THE INFANT AND FAMILY

GROWTH AND DEVELOPMENT OF

THE INFANT
Freud’s Psychosexual Theory
INFANT
 Psychosexual stage: oral stage
 Characteristics:
 Mouth is the center of pleasure (major source of
gratification and exploration).
 Security is primary need.
 Major conflict: Weaning away from mother’s breast
 Nursing implications:
 Feeding produces pleasure & sense of comfort and safety.
 Feeding should be pleasurable and provided when
required.
 Provide oral stimulation by:

1. giving pacifiers
2. do not discourage thumb-sucking
3. Breastfeeding may provide more stimulation than
formula feeding because it requires the infant to expend
more energy.
Erikson’s theory of Psychosocial
Development
 Developmental Task: Trust vs. Mistrust. Child learns to love
and be loved.
 Nursing Implications:
1. Consistent, predictable, reliable and affectionate care is
received; characterized by hope.
2. Deficient, inconsistent care produces an unfavorable outcome
at this stage.
3. Provide a primary caregiver
4. Provide experiences that add to security, such as soft sounds
and touch.
5. Provide visual stimulation for active child involvement.
PIAGET’S COGNITIVE DEV’T.
SENSORIMOTOR(BIRTH TO 2 YEARS)
 Neonatal reflex
 Age span – 1 month
 Nursing implications:
o Stimuli are assimilated into beginning mental images.
Behavior entirely reflexive.
SENSORIMOTOR

 Primary Circular Reaction

 Age span: 1-4 months
 Nursing Implications:
o Hand-mouth and ear-eye coordination develop. Infant
spends much time looking at objects and separating self
from them.
o Beginning intention of behavior is present (the infant
brings thumb to mouth for a purpose: to suck it).
o Enjoyable activity for this period: a rattle or tape of
parent’s voice.
SENSORIMOTOR
 Secondary circular reaction
 Age span : 4-8 months
 Nursing Implications:
o Infant learns to initiate, recognize, and repeat pleasurable
experiences from environment.
o Memory traces are present
o Infant anticipates familiar events (a parent coming near
him will pick him up).
o Good toy for this period: mirror
o Good game: peek- a-boo
SENSORIMOTOR

 Coordination of secondary reactions

 Age span: 8-12 months
 Nursing Implications:
o Infant can plan activities to attain specific goals.
o Perceives that others can cause activity and that activities of
own body are separate from activity of objects.
o Can search for and retrieve toy that disappears from view.
o Recognizes shapes and sizes of familiar objects.
o Because of increase sense of separateness, infant experiences
separation anxiety when primary caregiver leaves.
o Good toy for this period: nesting toys like colored boxes.
BIOLOGIC DEVELOPMENT
 Physical changes and developmental
achievements so dramatic during infancy.
 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.
 Acquisition of these fine and gross motor skills
occurs in an orderly sequence head-to-toe and
center-to-periphery (cephalocaudal and
proximodistal) sequence.
PROPORTIONAL CHANGES
 During the first year growth is very rapid, especially
during the initial 6 months.
 Infants gain 150 to 210 grams (5 to 7 ounces) weekly
until approximately age 5 to 6 months.
 An average weight for a 6-month-old child is 7.26
kg(16 pounds).
 Weight gain slows during the second 6 months.
 By 1 year of age the infant’s birth weight has tripled,
for an average weight of 9.75kg (21.5 pounds).
 Infants who are breastfed beyond 4 to 6 months of age
typically gain less weight than those who are bottle-
fed.
HEIGHT
 Height increases by 2.5cm (1 inch) a month
during the first 6 months and also slows during
the second 6 months.
 Average height is 65cm at 6 months and 74cm
at 12 months.
 By 1 year the birth length has increased by
almost 50%. This increase occurs mainly in the
trunk, rather than in the legs, and contributes to
the characteristic physique of the infant.
HEAD GROWTH
 Head growth is rapid
 During the first 6 months head circumference increases
approximately 1.5cm a month but decreases to only 0.5
cm monthly during the second 6 months.
 The average size is 43cm (17 inches) at 6 months and
46cm(18 inches) at 12 months.
 By 1 year, head size has increased by almost 33%.
 Closure of the cranial sutures occurs, with the posterior
fontanel fusing by 6 to 8 weeks of age and anterior
fontanel closing by 12 to 18 months of age (the average
age being 14 months.)
 Expanding head size reflects the growth and
differentiation of the nervous system.
