```INFANCY
1
The First Year of Life



Time of rapid growth and
development.
Growth in the first year is
extremely rapid.
It occurs in spurts, called saltatory
growth.
2
Infant Weight

At birth: 2.7 – 4.0 kg









At 5 months: 2X birth weight.
At 12 months: 3 X birth weight.
At 2 years: 4 X birth weight.
At 3 years: 5 X birth weight.
At 5 years: 6 X birth weight.
At 7 years: 7 X birth weight.
At 8 years: 8 X birth weight.
At 9 years: 9 X birth weight.
At 10 years: 10 X birth weight.
3
Weight Gain






AGE
0-3 months:
3-6 months:
6-9 months:
9-12 months:
1-3 years:
3-6 years:
(per day)
WEIGHT GAIN
30 g/day
20 g/day
15 g/day
12 g/day
8 g/day (2.8kg/yr)
6 g/day (2 kg/yr)
4
Weight Gain






AGE
0-3 months:
3-6 months:
6-9 months:
9-12 months:
1-3 years:
4-6 years:
(per month)
WEIGHT GAIN
900 g
600 g
450 g
360 g
240 g/month(2.8 kg/yr)
180 g/month (2 kg/yr)
5
Formula For Weight



During Infancy
WT (Kg) = [ Age (months) +9] /2.
During 2-6 Years
WT (Kg) = Age (yrs) X 2+ 8.
During 7-12 Years
WT (Kg) = [Age (yrs) X 7-5] /2.
6
Length/ Height


Supine length is measured
for children of less than two
years of age.
After two years of age,
standing height is taken as
a measure of stature.
7
Length

At Birth:




At
At
At
At
birth: 48 – 53 cm
one year = 75 cm.
two years = 87.5 cm.
four years = 100 cm.
8
Length Gain






AGE
0-3 months:
3-6 months:
6-9 months:
9-12 months:
1-3 years:
3-6 years:
GAIN
3.5 cm/ month
2 cm / month
1.5 cm/ month
1.2 cm/ month
1 cm/month(12 cm/yr)
0.25 cm/month (3 cm/yr)
9
Gain In Length





1st year = 25 cm
2nd year = 12 cm
3rd year = 10 cm
4th year = 3 cm
At puberty:


Girls = 6-11 cm
Boys= 7-12 cm
10
Formula for Calculating Height
From 1- 6 Years
Height (cm) = Age (Yrs) X 6 + 77
11



At birth: 35.3 ± 1.2 cm.
Increases by 6 cm during
the first 3 months.
Further increases by
another 6 cm during 3- 12
months.
12
Gain in head circumference




During 1st year = 12 cm.
During 2nd year = 2 cm.
During 3rd year = 1.5 cm.
From 3 to 14 years = 2.5 cm
13
Changes in head circumference





AGE
0-3 months:
3-6 months:
6-12 months:
1-3 years:
3-6 years:
GAIN
2 cm/ month
1 cm / month
0.5 cm/ month
0.25 cm/month
1 cm/year
14
VISION





An infants vision is
at first, visual acuity
20/100-20/400
Within a week they can focus on objects that are
15-30 cm away
Binocularity: fixation of two ocular images into one
cerebral picture begins to develop by 6 weeks and
established by 4 months.
Lack of binocular vision results in strabismus
Have visual preference for looking at the human
face
15
Vision




Depth perception (stereopsis) begins in the 2nd – 3rd
month, well developed by age 7 months.
What is Depth Perception?
Recognizing that an object is three-dimensional, not flat.
With this improved vision they develop hand-eye
coordination.
Why is the development of hand eye coordination
important?
Important for skills such as eating, catching, coloring,
tying shoes, etc
16
Hearing

Birth:



8-12 weeks:


Turns head to side when sound is made
at level of ear
>12 weeks:


Responds to loud noise by startle or
Moro
Responds to sound of human voice more
readily than to any other sound
Locates sound by turning head
to side and then looking up or down
24-32 weeks:

Responds to own name
17
Smell and Taste




The sense of smell does not develop
much before birth because baby is
surrounded by amniotic fluid until
birth.
