Infant to Toddler

Infant Through Preschool

Stages of Growth and Development

• Human growth and development are continuous and complex.
• Stages are typically organized by age groups.
• Growth and development are based on timing and sequence of developmental tasks.

Physical Changes

Size Increases Rapidly

Growth Pattern

Reflexes

Feeding

Play

Vital Signs

Infant: 1 month to 1 year of age

Cognitive Changes

• Sensorimotor stage

• Continued development of sight, hearing, and touch
• Memory and language development

Psychosocial changes

• Erikson’s: Trust vs Mis Trust
• Separation and individuation
• Play (what kind of play)

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Health Risks

• Injury prevention

• Sudden infant death syndrome

• Child maltreatment

Nutrition

Teeth

Health Promotion

Sleep

Language Development

Immunizations

NCLEX ?

A mother has brought her 6-month-old infant in for a well-child check. Which of her statements indicates a need for further teaching?

1. “I can start giving her whole milk at about 12 months.” 2. “I can continue to breastfeed for another 6 months.” 3. “I can give her plenty of fruit juice to increase her vitamin intake.” 4. “I can start giving her solid food now, introducing one food at a time.”

TODDLER

12 TO 36 MONTHS OF AGE

PHYSICAL CHANGES

DIET

SLEEP

TOILETING

Vital Signs

Toddler: 12 to 36 months of age

Cognitive Changes

Psychosocial Changes

• Memory, language
• “No” becomes their favorite word

• Erikson’s developmental stage
• Intense personality and emotional reactions causing change in mood
• Sibling Rivalry

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Play

• Parallel play

Health Risk

MVC

Drowning

Poisoning

Car seat positioning is KEY

PREVENTION

Call POISON CONTROL

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Health Promotion

Teeth

Toilet Training

Nutrition

Immunizations

First water, then toothpaste

• Mental Readiness
• Psychologic readiness
• Parental Readiness

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Physical anorexia Self-feeding Picky eater

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Temper Tantrums

Approach with consistency and developmentally appropriate expectations and rewards. Consistency among caregivers Prioritiz what rules are important Develop consequences based on developmental level TEMPER TANTRUMS ARE NORMAL

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Temperament

• “"the manner of thinking, behaving, or reacting characteristic of an individual”
• the way in which a person deals with life
• Attributes of Temperament (Box 28.2 pg 696)

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• Gross motors skills involve larger muscle activities such as:
• 2 months of age: turning their head from side to side
• 4 months: holding the head up
• learning to sit
• eventually stand and walk.
• Fine-motor mvmnts are more difficult to achieve:
• Graasping a rattle with the whole hand comes first
• 8-9 months they should advance to being able to grab things with their thumb and index finger
• 11 months they have the control and the ability to put things in containers and enjoy removing them.
• 1 year they should be able to start building towers or stacking things (with failure)

Livia 4 months

Solitary Play

When a child plays alone without interacting with others.

• Feeding should be with a nipple, utilizing appropriate flow rates to prevent aspiration
• Breastmlk or formula is the primary source of nutrients until 1 year
• When extrusion reflex as disspeared, it is now safe to start introducing solid food.

Attributes of Temperament

Pg 696 MCNC Box 28.2

• Activity: Level of physical motion during activity, such as sleep, eating, play, dressing, and bathing
• Rhythmicity: Regularity in the timing of physiologic functions, such as hunger, sleep, and elimination
• Approach-withdrawal: Nature of initial responses to a new stimulus, such as people, situations, places, foods, toys, and procedures (Approach responses are positive and are displayed by activity or expression; withdrawal responses are negative expressions or behaviors.)
• Adaptability: Ease or difficulty with which the child adapts or adjusts to new or altered situations
• Threshold of responsiveness (sensory threshold): Amount of stimulation, such as sounds or light, required to evoke a response in the child
• Intensity of reaction: Energy level of the child’s reactions regardless of quality or direction
• Mood: Amount of pleasant, happy, friendly behavior compared with unpleasant, unhappy, crying, unfriendly behavior exhibited by the child in various situations
• Distractibility: Ease with which a child’s attention or direction of behavior can be diverted by external stimuli
• Attention span and persistence: Length of time a child pursues a given activity (attention) and the continuation of an activity despite obstacles (persistence)

Piaget's Theory

Sensorimotor ----> Preoperational

Object Permance Advances: still cannot find an object BUT increasingly aware of the existence of objects behind closed doors, in drawers, and under tables. (THEY WANT TO FIND IT) Parents need to be aware of this developmental achievement and find high places and locked cabinets the only places that are inaccessible to toddlers.

Preoperational Thought Egocentric: Inability to envision situations from perspectives other than one’s own; Inability to put self in another's place Magical thinking: Believing that thoughts are all-powerful and can cause events.

• They start imitating their parents, particularly the same sex parent.

Growth slows down

Fine-motor movements

• demonstrated in increasingly skillful manual dexterity
• can grasp a very small objects
• they can drop a raisin into a narrow-necked bottle
• throw objects and retrieve them

Gross-motor movements

• LOCOMOTION
• Walking
• Running
• Jumping
• Standing on one foot
• Tip toeing

Autonomy vs Shame

• Children develop a sense of independence and personal control over their physical skills
• Example:
• A child learning to potty train may feel a sense of autonomy when they successfully go to the bathroom on their own. However, they may experience shame and doubt if they have an accident.

