The Infant and Toddler
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Questions and Answers

What percentage of their birth weight do infants typically lose in the first 3-4 days?

  • 15-20%
  • 5-10% (correct)
  • 10-15%
  • 2-5%

    • At what age do infants typically double their birth weight?

  • 3-4 months
  • 10-12 months
  • 7-8 months
  • 5-6 months (correct)

    • What cognitive milestone signifies that infants understand object permanence?

  • Achieving this milestone around 8-12 months (correct)
  • Reaching for toys
  • Understanding 'no-no'
  • Recognizing familiar faces

    • What is a common reason for colic in infants?

    <p>Feeding too quickly</p> Signup and view all the answers

    What is the recommended approach to manage negativism in toddlers?

    <p>Offering limited choices</p> Signup and view all the answers

    What is one potential risk associated with co-sleeping?

    <p>Increased risk of Sudden Infant Death Syndrome (SIDS)</p> Signup and view all the answers

    When are solid foods typically introduced to infants?

    <p>5-6 months</p> Signup and view all the answers

    What defines the age group known as toddlers compared to infants?

    <p>Greater independence and advanced motor skills</p> Signup and view all the answers

    What is one way parents can encourage positive sleep patterns in infants?

    <p>Creating a consistent bedtime routine</p> Signup and view all the answers

    What age are infants likely to begin playing with food?

    <p>9 months</p> Signup and view all the answers

    What is a key nutritional advantage of breastfeeding compared to bottle-feeding?

    <p>Breast milk contains antibodies that support immunity.</p> Signup and view all the answers

    What is a developmental challenge associated with toddlerhood according to Erikson's theory?

    <p>Achieving autonomy versus shame and doubt.</p> Signup and view all the answers

    Which effective discipline strategy for toddlers is focused on reinforcing positive behavior?

    <p>Applying positive reinforcement.</p> Signup and view all the answers

    What distinguishes parallel play from cooperative play in toddlers?

    <p>Parallel play does not involve direct interaction.</p> Signup and view all the answers

    What behavior is typical of negativism in toddlers?

    <p>Frequently responding with 'no'.</p> Signup and view all the answers

    What does the grasp reflex in newborns involve?

    <p>Automatically gripping any object placed in the hand.</p> Signup and view all the answers

    How does the concept of object permanence develop in infants?

    <p>It typically develops between 8-12 months of age.</p> Signup and view all the answers

    Which of the following is a potential disadvantage of bottle-feeding?

    <p>It may not provide adequate immunological benefits.</p> Signup and view all the answers

    What is the role of 'time-out' as a discipline technique for toddlers?

    <p>To remove the child from reinforcing situations temporarily.</p> Signup and view all the answers

    What is a benefit of therapeutic play in toddler development?

    <p>It can facilitate healing and coping through play activities.</p> Signup and view all the answers

    What is a significant risk factor associated with co-sleeping for infants?

    <p>Higher likelihood of SIDS</p> Signup and view all the answers

    At what age do infants typically achieve object permanence?

    <p>8-12 months</p> Signup and view all the answers

    What is a common characteristic of colic in infants?

    <p>Prolonged periods of crying and irritability</p> Signup and view all the answers

    Which method is effective for managing negativism in toddlers?

    <p>Offering limited choices</p> Signup and view all the answers

    Why is the timing of introducing solid foods to infants around 5-6 months considered crucial?

    <p>Their tongue extrusion reflex has disappeared</p> Signup and view all the answers

    What is a key benefit of breastfeeding over bottle-feeding?

    <p>Lower risk of allergies and infections</p> Signup and view all the answers

    Which developmental milestone reflects a toddler's emerging autonomy according to Erikson's theory?

    <p>Exhibiting negativism</p> Signup and view all the answers

    What discipline strategy emphasizes guiding children toward appropriate behavior?

    <p>Setting clear limits</p> Signup and view all the answers

    What differentiates cooperative play from parallel play in toddler development?

    <p>Cooperative play involves shared goals among peers</p> Signup and view all the answers

    What is a common emotional response exhibited by toddlers during challenging transitions?

    <p>Temper tantrums due to frustration</p> Signup and view all the answers

    What physical development milestone is typically observed in infants at 6 months old?

    <p>Doubles birth weight</p> Signup and view all the answers

    What is a typical social behavior of an 8-month-old infant?

    <p>Enjoys playing pat-a-cake</p> Signup and view all the answers

    What dietary change should be introduced around 9 months of age for infants?

    <p>Add meat and beans</p> Signup and view all the answers

    At what age do infants usually start to show impatience when food is being prepared?