Within 10 days they can distinguish the
smell of their mother from another
person.
The sense of taste develops rapidly.
During the 1st year, babies learn about
the world through their mouth, putting
everything in sight in it.
Parents need to make sure the objects
are clean, not too small, and without
edges.
18
Development During the First
Year
Teeth
 Development of the baby’s teeth usually begin about
the 6th week of pregnancy
 The first baby teeth appear at about 6 or 7 months
(primary teeth).
 Teething often causes pain and swelling and makes
for a cranky baby
19
Language Acquisition




Cooing: Repetition of vowel sounds
by infants
Babbling: Repetition of
meaningless language sounds
(e.g., babababa)
Single-Word Stage: The child says
one word at a time
Telegraphic Speech: Two word
sentences that communicate a
single idea (e.g., Want yogurt)
20
Language development
12 weeks cooing, smiles
when talked to
16 weeks turns head in
response to human voice
20 weeks makes vowels and
consonant sounds
6 months babbling (all
sounds)
8 months repeat certain
syllables (ma-ma)
12 months understands and
says some words
21
Psychosocial development



Erik Erikson: First
Psychosocial Stage:
Trust vs. Mistrust
Consistent loving care
by a mothering person
is essential to build a
trust relationship.
Mistrust develops
when basic needs are
inconsistently met.
22
Piaget’s Cognitive Stages
23
Sensorimotor Stage (0-2)

Stage One (birth-1 mo.)
•

Stage Two (1 - 4 mos.)
•

Use of reflexes
Primary circular reactions: Actions that are at first
random and activate a reflex are attempted again to try and
induce the experience again (recognition of causality). The
interesting events are occurring within the body (plays with
hands, fingers, feet).
Stage Three (4 - 8 mos.)
•
Secondary circular reactions: The interesting events in
this case are located in the external world (Making
Interesting Sights Last)
•
•
Beginning of object permanence: shows separation anxiety
Able to imitate selective activity
24
Infants’ imitation of facial expressions
25
Sensorimotor Stage, Cont’d

Stage Four (8 - 12 mos.)
•
•
•
•
Coordination of
secondary schemata
Anticipation
Intentionality occurs in
interactions with the
environment and the infant
is moving towards goal
directed behavior: works to
get toy that is out of reach
Fully developed object
permanence
26
Moral development (Kohlberg)


Level 1: Preconventional morality (0-9y)
Stage 1: the punishment-and-obedience
orientation.



Children determine the goodness or badness of an
action in terms of its consequences.
They avoid punishment and obey unquestioningly
those who have the power to determine and
enforce the rules
They have no concept of the underlying moral
order
27
Play
•
Solitary Play: When a
child plays alone even
when with other
children
28
Principles of Motor Development


Gross movements before fine
movements
Pattern of development is usually the
same, but the rate differs greatly from
child to child and from culture to
culture.
29
2-3 months
30
Gross Motor Development

First Month




Second month


Turns head to clear nose from bed
Keeps hands fisted or slightly open
Head lag when pulled from lying to sitting
Holds head up while on tummy almost 45
degrees
Third month



Lift head and chest of the bed
Turns head to sounds
Reaches for objects with both hands
31

Fourth month



Fifth month




Rolls from back to side
Able to raise head and chest off surface to
angle of 90 degrees
Rolls from abdomen to back
May sit if supported
When supine, puts feet to mouth
Sixth month



Transfer toy from one hand to next
army crawl on tummy
Rolls from back to abdomen
32

Seventh month




Eighth month




Pushes up on hands and knees
Sits w/ little support
When held in standing position
bounces actively
Sit without support
Creeps
Stands leaning against
something
Ninth month

May crawl upstairs
33

Tenth month



Eleventh month


Stands w/ little support
Cruises the room.
Stands alone
Twelfth month

Walks
34
Fine Motor Behavior






At 4 month: brings hands together and shake
rattle.