• To promote autonomy:
• Use “I” messages rather than “you” messages to communicate thoughts, feelings, expectations, or beliefs without imposing blame or criticism
• Emphasize that the act, not the child, is bad.

Sibling Rivalry

• A natural jealousy and resentment toward a new child in the family or toward other children in the family when a parent turns his or her attention from them and interacts with their brother or sister.

• The average newborn is 2700 to 4000 g (6–9 lb), is 48 to 53 cm (19–21 inches) in length,
• Birth weight doubles in approximately 5 months and triples by 12 months.
• Height increases an average of 2.5 cm (1 inch) during each of the first 6 months and about 1.2 cm (½ inch) each month until 12 months

12 month old

24 hours old

6.6 lbs

19 lbs

Imitative Activity

• Clapping
• Patting a doll
• Peek-a-boo

Simple Repetitive Acts

• Sucking thumb
• opening/closing fingers
• arching their back
• Babbling

Reflexive Behavior

• Rooting Reflex
• Sucking Reflex
• Grasping Reflex
• Moro reflex

Prevention

Keep things locked up! If child is awake and breathing, CALL POISON CONTROL , before 911.

Object Permanence

• The second major accomplishment is achieving the concept of object permanence.
• The realization that objects that leave the visual field still exist

Are they ready???

Mental readiness

• Recognizes urge to defecate or urinate
• Verbal or nonverbal communicative skills to indicate when wet or has urge to defecate or urinate
• Cognitive skills to imitate appropriate behavior and follow directions

Psychologic readiness

• Expresses willingness to please parent
• Able to sit on toilet for 5 to 8 minutes without fussing or getting off
• Curiosity about adults’ or older sibling’s toilet habits
• Impatience with soiled or wet diapers; desire to be changed immediately

Parental readiness

• Recognizes child’s level of readiness
• Willing to invest the time required for toilet training
• Absence of family stress or change, such as a divorce, moving, new sibling, or imminent vacation

ONLY YOU CAN PREVENT ECC!

Early Childhood Carries

A special form of tooth decay in children between 18 - 36 months. WAYS TO PREVENT

• feed last bottle before bedtime
• substitute a botle of water for milk/ juice
• DO NOT use a bottle as a pacifier
• NEVER coat pacifiers with sweet substances

Sleep

• Total sleep decreases only slightly during the second year
• averages about 11 to 12 hours a day.

• Toddlers are more prone to having bedtime resistance (refusal to go to bed) and frequent night waking.
• Consistent bedtime routines are best to avoid temper tantrums

Child maltreatment

• Highest amongst this age range
• Shaken baby syndrome
• Is it SUS???

Trust vs Mistrust

• When infants are not provided a safe haven and consistent and loving care, an insecure attachment develops; such infants do not feel they can trust the world in which they live. This insecure attachment may result in MISTRUST.
• Insecure attachment may also exist in homes where there is domestic violence and maternal postnatal depression.

Separation and individuation

• Between 4 and 8 months old, infants progress through the first stage of separation-individuation
• While in the hospital setting, to minimize additional stress to the childs psychosocial changes

Dental

• Dental visits should start as early as 6 months.
• Prevent ECC (Early childhood carries)
• Anticipatory Guidance

Sleep

• Sleep will vary
• Sleep through the night at 3-4 months
• Requie less sleep during the day the closer

Daily Sleep

• 2 month old: avg 15 hours
• 6-12 month: avg 13 hours

SIDS

Defined as the sudden death of an infant younger than 1 year of age that remains unexplained after a complete postmortem examination (autopsy), including an investigation of the death scene and a review of the case history.

Risk Factors

• Maternal smoking
• Co-sleeping
• Prone sleeping
• Cardiac arrhythmias
• soft bedding
• Low birth weight or preterm birth (<37 weeks)
• Low Apgar scores
• Recent viral illness
• • Siblings of two or more SIDS victims
• Male gender
• Infants of American-Indian or African-American ethnicity

Toileting

• Voluntary control of the anal and urethral sphincters is achieved sometime after the child is walking.
• Between 18-24 months

Physical Readiness

• Voluntary control of anal and urethral sphincters, usually by 24 to 30 months old
• Ability to stay dry for 2 hours; decreased number of wet diapers; waking dry from nap
• Regular bowel movements
• Gross motor skills of sitting, walking, and squatting
• Fine motor skills to remove clothing

Diet

• Physiologic anorexia
• Able to feed self with finger foods
• Picky eater
• 1 T. solid food per year of age for EVERY meal (ex. a 2 year would need 2 T. of solid food for each meal)

Nutrition

• Breast is best OR formula
• Solid food when extrusion reflex is absent
• No honey
• One food at a time

(pg. 810 in the MCNC "Feeding During the First Year")

Language Development

• Infants proceed from crying, cooing, and laughing to imitating sounds, comprehending the meaning of simple commands, and repeating words with knowledge of their meaning.
• As a nurse, you promote language development by encouraging parents to name objects on which their infant’s attention is focused.
• Reading books to the infant will help with language development.