Growth and Development Of Infants During this very important first year babies grow dramatically, not only

physically in weight and height, but developmentally. By the end of the first year of life, the helpless and dependent infant will have developed into a little person eagerly demonstrating their independence through a number of skills. BIOLOGIC DEVELOPMENT All major body systems undergo progressive maturation, and there is concurrent development of skills that increasingly allows infants to respond to and cope with the environment. Proportional changes During the first year the growth is very rapid, especially during the initial 6 months. Weight: Infants birth weight is around 2.5 to 4kg. He gains about 150 to 210 gm weekly until approximately age 5 to 6 months, when the birth weight has atleast doubled. An average weight for a 6 month old child is 7.26 kg. Height: Height increases by 2.5 cm a month during the first 6 months and also slows during the second 6 months. Average height is 65 cm at 6 months and 74 cm at 12 months. By 1 year the birth length has increased by almost 50%. The increase occurs mainly in the trunk, rather than in the legs. Head: Head growth is also rapid. During the first 6 months head circumferences increases approximately 1.5 cm per months but decreases to only 0.5cm monthly during the second 6 months. The average size is 43 cm at 6 months and 46 cm at 12 months. By 1 year, head size has increased by almost 33%. Closure of the cranial sutures occur , with the posterior fontanel fusing by six to eight weeks of age and the anterior fontanel closing by 12 to 18 months of age. CHEST CIRCUMFERANCE Chest circumference approximately equals the head circumference by the end of the first year. The heart grows less rapidly than does the rest of the body. Its weight is usually doubled by 1 year of age in comparison with the body weight, which triples during the same period. The size of the heart is still large in relation to the chest cavity; its width is approximately 55% of the chest width. MATURATION OF SYSTEMS: Other organs also change and grow during infancy. RESPIRATORY SYSTEM Respiratory rate slows somewhat and is relatively stable. Respiratory movements continue to be abdominal. The close proximity of the trachea to the bronchi and its branching structures rapidly transmits an infectious agent from one anatomic location to another. The short, straight Eustachian tube closely communicates with the ear, allowing infection to ascend from the pharynx to the middle ear. Cardiovascular system: The heart rate slows and the rhythm is often sinus arrhythmia (rate increases with inspiration and decreases with expiration).Fluctuations in blood pressure occur during varying states of activity and emotion. Significant hemopoietic changes occur during the first year. Fetal hemoglobin is present up to the first 5 months, with adult hemoglobin steadily increasing through the first half of infancy. Fetal hemoglobin results in a shortened survival

