Infancy: First Year Development

Infancy Overview (Birth to 1 Year)

• During the first year, infants experience rapid physical, psychological, and social development.
• Infants need to learn how to walk, eat solid foods, and communicate.
• Developing trust, emotional relationships with family, and stable sleep/feeding patterns are key.

Neonate/Newborn Characteristics

• The neonatal period spans the first 28 days of life.
• Average newborn length is 48-53 cm (19-21 inches).
• Average newborn weight is 3200-3600 g (7-8 lb).
• Genetics and ethnicity affect birth weight, length, and head circumference.
• Wrinkled skin, undeveloped central nervous system, and uncoordinated movements are typical.
• Birth weight usually triples by first birthday.
• Newborns' heads are large compared to their bodies with long trunks, large round abdomens.
• Newborns have larger cheeks, flat noses, and receding chins.
• Newborns can see but their vision isn't clear.
• Diet is mainly breastmilk or formula milk for the first six months with solid foods added at 5-7 months.
• Monitor for allergies when introducing solid foods.
• Newborns can hear, react to touch and pain, and can also taste and smell.

Newborn Reflexes

• Moro reflex (startle reflex): arms thrown apart, legs extend, head thrown back in response to loud noise.
• Rooting reflex: head turns toward touch near the mouth, necessary for feeding.
• Sucking reflex is initiated when the lips are touched.
• Grasping (palmar) reflex: fingers close around an object when the palm is stroked, declines by the second month and disappears by the third month.

Infant Development Milestones

• By 1 month, infants can hold their head up.
• At 2 months, they smile and follow objects.
• By 3 months, they raise heads and shoulders when lying on their stomachs.
• At 4 months, they roll over, sit (with support), and Moro and rooting reflexes disappear. Can hold objects.
• By 5 months, they hold objects with both hands and put them in their mouth. Can grasp objects and play with their toes.
• At 6 months, the first two lower front teeth emerge, start to chew, hold a bottle, and sit alone.
• At 7 months, upper teeth erupt, say "dada/mama" and fear strangers.
• Around 8 months, they stand and respond to the word "no".
• At 9 months, infants begin crawling and can eat finely chopped foods.
• By 10 months, they understand words and walk while holding furniture.
• At 11 months, infants may take a few steps.
• By 1 year, many walk, hold a cup, know words, shake their heads "no", and engage in "solitary play".

Infant Diet

• For the first 6 months, diet consists of breastmilk or formula.
• Solid foods, like strained fruits and vegetables, are added at 5-7 months based on doctor/nurse advice.
• Chopped foods are added around months 9-10, and 1-year-olds can eat table foods.

Infant Safety and Soothing

• Infants are dependent on caregivers.
• Support workers must ensure the infant's physical and emotional needs are being met.
• Practice good hand hygiene when touching or picking up infants due to their weak immune systems.
• Babies cry to communicate when wet, hungry, tired, or uncomfortable.
• Respond to crying immediately to help the infant feel safe. Infants cannot be spoiled with too much attention.

How to Soothe a Crying Infant

• Ensure all physical needs are met.
• Use gentle motions like rocking or swinging.
• Hold the baby close to your chest.
• Rub the baby's back or stomach.
• Swaddle the baby.

Holding Infants

• Prioritize hygienic measures.
• Use gentle, smooth movements.
• Avoid sudden or jerky motions.
• Use both hands to lift a newborn whilst supporting their entire body as well as their head.
• Don’t let arms or legs dangle.

Bottle Feeding Guidelines

• Formula comes in ready-to-feed, powdered, and concentrate forms.
• Prepare bottles one at a time or in batches.
• Follow container directions carefully.
• Refrigerate prepared bottles and use within 24 hours.
• Wash formula containers before opening and sterilize baby bottles, caps, and nipples.

Bottle Feeding Techniques

• Bottle-feed every 3-4 hours.
• Most babies do not like cold formula.
• Warm bottles by placing them in warm water or under warm tap water.
• Test temperature by sprinkling drops on your wrist; it should feel warm.

Burping Infants

• Babies swallow air during feedings.
• Air in stomach can cause cramping and vomiting.
• Burping helps release trapped air.
• Most babies burp midway and after feeding.