    <p>8 months</p> Signup and view all the answers

    What is a common physical development behavior of a 12-month-old infant?

    <p>Stands alone and may walk</p> Signup and view all the answers

    What characterizes the growth of an infant during the first year of life?

    <p>Follows a consistent pattern that can be tracked through growth charts</p> Signup and view all the answers

    Which growth pattern describes development from the head to the toes?

    <p>Cephalocaudal development, indicating a top-down progression</p> Signup and view all the answers

    What is a significant developmental task for both infants and their parents during the first year of life?

    <p>Developing effective feeding patterns to foster trust and security</p> Signup and view all the answers

    What should be assessed to determine if an infant is at risk of growth and development delays?

    <p>Whether the infant is meeting standard developmental milestones</p> Signup and view all the answers

    What defines the main challenge faced by infants in the realm of cognitive development?

    <p>Establishing trust versus mistrust in caregivers</p> Signup and view all the answers

    What does the term 'maturation' refer to in the context of infant development?

    <p>Progressive improvement in the body's functionality</p> Signup and view all the answers

    Which statement accurately describes the maturation of the kidney function in infants?

    <p>Kidney function is not mature until the end of the second year of life</p> Signup and view all the answers

    Which of the following is considered a protective reflex that develops in infants around 7-9 months?

    <p>Parachute reflex</p> Signup and view all the answers

    What is the primary purpose of using growth charts in monitoring child development?

    <p>To provide a visual representation of a child's growth compared to percentiles</p> Signup and view all the answers

    Why is the concept of 'self-soothing' significant in infant sleep development?

    <p>It promotes the infant's ability to fall back asleep independently without caregiver intervention.</p> Signup and view all the answers

    What is a key factor in helping infants develop trust in their caregivers?

    <p>Responding consistently to their needs</p> Signup and view all the answers

    Which activity is considered detrimental to an infant's social development?

    <p>Keeping the infant isolated in a playpen for long periods</p> Signup and view all the answers

    At what age do infants typically begin to lift their head slightly when placed on their stomach?

    <p>1 month</p> Signup and view all the answers

    What is an appropriate feeding guideline for infants around 2 months of age?

    <p>Breast milk or formula every feeding</p> Signup and view all the answers

    Which of the following milestones is expected for a 3-month-old infant?

    <p>Staring at their hands</p> Signup and view all the answers

    What is a recommended technique for coping with an irritable infant during diaper changes?

    <p>Shield the infant's eyes from bright light</p> Signup and view all the answers

    Which coping strategy is effective when handling a lethargic infant?

    <p>Talk in a calm voice</p> Signup and view all the answers

    How should parents assist their infants in developing self-soothing behaviors?

    <p>Encourage the infant to grasp the pacifier independently</p> Signup and view all the answers

    What characterizes colic in infants?

    <p>Unexplained irritability and crying</p> Signup and view all the answers

    Which of the following should be avoided to prevent discouraging infant interaction?

    <p>Bright lights in the infant's environment</p> Signup and view all the answers

    What is the primary goal of skilled health services during the first year of a child's life?

    <p>To identify families at risk for various issues</p> Signup and view all the answers

    Which statement best describes the importance of vaccinations during early childhood?

    <p>Proper immunization helps prevent serious illnesses and complications.</p> Signup and view all the answers

    During which months should a child ideally visit a health care setting at least five times in the first year?

    <p>2, 4, 6, 9, 12</p> Signup and view all the answers

    What should parents monitor to ensure proper growth of their infant?

    <p>Growth patterns including both weight and height</p> Signup and view all the answers

    What is one key message to convey to parents regarding their 2-month-old infant's crying?

    <p>Holding and soothing are important to develop trust.</p> Signup and view all the answers

    Which toy is appropriate for infants aged 0–2 months to stimulate their vision?

    <p>Black-and-white contrasting mobiles</p> Signup and view all the answers

    What is one major concern regarding toy selection for infants?

    <p>Avoiding toys with small or removable parts</p> Signup and view all the answers

    What nutritional benefit does breastmilk provide that is particularly important for infants?

    <p>Optimal growth and development</p> Signup and view all the answers

    What reflex allows infants to locate and latch onto a nipple for feeding?

    <p>Rooting reflex</p> Signup and view all the answers

    At what age range are solid foods typically introduced to infants, according to recommended practices?

    <p>5-6 months</p> Signup and view all the answers

    What is the primary benefit of introducing rice cereal as the first solid food for infants?

    <p>Less allergenic than other foods</p> Signup and view all the answers

    Which of the following statements about the addition of DHA and ARA to infant formulas is correct?