of red blood cells and thus a decreasing number of RBCs. A common result at 2 to 3 months of age is physiologic anemia. Digestive system The digestive processes are relatively immature at birth. Gastric digestion in the stomach consists primarily of the action of Hcl and rennin. Digestion also takes place in the duodenum. During infancy the stomach enlarges to accommodate a greater volume of food. By the end of the first year the infant is able to tolerate three meals a day and evening bottle. The liver is the most immature of all the gastrointestinal organs throughout the infancy. The ability to conjugate bilirubin and secrete bile is achieved after the first couple of weeks of life. Maturation of the sucking, swallowing and breathing reflexes and the later eruption of teeth parallel the changes in the gastrointestinal tract and prepare the infant for the introduction of solid foods. Sucking is nutritive and nonnutritive. Swallowing is the ability to collect the food and propel it into the esophagus. Infant also exhibit a special reflex called the santmyer swallow. When a puff of air is directed at the face, the infant will exhibit a reflex swallow. Immunologic system The term newborn receives significant amounts of maternal immunoglobin G, which for approximately 3 months confers immunity against many antigens to which the mother was exposed. Approximately 40% of adult levels of IgG are reached by 1 year of age. The production of IgA, IgD, IgE is much more gradual, and the maximum level are not attained until early adulthood. Renal system: The renal system is still immature. It may predispose the infant to dehydration. The filtration capacity of the glomeruli is reduced. Urine is voided frequently and has a low specific gravity. Thermoregulation During the infancy, thermoregulation becomes more efficient; the ability of the skin to contract and of muscles to shiver in response to cold increases. The immaturity of the renal structures also predisposes the infant to dehydration. MOTOR DEVELOPMENT. Fine motor development: Grasping occurs during the first 2 to 3 months as reflex and gradually becomes voluntary. At 1 month of age the hands are predominantly closed, and by 3 months they are mostly open. By 4 months of age, the infant regards both a small pellet and the hands and then looks from the object to the hands and back again. By 5 months the infant is able to voluntarily grasp an object. Gradually the palmar grasp is replaced with a pincer grasp. By 8 to 9 months of age, the infant uses a crude pincer grasp and by 10 months of age the pincer grasp is sufficiently established to enable infants to pick up a raisin and other finger foods. By 11 months the infant has progressed to a neat pincer grasp By 6 months of age infants have increased manipulative skills. They hold their bottle, grasp their feet and pull them to their mouth. By 7 months they transfer objects from one hand to another, use 1 hand for grasping and hold a cube in each hand simultaneously. They enjoy banging objects and will explore the movable parts of a toy. By 10 months of age infants can deliberately let go of an object and will offer it to someone. By 11 months they put object into container and like to remove them. By age 1 year, infants try to build a tower of two blocks but fail.

Gross motor development Gross motor behavior includes developmental maturation in posture, head balance, creeping, sitting, standing and walking. The full-term neonate is born with some ability to hold the head erect and reflex assumes the postural tonic neck position when supine. Several of the primitive reflexes have significance in terms of development of later gross motor skills. Head control: The full term new born can momentarily hold the head in midline and parallel when the body is suspended ventrally and can lift and turn the head from side to side when prone. By 3 months of age infants can hold their head well beyond the plane of the body. By 4 months of age, infants can lift the head and front portion of the chest approximately90 degree above the table. By 4 to 6 months head control is well established. Rolling over Newborns may roll over accidently because of their rounded back. The ability to turn willfully from the abdomen to the back occurs at 5 months of age, and the ability to turn from the back to the abdomen occurs at 6 months. Sitting For the first 2 to 3 months the back is uniformly rounded. By the age of 7 months infants can sit alone, leaning forward on their hands for support. By age of 8 months they can sit well while unsupported and begin to explore their surroundings in this position rather than in a lying position. By 10 months they can maneuver from a prone to a sitting position. Locomotion By 6 to 7 months of age they are able to bear all their weight on their legs with assistance. Crawling, progress to creeping on hands, and knees by 9 months. By 11 months they walk while holding on to the furniture and by age 1 year they may be able to walk with one hand. Motor Quotient (MQ) It is used to assess the infants motor age development. MQ = motor age (MA) -----------------------Chronological age Psychosocial development Developing a sense of trust V/S MISTRUST (Erikson) Eriksons phase 1:- (birth to 1 year) is concerned with a sense of trust while overcoming a sense of mistrust. The trust that develops is a trust of self, of others and of the world. By about 4 months, they learn to smile, coo, and move their arms around when excited. By 5 months, babies show a clear preference for a loved one. In the following months, "separation protest" and "stranger anxiety" are two of the ways babies demonstrate this growing attachment. A close bond provides a foundation for future relationships: babies learn from their parents how to love and how to trust. Infants trust that their feeding, comfort, stimulation and caring needs will be met. The infant and parent must jointly learn to satisfactorily meet their needs inorder for mutual regulation of frustration to occur. When this synchrony fails, mistrust is the eventual outcome. Failure to learn delayed gratification leads to mistrust. Mistrust can either from too much or too little frustration. * 100