 By the end of the first year the brain has increased in
weight about 2 ½ times.
 Primitive reflexes are replaced by voluntary, purposeful
movement, and new reflexes that influence motor
development appear.
CHEST
 The chest assumes a more adult contour, with the lateral
diameter becoming larger than the anteroposterior diameter.
 The chest circumference approximately equals the head
circumference by the end of the first year.
 Heart - grows less rapidly than does the rest of the body.
 - weight is usually doubled by 1 year of age; in
 comparison, body weight 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 organ systems also change and grow
during infancy.
 The RR slows somewhat and is relatively stable .
 Respiratory movements continue to be
abdominal.
Factors that predisposes the infant to more
severe and acute respiratory problems.
 1. The close proximity of the trachea to the bronchi
and its branching structures rapidly transmits
infectious agents from one anatomic location to
another.
 2. The short, straight eustachian tube closely
communicates with the ear, allowing infection to
ascend from the pharynx to the middle ear.
 3. the inability of the immune system to produce IgA
in the mucosal lining provides less protection against
infection in infancy than during later childhood.
HR & BP
 The heart rate slows and the rhythm is often sinus
arrhythmia (i.e., rate increases with inspiration and
decreases with expiration).
 Systolic pressure rises during the first 2 months as a
result of the increasing ability of the ventricle to pump
blood into the systemic circulation.
 Diastolic pressure decreases during the first 3 months,
then gradually rises to values close to those at birth.
 Fluctuations in BP occur during varying states of activity
and emotion.
HEMATOPOIETIC CHANGES
 Fetal hemoglobin is present for the first 5 months, with
adult hemoglobin steadily increasing through the first half
of infancy.
 Fetal hemoglobin results in a shortened survival of RBC
and thus a decreased number of RBCs resulting to
physiologic anemia. High levels of HgbF are thought to
depress the production of erythropoietin, a hormone
released by the kidney that stimulates RBC production.
 Maternal iron stores are present for the first 5-6 months
and gradually diminish, which also accounts for lower
hemoglobin levels toward the end of the first 6 months.
 The occurrence of physiologic anemia is not affected by
an adequate supply of iron. However when erythropoiesis
is stimulated, iron supplies are necessary for the formation
of hemoglobin.
Digestive Processes
 The digestive processes are immature at birth.
 Saliva is secreted in small amounts, but the majority of the
digestive processes do not begin to function until age 3
months, when drooling is common because of because of
the poorly coordinated swallowing reflex.
 The enzyme ptyalin (amylase) is present in small amounts
but usually has little effect on the foodstuffs because of
the small amount of time the food stays in the mouth.
 Secretion of pancreatic enzyme amylase which is needed
for digestion of complex carbohydrates, is deficient until
about the 4th to 6th month of life.
 Lipase is also limited, and infants do not achieve adult
levels of fat absorption until 4-5 months of age.
 Trypsin is secreted in sufficient quantities to catabolize
protein into polypeptides and some amino acids.
 Solid foods are passed incompletely broken down in the
feces. An excess quantity of fiber easily disposes the
child to loose, bulky stools.
 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 3
meals a day and an evening bottle and may have one or
two BM daily.
 With any type of gastric irritation, however, the infant is
vulnerable to diarrhea, vomiting and dehydration.
 The liver is most immature of all the GI organs throughout
infancy.
 The ability to conjugate bilirubin and secrete bile is
achieved after the first couple of weeks of life.
 The capacities of gluconeogenesis, formation of plasma
protein and ketone, storage of vitamins and deaminization
of amino acids remain relatively immature for the first
year of life.
 Maturation of suckling, sucking, and swallowing reflexes
and the eruption of teeth parallel the changes in the GI
tract and prepare the infant for the introduction of solid
foods.
Immunologic System
 IS undergoes numerous changes during the first year.
 IgA is present in large amounts in colostrum; this is
believed to have a protective role in the GI tract against
many bacteria such as E. coli and viruses.
 The function and quantity of T-lymphocytes,
lymphokines, and complement is reduced in early infancy,
thus preventing optimal response to certain bacteria and
viruses.
 The full term newborn receives significant amounts of
maternal IgG, which for approximately 3 months confers
immunity against antigens to which the mother was
exposed.
 During this time the infant begins to synthesize IgG;
approximately 40% of adult levels are reached by 1 year
of age.
 Significant amounts of IgM are produced at birth and
adult levels are reached by 9 month of age.
 The production of IgA, IgD, IgE is much more gradual,
and maximum levels are not attained until early
childhood.