    <p>They are added to promote neurological development.</p> Signup and view all the answers

    At what age is it generally recommended to start weaning an infant?

    <p>By 2 years when the child begins eating family meals</p> Signup and view all the answers

    Why should whole cow's milk be avoided in infants younger than 1 year?

    <p>It is too high in protein for their kidneys.</p> Signup and view all the answers

    Which guideline is applicable for safely preparing and storing infant bottles?

    <p>Refrigerate prepared bottles until needed.</p> Signup and view all the answers

    Study Notes

    Infant Development

    • Infants lose 5-10% of their birth weight in the first few days but regain it by 10-12 days.
    • They double their birth weight by 5-6 months and triple it by one year.
    • Infants have a higher percentage of extracellular fluid (40%) compared to adults (20%), making them more susceptible to dehydration.
    • Object permanence, the understanding that objects continue to exist even when out of sight, typically develops around 8-12 months.
    • Co-sleeping is discouraged due to the increased risk of SIDS.
    • At nine months, infants typically recognize "no-no" and may take one long nap daily.
    • Colic is characterized by unexplained periods of intense crying and irritability in a healthy infant, possible causes include feeding too quickly, swallowing air, formula intolerance, or environmental factors.
    • Parents can encourage positive sleep patterns by synchronizing their infant's circadian rhythm with the family routine, creating a consistent bedtime routine, and encouraging self-soothing behaviors after six months of age.
    • Solid foods are typically introduced around 5-6 months of age when the infant's tongue extrusion reflex has disappeared, their gastrointestinal tract is mature enough to handle solid foods, and they are developmentally ready to explore new tastes and textures.

    Toddler Development

    • Toddlers exhibit slower physical growth but have advanced motor skills like walking and running.
    • They display greater independence and autonomy and their language skills develop rapidly, allowing for increased communication and social interaction.
    • "Negativism," frequent "no" responses, is a typical behaviour in toddlerhood, reflecting their drive for autonomy and testing boundaries.
    • Parents can effectively manage this by offering limited choices, using distraction techniques, and remaining patient and understanding.

    Key Terms

    • Body Surface Area (BSA): The measurement of the outer surface of the human body, expressed in square meters. It is proportionally larger in infants and children than in adults, impacting factors like medication dosage calculations.
    • Colic: A condition affecting infants, characterized by periods of intense, unexplained crying and fussiness, often occurring in the evening.
    • Object Permanence: The understanding that objects continue to exist even when they are out of sight. This cognitive milestone typically emerges in infants around 8-12 months of age.
    • Parallel Play: A type of play observed in toddlers where they play alongside each other but do not engage in direct interaction or shared activity.
    • Negativism: A characteristic behavior in toddlers, marked by frequent "no" responses and resistance to suggestions or commands, reflecting their emerging sense of autonomy.
    • Sudden Infant Death Syndrome (SIDS): The sudden and unexplained death of an infant younger than one year old, typically occurring during sleep.
    • Time-Out: A disciplinary technique involving removing a child from a stimulating or reinforcing situation for a brief, predetermined period to help them regain control of their behavior.

    Infant Development

    • Infants lose 5-10% of their birth weight in the first 3-4 days but regain it by 10-12 days.
    • By 5-6 months, infants double their birth weight and triple it by one year of age.
    • Infants have a higher percentage of extracellular fluid (40%) compared to adults (20%), making them more susceptible to dehydration due to their higher metabolic rate.
    • Object permanence, the understanding that objects continue to exist even when out of sight, develops around 8-12 months.
    • Co-sleeping is discouraged due to increased risk of Sudden Infant Death Syndrome (SIDS) and potential for accidental suffocation.
    • At nine months, infants typically recognize "no-no", may take one long nap daily, and start playing with food by removing it from their mouths.
    • Colic is characterized by unexplained periods of intense crying and irritability in a healthy infant. Possible causes include feeding too quickly, swallowing air, formula intolerance, or environmental factors.
    • Encouraging positive sleep patterns involves synchronizing an infant's circadian rhythm with the family routine, creating a consistent bedtime routine, and promoting self-soothing after six months.

    Introducing Solid Foods

    • Solid foods are introduced around 5-6 months when the infant's tongue extrusion reflex has disappeared, their gastrointestinal tract is mature, and they are developmentally ready to explore new tastes and textures.

    Toddler Development

    • Toddlers exhibit slower physical growth compared to infants.
    • They develop advanced motor skills like walking and running, displaying greater independence and autonomy.
    • Language skills develop rapidly, facilitating increased communication and social interaction.
    • "Negativism," characterized by frequent "no" responses, reflects their drive for autonomy and testing boundaries.
    • Parents can manage negativism by offering limited choices, using distraction techniques, and remaining patient and understanding.