Cognitive development This is the process by which babies develop the abilities to learn and remember. Babies begin to recognize and interact with loved ones and start to understand that people and objects still exist even when they are out of sight (object permanence). Sensorimotor phase (PIAGET) The period from birth to 24 months is known as sensorimotor phase and is composed of 6 stages. Stage/ age 1. Use of reflexes Birth 1 month 2. Primary circular reactions 1 to 4 months. Cognitive development Repetitious use of reflexes establishes a pattern of experiences Voluntary activity recognition of causality beginning separation of self from others engages in activity for the pleasure of the activity Intentional activity Object permanence Progressive idea of time, idea of quality and quantity behavior Mostly reflexive Little or no tolerance for frustration Recognizes familiar faces and objects Shows anticipation before feeding Discovers parts of own body Becomes bored when left alone No separation anxiety Secures objects and searches for objects Able to tolerate some frustration Imitates sound and simple gestures. Language development independence in self feeding Actively searches for a hidden object. Comprehends meaning of words and simple commands. Knows that gestures have certain meaning. Able to put objects in a container. Works to get toy that is out of reach. Ventures away from parents to explore surroundings

3.

Secondary circular reactions 4 to 8 months

4.

Coordination of secondary schemas 9 to 12 months

Object permanence advances Associates symbols with events Distinguishes objects from related activity

DEVELOPMENT OF BODY IMAGE The development of body image parallels sensorimotor development. Infants Kinetic and tactile experience are the first perception of the body and the mouth is the principle area of pleasure sensation .other parts of the body are primary object of pleasure-the hands and fingers to suck and the feet to play with. As physical needs are met, they feel comfort and satisfaction with their body. achieving the concept of object permanence is basic to the development of self-image.by the end of the first year infants recognize that they are distinct from their parents At the same time there is increasing interest in the image, especially in the mirror .as motor skills develop they learn that parts of the body are useful. All these achievement transmit messages to them about themselves. Therefore it is important to transmit positive messages to infant about their bodies. DEVELOPMENTOF SEXUAL IDENTITY Freud termed the infant period the oral phase. During infancy the major source of pleasure seeking is centered on oral activities such as sucking, biting, chewing and vocalizing. The oral region or the sensory area of the mouth provides the greatest sensual satisfaction. According to this theory, infants suck for enjoyment or relief of tension as well as for nourishment. One of these activities is preferred by the children over the other and the preferred method can provide some indication of the personality they develop. SOCIAL DEVELOPMENT Infants social development is initially influenced by their reflexive behavior, such as the grasp, and eventually depends primarily on the interaction between them and the principle care givers. Attachment of the parent is increasingly evident during the second half of the first year. In addition, tremendous strides are made in

communication and personal social behavior. Play is a major socializing agent and provides the stimulation needs to learn from interaction with the environment. PLAY From birth to three months infant responses to the environment are global and largely undifferentiated. Play is dependent, pleasure is demonstrated by a guilting attitude a smile .From three to six months infant show more discriminate interest in stimuli and begin to play alone with rattle or someone else. By 4 months of age they laugh aloud, show preference for certain toys, and become excited when food or a favorites object is brought to them. They recognize an image in a mirror, smile at it, and vocalize to it. By 6 months to 1 year play involves sensorimotor skills. at 6 to 8 months, they usually refuse to play with strangers. This represents tremendous advance from the newborn who signaled biologic needs by crying to express displeasure. SOCIAL DEVELOPMENT/LANGUAGE DEVELOPMENT. The infants first means of communication is crying. Crying as a biologic sign conveys a message of urgency and signs of displeasure, such as hunger. During the end of first year infant cry for attention, from fear and from frustration, usually in response to their developing but inadequate motor skills. Vocalization heard during crying eventually becomes labeled and words. Infant vocalize as early as 5 to 6 weeks of age by making small throaty sounds. By 2 months they make a single sound such as ah,eh,g,p and ug. By 9 to10 months they comprehended the meaning of the word no and accompanied by gestures .By age 1yr they can say three to five words with meaning distant as many as 100words GROWTH AND DEVELOPMENT DURING INFANCY: AGE ( mon) 1 PHYSICAL Weight gain:150-210 gm Height gain:2.5 cm /month Head circumference: increases by 1.5 cm Primitive reflexes present strong Dolls eye reflex Dance reflex GROSS MOTOR Flexed position with pelvis high Can turn head from side to side when prone Has marked head lag Holds head momentarily parallel and in midline when suspended in prone position Assumes asymmetric tonic neck reflex position Assumes less flexed position when prone. Less head lag when pulled to sitting position. Can maintain head in same plane as rest of body. FINE MOTOR Hands predominantly closed. Grasp reflex strong. Hand clenches on contact with rattle. SENSORY Visual acuity: 20 / 100.quiets when hears a voice VOCALIZATION Cries to express displeasure. makes small, throaty sounds. Makes comfort sounds during feeding. COGNITION Sensorimotor phase. Use of reflexes. Primary circular reaction.