 Thermoregulation becomes more efficient during infancy.
 The ability of the skin to contract and of muscles to shiver
in response to cold increases.
 The peripheral capillaries respond to changes in ambient
temperature to regulate heat loss.
 Increased adipose tissue during the first 6 months
insulates the body against heat loss.
 A shift in the total body fluid occurs.
 At birth 75% of the terms infant’s body weight is water,
and there is excess of ECF.
 As the percentage of body water decreases, so does the
ECF- from 40% at term to 20% in adulthood.
 The high proportion of ECF, which is composed of blood
plasma, interstitial fluid and lymph, predisposes the infant
to a more rapid loss of total body fluid, and consequently,
dehydration.
 The immaturity of the renal structures also predisposes the
infant to dehydration.
 Complete maturity of the kidney occurs during the latter
half of the second year, when the cuboidal epithelium of
the glomeruli becomes flattened.
 Before this time the filtration capacity of the glomeruli is
reduced.
 Urine is voided frequently and has a low specific gravity.
 Auditory acuity is at adult levels during infancy.
 Visual acuity begins to improve, and binocular fixation is
established.
 Binocularity, or the fixation of two ocular images into one
cerebral picture (fusion), begins to develop by 6 weeks of
age and should be well established by age 4 months.
 Depth perception(stereopsis) begins to develop by age 7 to
9 months but may exist earlier as an innate safety
mechanism against accidental falling.
Temperament
 Temperament is a child’s way to interact with the
surrounding environment.
 Children are thought to be genetically endowed with
specific temperamental characteristics, which, when
combined with the caregivers personality, produce a
characteristic pattern of social interaction between the
child and the environment.
Categories:
1. activity- intensity and frequency of physical activity.
 2. rhythmicity- regularity of repetitive physiological
functions, i.e, sleep cycle, eating patterns, elimination
patterns.
 3. approach-withdrawal – initial reaction to a given
stimulus like people or situations.
 4. adaptability- ease or difficulty with which the child
reacts or adapts to a given stimulus.
 5. intensity of response – degree of energy used by the child
to react to stimulus.
 6. threshold of responsiveness – amount of stimulation
needed to evoke a child’s response.
 7. mood- amount of happiness versus unhappiness or
pleasant/friendly behavior versus unpleasant/unfriendly
behavior exhibited in various situations.
 8. distractibility – effectiveness of the stimulus to alter the
direction of the ongoing behavior.
 9. attention span and persistence – length of time the child
pursues an activity and the continuation of an activity
despite the obstacles.
Personality type
 Easy – easygoing and adapts rapidly to stimuli, has an
overall positive mood, likes to respond to be around
people, sleeps and eat well, has regular and predictable
behaviors.
 Difficult- adapts slowly to stimuli, has an overall negative
mood, requires a structures environment, likes people but
do well alone, seems to be in constant motion, has
irregular patterns of behavior.
 Slow to warm-up – adapts slowly to stimuli but is
watchful, quietly withdraws and usually moody, primarily
a loner and socially shy, oversensitive and slow to mature,
primarily inactive, reacts passively to change in routine.
Fine Motor Development
 Grasping occurs during the first 2-3 months as a 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 (using the whole hand) is
replaced with a pincer grasp (using the thumb ans index
finger.)
By 6 months of age, infants have increased manipulative skill:
hold their bottle, grasp their feet and pull them to their mouth,
and feed themselves a cracker.
By 7 months they transfer objects form one hand to the other,
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 the pincer grasp is sufficiently established
to enable infants to pick up a raisin and other finger foods.
They can deliberately let go of an object and will offer it to
someone.
By 11 months they put objects into a container and like to
remove it.
By 1 year, infants try to build a tower of two blocks but fail. Can
turn pages in a book, many at a time.
Gross motor development
 Gains head control by 4 months
 Rolls from back to side by 4 months
 Rolls from abdomen to back from 5 months
 Rolls from back to abdomen by 6 months
 Sits alone without support by 8 months
 Stands holding furniture by 9 months
 Crawls (may go backward initially) by 10 months
 Creeps with abdomen off floor by 11 months
 Cruises (walking upright while holding furniture) by 10-12
months
 Can sit down from upright position by 10-12 months
 Walks well with one hand held by 12 months
Sensory development
 Hearing and touch well developed at birth
 Sight not fully developed until 6 years; differentiates light
and dark at birth; prefers human face; smiles at 2 months.