    Sensory Stimulation

    • Sensory stimulation is crucial for infant development.
    • Examples of stimulating experiences include providing opportunities for visual exploration (bright colors, patterns), auditory stimulation (music, sounds), tactile experiences (different textures), and taste and smell exploration.

    Breastfeeding vs. Bottle-Feeding

    • Breastfeeding offers numerous advantages, including providing optimal nutrition, immunological benefits, and fostering parent-infant bonding.
    • Bottle-feeding can be a convenient alternative, allowing for flexibility in feeding schedules and shared feeding responsibilities.

    Toddlerhood Development Tasks and Challenges

    • According to Erikson, toddlers are in the stage of Autonomy vs. Shame and Doubt.
    • They strive for independence and autonomy, leading to challenges such as temper tantrums, negativism, and separation anxiety.
    • Parents play a crucial role in fostering autonomy while providing appropriate boundaries and emotional support.

    Effective Discipline for Toddlers

    • Effective discipline emphasizes positive reinforcement, setting clear limits, and using time-outs appropriately.
    • Positive reinforcement focuses on rewarding desired behavior, while setting clear limits provides structure and consistency.
    • Time-outs offer a brief period of separation to help toddlers regain control of their emotions.

    Play in Toddler Development

    • Play is essential for toddler development, facilitating social, emotional, cognitive, and physical growth.
    • Parallel play involves toddlers playing alongside each other without direct interaction, while cooperative play involves sharing and collaborating.
    • Various play activities, such as imaginative play, building with blocks, and role-playing, offer developmental benefits.

    Glossary of Key Terms

    • Body Surface Area (BSA): The measurement of the outer surface of the human body, which is proportionally larger in infants and children than in adults.
    • Colic: A condition affecting infants characterized by periods of intense, unexplained crying and fussiness.
    • Epiphysis: The rounded end of a long bone where growth occurs in children and adolescents.
    • Grasp Reflex: An involuntary reflex present in newborns, causing them to tightly grasp any object placed in their hand.
    • Myelinization: The process of forming a myelin sheath around nerve fibers, essential for proper nerve impulse transmission.
    • Negativism: A characteristic behavior in toddlers marked by frequent "no" responses and resistance to suggestions or commands.
    • Object Permanence: The understanding that objects continue to exist even when they are out of sight.
    • Parallel Play: A type of play observed in toddlers where they play alongside each other but do not engage in direct interaction or shared activity.
    • Percentile: A statistical measure used to compare a child's growth measurements to other children of the same age and gender.
    • Pincer Grasp: A refined grasping skill that develops around 9-12 months, enabling infants to pick up small objects using their thumb and index finger.
    • Prehension: The ability to grasp and manipulate objects, developing gradually in infants.
    • Ritualism: The tendency of toddlers to engage in repetitive routines and rituals for security and predictability.
    • Separation Anxiety: Distress experienced by infants and toddlers when separated from their primary caregivers.
    • Sudden Infant Death Syndrome (SIDS): The sudden and unexplained death of an infant younger than one year old, typically occurring during sleep.
    • Temper Tantrum: An outburst of intense anger, frustration, or distress often seen in toddlers as they struggle to regulate their emotions.
    • Therapeutic Play: The use of play activities to support children's physical, emotional, cognitive, and social development.
    • Time-Out: A disciplinary technique involving removing a child from a stimulating or reinforcing situation for a brief, predetermined period.
    • Weaning: The process of gradually transitioning an infant from breastfeeding or bottle-feeding to drinking from a cup.