Posterior fontanel closed. Crawling reflex disappears.

Hands often open. Grasp reflex fading.

3.

Primitive reflexes fading

More erect head holding Only slight head lag. Assumes symmetric body positioning. Regards own hand.

Actively holds rattle. Grasp reflex absent Hands kept loosely open Clutches own hand Pulls at blankets and

Binocular fixation and convergen ce to near objects begins. Turns head to side when sound is made at level of ear. Follows object to periphery. Locates sound by turning

Vocalizes to familiar voice. Vocalizes, distinct from crying

Demonstrates social smile.

Squeals aloud to show pleasure .coos, babbles, and chuckles. Less crying.

Displays considerable interest in surroundings. Ceases crying when parent

clothes

head to side.

Drooling begins. Moro, tonic neck, and rooting reflex have disappeared.

Almost no head lag. Balances head well in sitting position.

Inspects and play with hands. Tries to reach objects with hand but overshoots. Grasp objects with both hand

Beginning signs of tooth eruption Birth weight doubles

6.

Growth rate may begin to decline Weight gain of 90 150 gms. Teething may begin with eruption of two lower central incisors. Chewing and biting may occur.

No head lagging when pulling to sitting position. Able to sit for longer periods Back straight Can turn over from abdomen to back. puts feet to mouth When prone, can lift chest and upper abdomen off surface Sit on high chair with back straight. Rolls from back to abdomen.

Able to grasp objects voluntarily. Uses palmar grasp Plays with toes. Takes objects directly to mouth. Holds one cube while regarding a second one. Rescuers a dropped object Grasp and manipulates small objects. Holds bottle. Grasp feet and pulls to mouth.

Able to accommod ate to near objects. Binocular vision fairly well established . Beginning eye- hand coordinatio n. Visually pursues dropped object. Can localize sounds made below ear. Adjusts posture to see an object. Can localize sound made above an ear. Will turn head to the side, then look up or down. Can fixate on very small objects. Responds to own name Has taste preference s

Makes consonant sounds n, k, g, p, b Laughs aloud Vocalization changes according to mood.

enters room. Show awareness of strange situations. Secondary circular reactions. Enjoys social interaction with people. Anticipates feeding when sees bottle

Squeals. Makes cooing vowel sounds interspersed with consonant sound.

Smiles at mirror image. Discovers parts of body. Is able to discriminate strangers from family. Recognizes parents Begin to fear strangers. Have definite likes and dislikes. Begins to imitate Frequent mood swings.

Begins to imitate sounds. Vocalizes to toys, mirror image. Takes pleasure in hearing own sounds.

Eruption of upper central incisors

Spontaneously lifts head off surface, when supine. Sits, leaning forward on both hands. Sits erect momentarily.

Transfers objects from one hand to another. Holds two cubes Bangs cube on table

Produces vowel sounds and chained syllabusbaba, dada, kaka. Talks when others are talking.

Regular bladder and bowel elimination. Parachute reflex appears.