 Usually searches and turns head to locate sounds by 12
months
 Has taste preferences by 6 months
 Responds to own name by 7 months
 Able to follow moving objects; visual acuity 20/50 or
better; amblyopia may develop by 12 months
 Can vocalize 4 words by 1 year
COPING WITH CONCERNS
RELATED TO NORMAL
GROWTH AND DEVELOPMENT
OF AN INFANT
STRANGER FEAR
 Parents are encouraged to have close friends or relatives
visit often to accustom the infant to new people.
 Infants also need opportunities to safely experience
stranger.
 The best approach for the stranger is to is to talk softly,
meet the child at eye level (to appear smaller), maintain a
safe distance from the infant, and avoid sudden, intrusive
gestures, such as holding the arms out and smiling
broadly.
SEPARATION ANXIETY
 Talking to infants when leaving the room, allowing them
to hear one’s voice on the telephone, and using
transitional objects reassures them of the parents
continued parents.
LIMIT SETTING AND DISCIPLINE
An effective approach used in used in disciplining a child is
the use of “time-out.” the place for time out needs to be
appropriate with the child’s abilities. Ex. Playpen is better
than a chair for most infants.
It is important to stress to parents that the earlier effective
disciplinary methods are employed, the easier it is to
continue these approaches.
Parents must recognize the child’s cognitive and behavioral
limitations; adequate protection from hazards must be
implemented because infants and toddlers do not
understand a cause-effect relationship between dangerous
objects and physical harm.
THUMBSUCKING AND USE OF
PACIFIERS
 During infancy and early childhood there is no need to
restrain nonnutritive sucking of fingers.
 Malocclusion may occur if thumb-sucking may persists
past 4 years of age, or 6 years as indicated by some
authorities or when permanent teeth erupt.
 Pacifier use should not replace actual feeding or suckling.
 Parents need to be alerted that continual dependency on a
pacifier may influence social and speech development.
 Nonnutritive sucking should not be withheld from preterm
infants esp. when performed in conjunction with the use
of concentrated sucrose for pain management.
 Thumbsucking reaches its peak at age 18-20 months and
is most prevalent when the child is hungry or tired.
 Persistent thumsucking in a listless, apathetic child always
warrants investigation. It may be a sign of boredom,
isolation, and lack of stimulation.
Teething
 This is one of the most difficult period in the infant’s (and
parents’) life is the eruption of deciduous or temporary
teeth.
 The first primary teeth to erupt are the lower central
incisors which appear at approximately 6-8 months of age.
 These are followed closely by the upper central incisors.
 Quick guide to assess deciduous teeth during the first 2
years:
 Age of the child in months -6 = number of teeth
 Teething is a physiologic process; some discomfort is
common as the crown of the tooth breaks through the
periodontal membrane.
 Some children show minimum evidence of teething, such
as drooling, increased finger sucking, or biting on hard
objects.
 Others are very irritable, have difficulty sleeping and
refuse to eat.
 Generally, signs of illness such as fever, vomiting, or
diarrhea are not symptoms of teething but of illness and
may warrant further investigation.
 However many parents report, a low-grade fever is
common in the 4-to-19-day period before and on the day
of tooth eruption.
 Giving the child a frozen teething ring helps relieve
inflammation.
 Several nonprescription topical anesthetic ointments are
available.
 The active ingredient in most of these is benzocaine.
 Parents should be advised to apply the gel correctly.
 If irritability is persistent and the sleeping and the feeding
is affected, systemic analgesics such as acetaminophen or
ibuprofen can be given as a temporary measure.
Infant Shoes
 Inflexible shoes that have hard soles can be detrimental.
They can delay walking, aggravate intoeing or outtoeing,
add impede the development of supportive foot muscles.
 It is helpful to explain to parents that changes in the feet
occur during infancy and early childhood as locomotion
and weight bearing progress.
 -At birth the feet are flat because the arches develop,
the pads disappear and the feet begin to assume a mature
shape.
 -A normal arch is determined by proper alignment of
the bones and development of the surrounding
musculature, not by the height of the arch.
Guidelines in choosing an infant shoes
 The shoe should retain its fit
 Should be made of durable material with a smooth interior
and few construction seams to irritate the skin.
 Soft and flexible esp. in the toe area.
 A good shoe conforms the anatomic shape of the foot,
with a rounded toe and sufficient toe room.
 During weight bearing there should be atleast the space of
half the width of the thumbnail, or 1.25cm (roughly ½
inch), between the end of the longest toe and the shoe.