    Infant Growth and Development

    • Infants are newborns from 4 weeks to 1 year old.
    • Growth is an increase in physical size and can be measured.
      • Growth charts are used to track growth and development.
      • Healthy children follow a consistent growth pattern.
      • Growth charts use percentiles.
      • A difference in percentile levels between height and weight may indicate under or overweight.
    • Development is a progressive increase in the function of the body.
    • Maturation is independent of the environment, but its timing can be affected by physical and psychological factors.
    • Physical, emotional, and cognitive development, as well as motor abilities, occur rapidly in the first year of life.
    • Milestones are general patterns of achievement at various stages of infancy.
    • Norms are what milestones or patterns are referred to, and can vary greatly for individual infants.
    • Cephalocaudal development starts from the head to the toe.
    • Proximodistal development starts from the midline to the periphery.
    • Height is a family trait, but weight is not a good indicator of health in infants.
      • Infants lose 5 to 10% of their birth weight in the first few days of life.
      • Infants regain their birth weight within 10 to 12 days of life.
      • Birth weight usually doubles by 5 to 6 months and triples by 1 year.
      • Infants are weighed without clothes or diapers.
    • Body System Requirements for Infants & Children
      • Neuro: Myelination of the brain cortex begins at 8-9 months gestation and continues through adolescence.
        • This is the basis for maturation of sensory, motor, and associative pathways.
        • Inadequate diet, caregiver interaction, or lack of environmental stimuli can lead to permanent deficits.
      • Metabolic Rate: Higher in children than adults, requiring more vitamins, minerals, calories, and fluids.
      • Respirations: Infants have irregular and abdominal respirations, with small airways easily blocked by mucus.
      • Cardiovascular: Neonates have increased need for cardiac output and increased heart rate.
      • Immunity: Infants rely on maternal immunity for the first 3 months, and immunizations are crucial to maintaining a healthy immune system.
      • Kidney Function: Not mature until the end of the second year. Drugs eliminate via the kidneys can accumulate to dangerous levels.
      • Sleep Patterns: Neonates sleep 8-9 hours per night and nap an equal amount during the day.
      • Bone Growth: Bone synthesis is greater than destruction, and occurs at the epiphysis. Vitamin A, D, sunlight and fluoride are needed for growth.

    Cognitive Development in the First Year of Life

    • Sleep-wake cycles, feeding preferences, and social interaction affect cognitive and emotional development throughout life.
    • Chief Tasks for Infant & Parent
      • Feeding: Establishment of effective feeding patterns.
        • If unmet, the infant may become irritable and fail to develop trust in the caregiver.
      • Sleep: Establishing a predictable sleep-wake cycle.
        • Neonates sleep at 2 to 4 hour intervals, increasing to 8 hours by 4 to 6 months.
        • Synchronizing sleep patterns for the family is a learned skill.
        • Infants should always be laid flat in a crib with no toys or pillows.
        • Co-sleeping is discouraged due to the risk of SIDS.
        • Infants rely on parents to soothe them back to sleep until 6 months of age.
      • Bonding & Social Interaction: Parental bonding and social interaction.
        • Begins at the neonatal phase, heightening when the infant responds with a social smile.
        • By 9 months, the infant may show separation anxiety.
    • Oral Stage of Personality Development
      • Sucking brings comfort and relief from tension.
      • Infants who are warm and comfortable associate food with love.
    • Infant Motor Development
      • Grasp Reflex: When the palms of the infant's hands are touched, flexion occurs, disappearing around 3 months.
      • Prehension: The ability to grasp objects between the fingers and opposing thumb, occurring around 5 to 6 months.
      • Parachute Reflex: Protective arm extension when an infant is suddenly thrust downward prone, occurring by 7 to 9 months.
      • Pincher Grasp: The coordination of the index finger and thumb, establishing by 1 year of age.
      • Moro Reflex: Also known as the startle reflex, the baby throws arms outward when a loud noise is heard.

    Emotional Development

    • Love and security are vital needs of infants.
    • Erikson’s Stages of Development:
      • Infant: Trust v. Mistrust
      • Toddler: Autonomy v. Shame/Doubt
      • Preschool: Initiative v. Guilt
      • School Age: Industry v. Inferiority
      • Adolescent: Identity v. Role Confusion.
        • Each stage builds on the previous.
        • Parents must interact appropriately to assist the child in successfully moving to the next developmental level.
    • Picking up an infant when they cry is important in building trust.
    • Parents should interact with their infants through singing, talking, and touching.
    • Limit-setting is essential.

    Physical and Psychosocial Development

    • 1 Month
      • Gains approximately 2.5 cm in length per month for the first 6 months.
      • Lifts head slightly when placed on stomach.
      • Turns head to side when prone.
      • Makes small throaty noises.
      • Sleeps 20 out of 24 hours.
    • 2 Months
      • Posterior fontanelle closes.
      • Tears appear.
      • Can hold head erect in the midposition.
      • Makes small throaty noises.
      • Sleeps 20 out of 24 hours.
      • Receives first DTaP, IPV, Hib, and second Hepatitis B vaccine.
    • 3 Months
      • Weighs 5.4 to 5.9 kg.
      • Stares at hands.
      • Supports head steadily.
      • Enjoys having people talk to them.
    • 4 Months
      • Weighs about 5.9 to 6.8 kg.
      • Drooling indicates teething.
      • Lifts head and shoulders when on abdomen.
      • Receives second DTaP, IPV, and Hib vaccine.
    • 5 Months

