The Infant and Family

The Infant and Family

  • Proportional changes
    • Infants gain 150 to 210 g (5-7 oz) weekly until approximately 5 to 6 months of age
    • At 6 months of age the birth weight has at least doubled 
    • Weight gain slows in the second 6 months 
    • Birth weight is tripled by 1 year 
    • Length occurs in spurts rather than gradually 
    • By 1 year the length has increased by 50%- mainly in the trunk rather than the legs
    • Head growth is also rapid 
    • By 1 year of age the head growth has increased by 33%
    • Closure of the cranial sutures occurs, with the posterior fontanel closing by 6 to 8 weeks of age and the anterior fontanel closing by 12-18 months of age
  • Physical development
    • Fontanel
      • Posterior fontanel closes by 2 to 3 months of age
      • Anterior fontanel closes by 12 to 18 months of age
    • Dentition
      • Six to eight teeth should erupt in infants’ mouths by the end of the first year of age. 
      • The first teeth typically erupts between the ages of 6 and 10 months (average age 8 months).
      • Some children show minimal indications of teething (sucking or biting on their fingers or hard objects and drooling)
      • Other are irritable, have difficulty sleeping, have a mild fever, rub their ears, and have decreased appetite for solid foods
  • Maturation of systems
    • Respiratory
      • Respiratory movements are mostly abdominal
      • Predisposed to respiratory issues:
        • Close proximity of trachea to bronchi
        • Short, straight Eustachian tube closely communicates with the ear-infection to ascend from pharynx to the middle ear
    • Heart
      • HR slows and the rhythm is often sinus arrhythmia
    • GI
      • Nutrition
        • Feeding alternatives
          • Breastfeeding provides a complete diet for infants during the first 6 months
            • Breast milk should never be thawed or rewarmed in the microwave – to prevent oral burns from uneven warming of the milk
          • Iron-fortified formula is an acceptable alternative to breast milk.
            • Cow’s milk is not recommended
          • It is recommended to begin vitamin D supplements within the first few days of life to prevent rickets and vitamin D deficiency
          • Iron supplements are recommended for infants who are being exclusively breastfed after the age of 4 months
          • Alternative sources of fluids (juice or water) are not needed during the first 4 months of life. Excessive intake of water could result in hyponatremia and water intoxication
          • After the age of 6 months, 100% fruit juice should be limited to 4 to 6 oz per day
        • Solids are introduced around 6 months of age
          • Indicators for readiness include interest in solid foods, voluntary control od the head and trunk, and disappearance of the extrusion reflex.
          • Iron-fortified cereal is typically introduced first due to its high iron content
          • New foods should be introduced one at a time, over a 5-to-7-day period, to observe for manifestations of allergy or intolerance, which might include fussiness, rash, vomiting, diarrhea, and constipation
          • Vegetables or fruits or fruits are started first between 6 and 8 months of age. After both have been introduced, meats ay be added
          • Citrus fruits, meats, and eggs are not started until after 6 months of age
          • Breast milk/formula should be decreased as intake of solid foods increases, but should remain the primary source of nutrition through the first year
          • Table foods that are well-cooked, chopped, and unseasoned are appropriate by 1 year of age
          • Appropriate finger foods include ripe bananas, toast strips, graham crackers, cheese cubes, noodles, firmly cooked vegetables, and raw pieces of fruit (except grapes).
        • Weaning can be accomplished when infants show signs of readiness and are able to drink from a cup (sometime in the second 6 months).
          • Gradually replace one bottle or breastfeeding at a time with breast milk or formula in a cup with handles
          • Bedtimes feedings are the last to be stopped.
        • Introduction of solid foods into the infant’s diet at this age is primarily for taste and chewing experience not for growth
        • Administration of Oral Iron Supplements
          • Ideally, iron supplements should be administered between meals for greater absorption.
          • Liquid iron supplements may stain the teeth; therefore administer with a dropper toward the back of the mouth (side). In older children, administer liquid iron supplements through a straw, or rinse mouth thoroughly after ingestion.
          • Avoid administration of liquid iron supplements with whole cow’s milk or milk products because these bind free iron and prevent absorption.
          • Educate parents that iron supplements will turn stools black or tarry green.
          • Iron supplements may cause transient constipation. Caution parents not to switch to a low-iron–containing formula or whole milk, which are poor sources of iron and may lead to iron deficiency anemia
          • In older children, follow liquid iron supplement with a citrus fruit or juice drink (no more than 3–4 oz).
          • Avoid administration of iron supplements with foods or drinks that bind iron and prevent absorption