Burping Techniques

• Pat or rub the baby’s back in circles for 2-5 minutes.
• Position the baby over your shoulder with a diaper or towel protecting you.
• Sit the baby on your lap, supporting them with a diaper or towel in front, remembering to always support the first 3 months after birth.
• Lay the baby face down on your lap over a towel or diaper.

Diapering

• Stools in breastfed babies are yellow and have a scrambled egg consistency.
• Stools in bottle-fed babies are yellow-brown and firmer.
• Stools are usually soft and unformed.
• An elimination pattern forms over time.
• A hard, formed stool indicates constipation.
• Watery stools indicate diarrhea which is very serious in infants.

Diapering Best Practices

• Notify the nurse if constipation or diarrhea is suspected.
• Change diapers when wet or soiled.
• For cloth diapers, rinse in the toilet, store in a diaper pail, and wash every 1-2 days separately in hot water with baby detergent.
• Run a second wash cycle without detergent and dry thoroughly.
• Disposable diapers are secured with tape.
• Fold and discard in the garbage (do not flush).
• Change diapers often to prevent diaper rash.
• Ensure the baby is clean and dry before putting on a diaper and notify the nurse if rash develops.

Bathing Infants

• Bathing promotes hygiene, good skin care, comfort, relaxation, bonding, and stimulation.
• Gather required items before starting the bath. Should not be left alone at any time.
• Sponge baths are given until the baby reaches 2 weeks old, or until the circumcision/cord site is fully healed.
• Check your employer's policy regarding bathing in shallow water tubs.

Safe Sleep Practices

• Prevent Sudden Infant Death Syndrome (SIDS) by following safety precautions.
• Always lay babies on their backs for sleep.
• Babies who sleep on their stomachs or sides are at higher risk of SIDS.
• Some babies with medical conditions may require sleeping on their stomachs, so check the care plan.
• Never put the baby on soft bedding.
• Babies can lie on their stomachs only while they are awake and being supervised.
• Ensure the baby is warm, not hot, in their bed.
• If the room temperature is comfortable for you, then it is also right for the baby.
• To determine if the baby is too warm, place your hand on the back of their neck. If it is sweaty, they are too warm.

Shaken Baby Syndrome

• Violently shaking a baby or small child can lead to physical and cognitive impairments.
• Weak neck muscles cause the head to swing violently, resulting in brain damage.
• The brain hits the skull wall - this causes bleeding behind the eyes and in the brain.
• Shaken baby syndrome can cause brain injury, seizures, blindness, paralysis, intellectual disability, or death.
• Less violent but frequent shaking can also cause long-term attention deficits and learning disabilities.

Preventing Falls

• Falls are a leading cause of injury and death in children.
• Infants can roll off tables and fall downstairs.
• Common causes of falls include baby seats and highchairs, as well as falling down the stairs.
• Never leave children unsupervised.

Safety Measures to Prevent Falls

• Do not leave infants and young children unsupervised as well as never leave them unattended in highchairs, couches, tables, beds, or any high surface.
• Always use the waist and crotch straps to secure a child in a highchair/infant seat.
• Always make sure you have securely locked the highchair tray in place.
• Keep highchairs away from stoves, tables, and counters.
• Do not use baby walkers to avoid serious falls and injuries.
• Use safety gates at the top and bottom of stairs.
• Always keep one hand on a child lying on a scale, change table, bed or other furniture.
• Keep one hand on the baby when changing diapers.
• Gather supplies before changing or bathing the child.
• Make sure all supplies are within reach.
• Keep crib rails up and locked safely.
• Frequently check on children in cribs.
• Ensure there are no large toys or firm bumpers like pads that the baby could stand on.

Preventing Choking

• Supervise children when they're eating.
• Cut or prepare food into small pieces or pieces.
• Do not feed infants and young children: hot dogs, raw carrots, peanuts, popcorn, whole grapes, raisins, hard candy, or gum.
• Always hold the infant, instead of propping bottles on rolled blankets.
• Check floors for small objects.

Preventing Burns

• Do not hold hot liquids or carry hot objects near children.
• Hot objects could be drinks, clothing irons etc.
• Avoid heating baby food in a microwave oven.
• Always test food and liquid temperature before feeding.
• Keep hot foods and drinks away from table edges.
• Avoid tablecloths.
• Always test bathwater temperature and keep children away from water faucets.