      • Sits with support.
      • Grasps objects offered.
      • Plays with toes.
      • Sleeps through the 10 a.m. feeding.
    • 6 Months
      • Doubles birth weight.
      • Sits alone momentarily.
      • Turns completely over.
      • First solid food is introduced.
      • Sucks food from a spoon.
    • 7 Months
      • Two lower teeth appear.
      • Begins to crawl.
      • Grasps objects more easily.
      • Shows fear of strangers.
    • 8 Months

      • Sits steadily alone.
      • Enjoys dropping articles into a cup and emptying it.
      • Plays pat-a-cake.
    • 9 Months
      • Can raise self to a sitting position.
      • Creeps.
      • Stands while holding onto furniture.
      • Introduce chopped and mashed foods.
    • 10 Months
      • Pulls to a standing position in the playpen.
      • Cries when toys are not returned.
      • Knows their name.
      • Plays simple games like peek-a-boo.
    • 11 Months
      • Stands upright while holding an adult’s hand.
      • Understands simple directions.
      • Enjoys playing with empty dishes and spoons after meals.
    • 12 Months
      • Stands alone for brief periods.
      • May walk.
      • Drinks from a cup.
      • Eats with a spoon with supervision.
      • Pincer grasp is well established.
      • Repeats acts that elicit a response.

    Infant Development

    • Infants develop at different rates.
    • Infant development varies widely, but there are central norms that can guide evaluation.
    • Newborns sleep at 2- to 4-hour intervals and sleep for 8 hours by age 4-6 months.
    • Infants should sleep on their backs on a firm, flat mattress, in a crib, to reduce the risk of SIDS.
    • Infants should be swaddled in a sleep sack with their hands near their mouths and legs flexed for comfort.
    • Infants rely on parents to soothe them back to sleep, but should learn to self-soothe by age 6 months.
    • Parents should be taught about normal growth and development and anticipated milestones for their child.
    • Early intervention is needed when special needs are recognized.
    • Community agencies can be helpful for families who need support with a special-needs child.
    • Infants need visual, touch, and manipulative stimuli for development.
    • A child’s response to a toy can indicate their growth and development.
    • Toys should be safe and varied to stimulate vision, touch, hearing, and movement.

    Infant Care

    • Irritable infants may be sensitive to environmental stimuli, like bright lights, loud noises, and movement, and benefit from a calm, nurturing environment.
    • Colicky infants are irritable and cry for unexplained reasons.
    • Colic may be caused by rapid feeding, air swallowing, formula intolerance, and environmental factors.
    • Colicky infants often find relief when held face down close to the body and gently rocked.
    • Parents should be attentive to pre-cry cues to calmly soothe their infants before they start crying.
    • Lethargic infants may respond to overly stimulating environments by "shutting down" and sleeping.
    • Parents should avoid bright lights, move the infant slowly and gently, talk in a calm voice, and sit the infant upright at intervals with lethargic infants.

    Infant Nutrition

    • Infants require more calories, protein, minerals, vitamins, and fluids per kilogram of weight than adults to support their rapid growth and development.
    • Breast milk is the best source of nutrition for infants younger than 6 months old.
    • Bottle-fed infants typically feed at 3 to 4-hour intervals.
    • Breastfed infants typically feed at 2 to 3-hour intervals.
    • Parents should create a regular but flexible feeding schedule while allowing the infant to rest between feedings.
    • The American Academy of Pediatrics (AAP) recommends that infants remain on human milk or iron-fortified formula for the first 12 months of life.
    • Infants who are breastfed longer than 6 months gain less weight by age 1 year and are less apt to be obese in later life.
    • High-fat diets can delay gastric emptying and cause abdominal distention and constipation.
    • High carbohydrate diets can cause distention, flatus, and excessive weight gain.
    • It is essential to monitor the weight, height, head circumference, and skinfold thickness of infants to ensure they are getting adequate nutrition.

    Infant Health

    • Infants should be seen at a health care setting at least five times during the first year (2 months, 4 months, 6 months, 9 months, and 1 year).
    • Parents should keep a record of their infant’s immunizations.
    • Infants may experience diaper rash, which can be worsened by commercial diaper wipes containing fragrance or other irritants.
    • Skilled health services should focus on providing periodic health appraisals, immunizations, assessing parent-child interactions, counseling about the developmental process, identifying families at risk, health education, and referrals to various agencies.

    Play

    • Play is a critical part of infant development.
    • Play helps promote physical, cognitive, and emotional development in infants.
    • Therapeutic play is a form of play that supports the recovery process.
    • Infants play by exploring and imitating.
    • Infants put everything in their mouths, so it is essential to avoid toys with small or removable parts.
    • Toys for each development age group should vary to stimulate vision, touch, hearing, and movement.

