Infant and Child Development

• These notes cover the care of infants and children

Principles of Growth and Development

• Growth refers to the physical changes as an individual matures, including increases in height, weight, and organ size
• Development is the process of gaining skills and abilities, especially mental, emotional, and social growth
• Growth and development follow a predictable pattern, and occurs over a lifetime, but at different rates
• Early experiences impact later development, with different individuals developing at different rates and in unique ways

Factors Influencing Growth and Development

• Genetics, environment, culture, social factors, health status, and nutrition affect growth and development
• Genetics determine physical growth, intelligence, and personality traits
• Environmental factors include nutrition, physical activity, social relationships, and healthcare access
• Cultural practices, societal norms, and family structure influence development
• Health status includes chronic illnesses, prenatal care, and vaccinations
• Adequate nutrition, especially in early stages, is vital for growth and cognitive development

Theories of Growth and Development

• Freud's psychosexual theory emphasizes childhood experiences in shaping personality
• Freud proposed stages of development: oral, anal, phallic, latency, and genital
• Conflicts during these stages can lead to fixations that influence adult behavior
• Erikson's psychosocial development theory has eight stages from infancy to late adulthood
• Each stage has a specific conflict (e.g., trust vs. mistrust, autonomy vs. shame), that must be resolved for healthy psychological development
• Emphasizes social relationships in development across the lifespan
• Piaget's cognitive development theory has four stages: sensorimotor, preoperational, concrete operational, and formal operational
• Children actively construct knowledge through interaction with their environment by adjusting their cognitive schemas

Principles of Growth and Development

• Children grow predictably, influenced by age, sex, and culture
• Predictable patterns help healthcare providers assess developmental milestones

Cephalocaudal and Proximodistal Development

• Cephalocaudal development means growth occurs from head downward before an infant can sit or walk
• Head control happens first, infants gain control of head and neck muscles so can hold their head steady
• Trunk stability is next, infants develop control over upper body and trunk, which allows them to sit without support
• Legs and feet last, infants gain control of legs and feet, to crawl/walk
• Proximodistal development growth proceeds from center of the body outward as an infant gains control of arms before hands and fingers
• Control of the arms first, and fine motor skills development later
• Babies initially swipe at toys with their whole arm; later using hands to grasp and fingers for precise movements

General to Specific Development

• Large muscle coordination develops before fine motor skills
• Learning to wave before learning to write

Interrelated and Interdependent Factors

• Growth and development are interconnected
• Ex: a child's physical health can influence cognitive development

Internal and External Factors

• Health, genetics, and organic functioning shape growth/development
• Parental attitudes, family dynamics, and environment impact development

Lifelong Process

• Development is continuous, with accomplishments at each stage laying the foundation for future achievements

Behavior as a Developmental Indicator

• Observing behavior (communication, play, social interaction) gives insight into developmental progress

Freud's Psychoanalytic (Psychosexual) Theory

• The oral stage (0-2 years): brings satisfaction from oral activities like sucking and feeding
• Focus: The mouth is the primary source of pleasure and exploration
• Establishing trust and developing comfort is key when giving oral stimulation
• Failure: If needs during this stage are unmet they may develop oral fixations later in life, or behaviors like nail-biting, smoking, overeating, thumb-sucking, or dependency issues
• The child may have issues with trust and dependency in relationships
• The anal stage (2-4 years): The focus is on bowel and bladder control
• Focus: Gaining control over bowel and bladder movements, and toilet training becomes a central task
• Key: Self-control and establishing autonomy
• Failure: Strict caregivers during toilet training can cause them to become overly neat, perfectionistic, or obsessive
• Also, lenient caregivers can cause them to develop messy, disorganized, or defiant tendencies
• Issues involving control, authority, and independence might rise
• The phallic stage (4-6 years): Awareness of gender differences; emergence of the Oedipus and Electra Complexes
• Focus: Awareness of gender differences and the development of sexual identity
• Involves the Oedipus Complex (desire for the opposite-sex parent and rivalry with the same-sex parent) and Electra Complex (similar feelings in girls)
• Development: resolving feelings of attraction/rivalry; healthy sense of identity and morality

Key Conflict

• Infants learn whether they can trust others based on their caregivers
• Positive Outcome: successfully resolving the trust vs. mistrust conflict can lead to a sense of security and a positive foundation for future relationships
• What happens during this stage?: Mistrust- caregivers who inconsistently meet needs

Autonomy vs. Shame/Doubt (18 months-3 years)

• Gaining independence while avoiding feeling ashamed

Key Conflict

• Children assert their independence, and if supported they develop autonomy
• Overcontrolled they may develop doubt in abilities
• Positive outcome- autonomy develops- feel more secure

Initiative vs. Guilt (3-6 years)

• Learning to initiate activities and exploring without excessive guilt
• Positive outcome- children feel more capable/secure

Industry vs. Inferiority (6-12 years):

• Learning and competence comes from achieving learning

Industry vs. Role Confusion (12-18 years):

• Building strong sense of self

Intimacy vs. Isolation (18-24)

• Developing meaningful relationships and connections

Autonomy vs. stagnation (24-54)

• Contributing to society and nurturing the next generation

Integrity vs. Despair (54-death)

• Reflecting on life, sense of regret

Piaget’s Cognitive Development Theory

• Sensorimotor: Senses, motor activities
• Preoperational: Language, egocentric thinking
• Concrete Operational: Logic, reversibility
• Formal Operational: Abstract thinking

Stages of Growth and Development: Newborns

• Apgar Score assessment: HR, Resp, Muscle tone, reflex, color
• Keep the baby warm, in skin to skin contact with a warm environment
• Clamping and cutting of the umbilical cord
• Vitamin K administration
• Normal baby weight: 2.5-4 kg
• Normal length: 45-55cm
• Head circumference: 33-35 cm
• Fontanelles- the baby spots
• Moro, rooting, sucking, grasp babinski
• Head may be moulding, skin may be reddish, eyes focus

Nutrition and Daily Care of Newborns

• Breastfeeding is recommended exclusively for the first 6 months
• Colostrum, rich in antibodies, is first milk produced
• Feed baby every 2-3 hours (8-12 times/day)
• Back sleeping/ position, change frequently, clean hands
• Monitor for Jaundice

Infant

• Birth weight doubles by 5-6 months
• Starts at 6 months (iron-fortified cereals, mashed vegetables, fruits)

Toddler Profile

• Weight: By 2.5 years, the birth weight has quadrupled.
• Height: Increases by 7.5 cm (3 inches) per year.

6 yrs

• By 6 years, requires 1200-1600 calories per day
• Atleast 2 cups

EENC- Essential Newborn Care

• The Unang Yakap (First Embrace) Protocol which follows the WHO

Immediate care

• Drying, drying
• Skin to skin
• Cutting the umbilical cord, and cleaning
• Encouraging Parental bonding

Kangaroo Mother Care (KMC)

• Very effective
• Important for the new baby
• Encouraged
• Benefits include emotional connection, skin-to-contact

National Immunisation Guidelines (NIP)

• Reduces disease
• Provides community resources
• Reduces morbidity and mortality, and prevents diseases like measles, polio etc
• Encourages regular assessment

Immunitisation System

• Vaccine procurement
• Vaccine delivery
• Public awareness
• Education

Integrated management of childhood illnesses- IMCI

• Case management includes children up to age of 5
• Very systematic

What to check for

• History of the taken, assessment with weight
• Temperature and hydration
• Give a full treatment plan
• Give antibiotics, referrals and malaria support if necessary