At 6 month: palmer grasp.
At 7 month: pass object from hand to
another.
At 8 month: advanced eye-hand coordination.
At 10 month: pincer grasp.
at 12 month: holds cup or spoon
35
36
Hematologic System
Hgb A production
largely replaces Hgb F
by 4 months
(physiologic anemia
due to fetal RBCs
destruction)
37
Respiratory System


RR slows.
Upper respiratory infections tend to be
more severe due to small lumen of
respiratory tract and inefficient mucus
production.
38
Immune System


Become
functioning at 2
months.
Produce both IgG
& IgM antibodies
by the first year.
39
Emotional





At 6 weeks: social smile.
At 4 months: recognize his primary
caregiver.
At 7-8 months: stranger anxiety,
continue until 12 months.
At 8 months: separation anxiety,
continue until preschool period.
Both are related to infant’s ability to
discriminate between familiar and
nonfamiliar people
40
Dentation



First tooth erupt 5-7 months
Has 6-8 deciduous teeth by the first
year of age.
The sequence of eruption is:




At
At
At
At
6
7
8
9
months:
months:
months:
months:
lower central incisors.
lower lateral incisors.
upper central incisors.
upper lateral incisors.
41
42
GI System






Can digest protein at birth.
Amylase deficiency until 3rd month of
age ( cannot digest complex CHO)
Lipase deficiency during entire 1st year.
Infant needs frequent feedings.
Extrusion reflex exists until 3-4 months.
Introduction of solid food 4-6 months.
43
Energy Requirement
Age
< 6 months
6mo-1 year
Energy requirement
Wt (kg) x 108/ day
Wt (kg) x 98/ day
44
Water requirements = amt in
foods + fluids






Age
Amount
3 days
80-100 ml/kg/day
10 days
125-150 ml/kg/day
3 mo
140-160 ml/kg/day
6 mo
130/155 ml/kg/day
9 mo
125-145 ml/kg/day
With BF and formula: none additionally
needed in first 4 to 6 months
45
Infant Nutrition
Birth through 4-6
months
 Breast milk
OR
 Iron-Fortified infant
formula
46
Breast- Versus Bottle-Feeding



Debate focused on whether breast-feeding is better for
the infant than bottle-feeding
American Pediatric Association strongly endorses breastfeeding throughout the first year of life
Benefits






Appropriate weight gain
Fewer allergies
Fewer illnesses
Reduced childhood cancer and reduced incidence of breast
cancer in mothers and their female offspring
Lower incidence of SIDS
Stronger attachment bond
47
Infant Nutrition
4 through 7 months
 Breast milk
OR
 Iron-Fortified infant formula
 Iron-Fortified infant cereal
 Vegetables
 Fruit
48
Infant Nutrition
8 through 11 months
 Same as 4 through 7 months
PLUS
 Meat
 Egg yolks
49
Infant Nutrition
11 months
 Finger foods
 Cup
50
Tips for Introduction of
Solid Foods
 Start slowly
 Only 1 new food every 4-5 days
 Hold baby during feeding
 First food: Iron-Fortified infant
rice cereal
51
Tips for Introduction of
Solid Foods
 Use single-ingredient foods
 Read food labels
 Avoid desserts
 Avoid foods that can choke
infants
52
Feeding Problems

Colic (<3months): gas production, and bloating



Cause? Not always known: formula fed! (high in
carbohydrate)
Overfeeding : swallowing too much air.
Breastfeeding?



Foods in the mother’s diet
Cow’s milk, or other items
Spitting up


Normal occurrence: after meals, mouthful of milk.
Unless projectile vomiting: Organic problem: pyloric
sphincter closure
53
Common Health Concerns





Teething: gum sore, tender can lead to
decreased intake and cry.
Thumb sucking: does not deform the jaw as
long as it stops by school-age.
Diaper dermatitis: prolong contact with urine or
feces.
Constipation: increased with formula fed.
Sleep problems: as a result of colic or other
health problems.
54
```