Sits steadily unsupported Readily bears weight on legs when supported. Adjust posture to reach an object.

Has beginning pincer grasp using index, fourth and fifth fingers against lower part of thumbs. Releases objects at will Rings bell purposefully.

Makes consonant sounds. Listens selectively to familiar words.

Increasing fear of strangers. Imitates simple acts and noises Tries to attract attention by coughing, or snorting. Increasing anxiety over loss of parents and fear of strangers. Respond to word no Dislikes dressing, diaper change

Eruption of upper later incisors may begin.

Creeps on hands and knees. Sits steadily on floor pulls self to standing position

Uses thumb and index finger in crude pincer grasp Preference for use of dominant hand Grasp third cube

Localize sounds by turning head diagonally and directly toward sound. Depth perception increasing

Responds to simple verbal commands Comprehends no no.

Parent is increasingly important for own sake Shows increasing interest in pleasing parents.

10

Labyrinth- righting reflex

Can change from prone to sitting position Stands while holding on to furniture Sits by following down Recovers balance easily while sitting While standing, lifts one foot to take a step.

Crude release of an object beginning. Grasp bell by handling

Says dada ,mama with meaning May say one word.

Imitates facial expressions Waves byebye Develops object permanence. Looks at and follows pictures in a book. Pulls clothes of another to attract attention.

11

Eruption of lower lateral incisor may begin

When sitting, pivots to reach toward back to pick up an object.

Explores objects more thoroughly Has neat pincer grasp Drops object deliberately for it to be picked up Puts one object after another in a container. Able to manipulate an object to remove it from tight- fitting enclosure.

Imitates definite speech sounds

12

Birth weight tripled. Birth length increased by 50% Head and chest circumference equal. Anterior fontanel almost closed Babinski reflex disappears Lumbar curve develops. lordosis evident during walk

Walks with 1 hand held May attempts to stand alone. Can sit down from standing position without help.

Releases cube in cup. Attempts to build two block tower but fails Tries to insert a pellet into a narrow necked bottle but fails. Can turn pages in a book, many at a time

Discriminat es simple geometric forms. Can follow rapidly moving objects

Says 3-5 words Recognizes objects by name Imitate animal sounds. Understands simple verbal commands

Experiences joy and satisfaction when a task is mastered. Reacts to restrictions with frustrations. Rolls balls to another on request. Plays game up- down Shakes head for no Shows emotions such as fear, anger, affection. Enjoys familiar surroundings and explores away from parents. Is fearful in strange situations; cling to

parents. May develop habit of securely blanket or favorite toy. Searches for an object even if it has not been hidden, only where object was last seen.

CONCLUSION: An understanding of infant growth and development patterns and concepts is necessary for parents and caregivers to create a nurturing and caring environment which will stimulate young children's learning. The growth and development of infants are periods of rapid change in the child's size, senses, and organs. Each change brings about new abilities. Caregivers can provide activities and opportunities for infants that encourage exploration and curiosity to enhance children's overall development. ASSIGNMENT: What are the various reflexes that can be elicited in a 2 month old baby and how? EVALUATION CRITERIA: TOTAL: 10 MARKS Introduction 2 Content 4 Organisation-2 Bibliography-1 Neatness -1

Bibliography: th 1. Hockenberry, Wilson. Wongs-Nursing care of Infants and Children. 8 edi. Mosby Elsevier; St. Louis; Missouri. 2007 th 2. Marlow Dorothy R, Redding Barbara A. Textbook of Pediatrics. 6 edi. Mosby; Elsevier; 3. Pilliteri Adele. Child health nursing-Care of Child and Family. Lippincott; Philadelphia. 1999. 4. Basavanthappa BT. Pediatric Child Health Nursing. Ahuja Publication house; new delhi. th 5. Ghai O.P. Essentials of paediatrics. 6 edi. CBS publishers; New Delhi. 2004