around 6 months- sucking reflex begins to

diminish
 9 months- capable to use cup
Self- feeding
 6 month- interested in handling spoon, begin
to feed themselves
Promoting Nutritional Health of
Infant
Adequate intake with a vegetarian diet
1. Continue BF
2. Select fresh, high-quality fruits, vegetables
3. Iron fortified, balanced, commercial formula
4. Feeding fortified cereal ensures that iron stores
are built
5. Dairy product are added toward the end of 1st
year
Promoting Infant Development in Daily
Living
1. Bathing
 Does not need a bath everyday but wash face,
hands and diaper area
 Prevent seborrhea
2. Diaper-area Care
 Change diaper as needed, wash skin properly
3. Care of Teeth
 Expose developing teeth to fluoride
 Initial dental check-up at 2 year old, continue
every 6 months interval.
Promoting Infant Development in Daily
Living
4. Dressing
 Easy to launder, soft
 When creeping begins, need long pants
 Soft-soled shoes, booties until they begin to walk
5. Sleep
 Requires 10-12 hours at night and several
naps at day time
Promoting Infant Development in Daily
Living
6. Exercise
 Expose child for only short period of
time, begin with 3-5 minute on day 1,
a little more the next day, and so on
up.
 End of 1st year - need s apace to crawl
then walk
 Parental Concerns/Problems related to
Normal Development
Teething
 Gums are sore and tender before new tooth breaks the surface
 Infants having high fever, seizures, vomiting or diarrhea,
earache may have underlying infection
Thumb Sucking
 Begin to suck thumb at about 3 months and continue until 1st
year of life
Use of Pacifiers
 Wean babies from pacifier at 3 months when sucking reflex
begins to fade.
 Parental Concerns/Problems related to
Normal Development
Head Banging
 Considered normal during the 2nd half of the 1st year of life and
through the pre-school- lasting about 15 minutes.
Sleep Problems
 Breastfed infants tend to wake more frequently than formula-fed
infants
Constipation
 Breast-fed infants are rarely constipated
 Persist beyond 5 0r 6 months- fibrous foods may relieve the
problem
Parental Concerns/Problems related to
Normal Development
Spitting up
 Spits up a mouthful of milk 2-3 times a day is normal-
burping the baby after feeding
 Associated signs: diarrhea, abdominal cramps, fever,
cough, cold suggest illness
Colic
 Paroxysmal abdominal pain that generally occurs in
infants under 3 months of age- thorough history must be
taken.
Parental Concerns/Problems related to
Normal Development
Loose Stools
 Breast-fed- have loose stools especially if mother is taking
laxatives
 Formula-fed- have soft stools if the formula was not
properly diluted
 Malabsorption syndrome - fever, cramping, vomiting,
loose appetite, decrease in voiding and weight loss should
be examined.
Diaper Dermatitis
 Erythematous- allergy to the material or laundry
products
 Fungal infections
Parental Concerns/Problems related to
Normal Development
Baby-Bottle Syndrome
 Most serious when bottle is filled with sugar
water, formula, milk or fruit juice

Obesity in Infants
 Weight greater than the 90th or 95th percentile
 Iron-deficiency anemia may develop
 Parental Concerns/Problems related to
Cognitive/Physically Challenged/Chronically
Ill Infants
Helping parents to interact
more fully with their infants to
help build a sense of trust in
infant
Ensure adequate nutrition
Thank You