 Roomy and square-toed socks allow for proper growth
and alignment.
 Inexpensive but well-constructed sneakers or soft-leather
mocassin type shoes are suggested as adequate footgear
for walking infants.
 Shoe size changes at approximately 3-month intervals
between 12 and 36 months. Child’s foot should be
measured every 3 months.
Head banging
 Normal - Beginning during the second half of the first
year of life – preschool period associated with nap time or
bedtime and lasting under 15 minutes.
 Mgt. – pad rails of cribs
Sleep concerns
 Place infants on their back to sleep until they are able to
roll over on their own @ around 4 months.
 Co-sleeping is discouraged
 Breastfed infants tend to wake more often than bottle-fed
infants.
 Late infancy – waking at night and remaining awake for
an hour or more can be common.
 - delaying bedtime by 1 hour, shortening
afternoon naps, not responding immediately to infants at
night, soft toys or music.
Constipation
 Occur in formula-fed infants.
 Mgt. – offer more fluid, fruits and vegetables
Loose stools
 Breastfed infants have softer stool than formula-fed
infants.
 If the mother is taking laxative.
 If the formula is not diluted properly.
Spitting up
 More common in bottle-fed infants due to overfeeding.
 Normal – 2-3x a day (sometimes after every meal).
 Mgt. – burping, use bib to protect the clothing .
Promoting Optimum Health
During Infancy
Nutrition
 Human milk is the most desirable complete diet for the
infant during the first 6 months.
 The normal infant receiving breast milk from a well
nourished mother usually requires no specific vitamin and
mineral supplements, with the exception of iron by 4-6
months of age.
 Water supplementation is not recommended for healthy
infants, because it may lead to water intoxication.
 The addition of solid foods before 4 to 6 months of age is
not recommended.
 Fruit juices are not required during the first 6 months of
life.
 During the second half of the first year, human milk or
formula continues to be primary source of nutrition.
 The major change in feeding habits is the addition of solid
foods.
Reasons for introducing solid foods at 6
months of age
 GI tract has matured sufficiently to handle more complex
nutrients and is less sensitive to potentially allergenic
foods.
 Tooth eruption is beginning and facilitates biting and
chewing.
 The extrusion reflex has disappeared
 Swallowing is more coordinated to allow the infant to
accept solids easily.
 Head control is well developed, which permits infant to sit
with support and purposely turn the head away to
communicate disinterest in food.
 Voluntary grasping and improved-eye-hand coordination
gradually allow infants to pick-up finger foods and feed
themselves.
 Their increasing sense of independence is evident in their
desire to hold the bottle and “try” to help during feeding.
Guidelines in introducing solid foods to
infant
 Introduce solid food when infant is hungry
 Begin spoon feeding by pushing food to back of tongue
because of infant’s natural tendency to thrust the tongue
forward.
 Use a small spoon with a straight handle; begin with 1 0r 2
teaspoons of food; gradually increase to a couple of
tablespoons for feeding.
 Introduce one food at a time, usually intervals of 4-7 days to
allow for identification of allergens.
 As the amount of solid increases, decrease the quantity of
milk to prevent overfeeding.
 Do not introduce food by mixing them with formula in the
bottle.
 Introduce rice cereal at 6 months because it is easy to
digest, has low allergenic potential, and contains iron.
 Introduce fruits and vegetables at 6-8 months.
 Introduce meats at 8-10 months because meats are harder
to digest, have high protein load, and should not be fed
until close to 1 year of age.
 Use single-food prepared baby foods rather than
combination meals because it contains more salt and sugar.
 Avoid adding sugar, salt, spices, when mixing own baby
foods.
 Avoid honey until at least 1 year of age because infants
can’t detoxify Clostridium botulinum spores sometimes
present in honey and can develop botulism.
 The feeding area should have a floor that can be easily
wiped and is relatively far from walls and upholstered
furniture.
 Place the child in a high chair to confine the mess in one
area.
 Large bib should be used as well as washable clothes that
are easily removed.
 In a carpeted eating area, a bed sheet or washable drop
cloth can be spread under high chair to save clean up time
and frustration.
Weaning
 Weaning is the process of giving up one method of
feeding for another.
 Signs of readiness for Weaning:
 1. they have learned that good things come from a spoon.
 2. their increasing desire for freedom of movement may
lessen their desire to be held close for feedings.
 3. they are acquiring more control over their actions and
can easily manipulate a cup to their lips (even if it is held
upside down).