    Infant Formula

    • Infant formula is regulated by the US Food and Drug Administration
    • Infant formula is composed of two major milk proteins:
      • Whey: Easily digested, potentially causes protein intolerance in certain infants
      • Casein: Digests more slowly, inhibits catabolic processes
    • Formula contains DHA and ARA, essential for neurological functioning
    • Formula contains between 20 to 40 calories per ounce
    • Formula can contain probiotics and prebiotics, which offer health benefits and help balance the bacteria in the gut
    • Rice starch formulas are used to treat GERD and reduce loose stools
    • Lactose-free formulas replace lactose with corn syrup
    • Soy milk is used for infants with galactosemia
    • Hydrolyzed formulas are used for infants with severe sensitivities
    • Feeding an infant the wrong formula is considered a medication error
    • Whole cow's milk or goat's milk is not recommended for infants under 1 year due to difficult digestion

    Solid Food Introduction

    • Solid foods can start at 5-6 months when the tongue extrusion reflex disappears and the GI tract matures
    • Rice cereal is recommended as the first solid food because it is less allergenic
    • Introduce new foods slowly, one at a time every 4-7 days, avoiding when the infant is ill
    • Orange juice should be withheld until 1 year of age
    • High allergen foods, such as peanuts and strawberries, can be introduced slowly before 11 months
    • Home-prepared baby foods are generally preferred as they are less expensive, contain less salt and sugar, and help infants become familiar with family tastes.
    • Organic and natural foods do not contain additives, but there is no substantial research indicating their superiority. Encourage parents to read nutritional labels.
    • Weaning involves substituting a cup for a bottle or breastfeeding. Signs of readiness include interest in new tastes, chewing, and biting at the nipple/bottle.

    Bottle Feeding Safety

    • Wash hands before making the bottle
    • Wash the bottle thoroughly between feedings
    • Never heat formula or breastmilk in the microwave
    • Heat the bottle by setting it in a warm container of water
    • Prepared bottles need to be refrigerated until ready to use

    Development of Feeding Skills

    • 7 months: Child reaches for the spoon
    • 9 months: Uses the spoon independently, refined pincer grasp to pick up food
    • 2 years old: More skilled at self-feeding, rotates the wrist and elevates the elbow to keep food on the spoon

    Infant Safety

    • Infants should remain rear-facing in the center of the rear seat of the automobile
    • Never leave an infant unattended on a flat surface, such as a changing table
    • Crib rails should be raised and securely locked
    • Infants’ chairs/seats/swings should never be placed on high surfaces, always keep them on the floor
    • Crawling infants should be protected from stairways, heavy/unsteady furniture, poisons, cleaning liquids, plants, batteries, plugs, loose hanging wires, and pets
    • Ensure cabinets are locked

    Toddler Characteristics

    • Toddlers (1-3 years old) have tripled their birth weight and gained control of their head, hands, and feet by 1 year.
    • Growth and development slow down in this period.
    • Toddlers are in Erikson's stage of autonomy vs. shame and doubt.
    • Negativism: Toddlers test their power by saying "no" frequently. Offer limited choices and use distraction to manage this.
    • Ritualism: Toddlers increase sense of security by making routines out of simple tasks. Respect their rituals.
    • Physical Development:
      • Gain 4-6 lbs per year until birth weight is quadrupled by 2.5 years
      • Grow 4 inches per year in height
      • Brain growth decelerates
      • Chest circumference exceeds abdominal circumference
      • Myelination of the spinal cord is complete by 2 years, leading to bowel and bladder control
      • Lymphatic tissue and adenoids enlarge, making tonsillitis, otitis media, and upper respiratory infections common
      • Eruption of deciduous teeth continues until 2.5 years
      • Vital signs:
        • Blood pressure averages 90/56 mmHg
        • Respiration slows to 25 breaths/minute
        • Pulse slows to 70-110 beats/minute

    Toddler Cognitive Development

    • Assimilate information through trial and error and repetition
    • Separation anxiety develops in infancy and continues throughout toddlerhood, though they can tolerate longer periods of separation.
    • Aware of cause and effect
    • Spatial relationships develop
    • Object permanence is established
    • Begin internalizing standards of behavior
    • Copy words and roles of models in the environment
    • Recognize sexual differences by 2 years old
    • Body image and self-esteem can be impaired by negative feedback, so focus on praising the behavior rather than the child.