 4. imitation becomes a powerful motivator by age 8 or 9
months .
 5. they enjoy using a cup or glass like others do.
 6. Throwing the bottle down
 7. Chewing on the nipple
 8. Taking only a few ounces of formula
 9. Refusing the breast or dawdling
 Weaning should be gradual, replacing one bottle feeding or
breastfeeding at a time.
 The nighttime feeding is usually the last feeding to be
discontinued.
 It is advisable never to begin allowing a child to take a bottle
of milk to bed- this is a major cause of nursing caries in
deciduous teeth.
 If breastfeeding is terminated before 5 or 6 months of age,
weaning should be to a bottle to provide for infants
continued sucking needs.
 If discontinued later, weaning can be directly from a cup, esp
by age 12 to 14 months.
 Any sweet liquid such as fruit juice should be given in a cup.
Sleep and Activity
 Generally , by 3-4 months of age infants have developed a
nocturnal pattern of sleep that lasts 9-11 months.
 The total daily sleep is approximately 15 hours.
 The number of naps varies per day but infant may take 1
or 2 naps by the end of the first year.
 Breastfed infants usually sleep for less prolonged periods,
with more frequent waking esp. during the night, than do
bottle –fed infants.
 Most infants are naturally active and need no
encouragement to be mobile. However, problems can
arise when devices such as playpens, strollers, commercial
swings, and walkers are used excessively.
 Walkers do not enhance coordination and are dangerous if
tipped over or placed near stairs.
Sleep problems
 Sleep problems in early infancy is correlated with maternal
depression.
 The best way to prevent sleep problem is to encourage
parents to establish bedtime rituals that do not foster
problematic patterns.
 One of the most constructive is placing infant awake in
their own crib.
 The bed should be used for sleeping only-not as a play pen.
 It is advisable not to hang playthings over or on the bed; in
this way the child associates the bed with sleep, not with
activity.
Dental Health
 The teeth and gums are initially cleaned by wiping with a
damp cloth.
 Oral hygiene can be made pleasant by singing or talking
to the infant.
 It is recommended that the infant have an oral
examination by 6 months of age from a qualified pediatric
health practitioner.
 Soft bristled toothbrush be used as more teeth erupt and
the infant adjusts to the routine of cleaning.
 Water is preferred to toothpaste.
 Dietary considerations are also important because habits
begun during infancy tend to continue into later years.
 Carbonated beverages should be avoided during infancy.
Immunizations

 BCG
 DPT
 OPV
 Hep B
 Measles
Play (Solitary)
 a. provide black /white contrast for premature and newborn
infants.
 b. hang mobile 8-10 inches from infant’s face
 c. Provide sensory stimuli (bath water) and tactile stimuli
(feel at various shapes of objects), large toys, balls.
 d. expose to environmental sounds: rattles, musical toys.
 e. use variety of primary-colored objects during infancy
 f. place unbreakable mirror in crib for infants to focus on
their face.
 g. provide toys that let infants practice skills to grasp and
manipulate objects.
 h. vocalization provides pleasure in relationship with people
(smiling, cooing, laughing)
Injury Prevention
Major Developmental Accomplishments
 Birth to 4 months: involuntary reflexes such as crawling
reflex, may propel infant forward or backward, and the
startle reflex may cause the body to jerk, may roll over,
increasing eye-hand coordination with voluntary grasp
reflex.
 4-7 months: rolls over, sits momentarily, grasps and
manipulate small objects, resecures a dropped objects,
has a well-developed eye-hand coordination, can focus on
and locate very small objects, mouthing is very prominent,
can push on hands and knees, crawls backward.
Major Developmental Accomplishments
 8-12 months: crawls/creeps, stands holding onto furniture,
stands alone, cruises around furniture, walks, climbs, pulls
on objects, throws objects, able to pick-up small objects;
has pincer grasp, explores by putting objects in mouth,
dislikes being restrained, explores away from parent,
increasing understanding of simple commands and
phrases.
 Aspiration of foreign objects (buttons, toys, peanuts, hot
dogs)
 Suffocation/Drowning
 Poisoning
 Burns- check temperature of bath water, formula, foods
 Motor vehicles – infant should be restrained in an approved
rear-facing car seat in the middle of the back seat of the car,
until they are 20 lbs. and 1 year of age (If 20 lb before 1 year
must still be rear-facing)
 Falls- keep siderails of crib up, never leave infant
unattended on table, bed and bathtub
 Bodily damage