    Toddler Speech Development

    • Comprehension exceeds verbalization
    • By 3 years old, vocabulary is around 900 words, and speech is more than 90% understandable
    • Toddlers learn by repeating sounds and words and need an appreciative audience
    • Respond to tone of voice and facial expressions
    • Late talkers may prefer listening to active speaking and may not have any issues with speech development.
    • Lead poisoning and hearing deficits should be ruled out before screening for developmental issues such as autism.

    Toddler Guidance and Discipline

    • Goal is to teach, not punish. Praise is effective and increases self-confidence.
    • Fear or physical aggression is not part of effective discipline and can lead to mental or physical abuse.
    • Temper tantrums are uncontrolled anger reactions. Parental responses reinforce desired or undesired behavior.
    • Setting limits includes praise for desired behavior and disapproval for undesired behavior.
    • Time-out is a period in a safe place that helps toddlers learn delayed gratification and self-regulation.
    • Fear can be learned and difficult to eliminate. Avoid shaming, make use of positive reinforcement, and provide comfort and reassurance.
    • Corporal punishment, including spanking, should be avoided in favor of alternative techniques.
    • Communicate love and respect to the child while clearly disapproving of the behavior.

    Daily Care of the Toddler

    • Talk to the toddler at eye level to seem less overwhelming, especially in a fear-provoking environment.
    • Maintain a consistent schedule, but be flexible for special occasions.
    • Clothing should be easy to put on and take off.
    • Sun protection includes covering skin and using SPF 30 or higher.
    • Shoes should be comfortable, fit the shape of the foot, and be half an inch longer and a quarter of an inch wider than the foot.
    • Posture can reflect security and self-confidence. Slouching can indicate insecurity.

    Toilet Independence

    • Voluntary control of anal and urethral sphincters begins around 18-24 months.
    • Readiness is important.
      • If the child wakes up dry in the morning or after a nap, it is an indication of maturity.
      • The child must be able to indicate in some way if they are wet or need to urinate or defecate.
      • The child must be willing to sit on the potty for a few minutes at a time.
    • Training pants or pull-up diapers are easier to remove and make the child aware they're wet.
    • Bowel training should be attempted first, but bladder control during the day is usually achieved first.
      • If bowel movements occur at the same time each day, toilet training progresses more rapidly.
      • The child should only be on the potty for a short time.
    • Bladder training starts when the toddler stays dry for approximately 2 hours at a time.
      • Some children might stay dry throughout the night.
      • Limiting fluids before bedtime can be helpful.
    • It is normal for children to have occasional accidents until they are four.
    • The parent(s) should accept accidents and change the child's clothes.
    • Affection is important to show even on bad days.
    • Use designated words to signify urination or defecation for caregivers to understand the child's needs.
    • Continue toilet training even if the child is hospitalized.
      • Toddlers will often regress during hospitalization.
      • Nurses should include toilet training as part of their care plan, as it helps promote the child's development.

    Nutrition

    • Caloric requirements for toddlers decrease to 100 calories/kg per day.
    • Limit milk intake to 720mL (24oz.) per day.
    • Insufficient solid food can lead to iron deficiencies.
      • Children between 1-3 years old are at a higher risk for anemia.
    • Avoid excess calories and large amounts of vitamins.
    • Toddlers have fluctuating appetites and strong food preferences.
      • Appetite may be strong one week and refuse to eat the next.
    • Create a flexible meal schedule designed for the whole family.
    • Provide nutritious meals at any time of the day (breakfast, lunch, or dinner).
      • Offer variety in colors and textures of food.
    • Encourage finger foods.
    • Serve food at moderate temperatures - not too hot or cold.
    • Avoid candy, cake, and soda between meals.
    • Discourage oversized servings - it can be overwhelming and lead to overeating.
    • Serve one tablespoon of solid food for each year of age.
    • Chop food into fine pieces.
    • Quiet time before mealtime can help the toddler wind down.
    • If a child refuses to eat, it could be due to tiredness or not being hungry.
      • Forcing a child to eat can create more challenges.
      • Avoid discipline or arguing during mealtime, as it will disrupt everyone's appetite.
    • Toddlers often have mealtime rituals.
      • Allow them to use favorite plates, spoons, and glasses.
      • Use unbreakable colorful dishes, washable plastic bibs, place mats, and floor protection.
      • Use small utensils that are easy for the child to hold.
    • Allow the child's rituals as long as they do not become too pronounced.
      • Rituals provide a sense of security and save adults time and energy.
    • Toddlers have short attention spans and may wander from the table or stand up in the highchair.
      • Make sure a safety belt is on when using a highchair, and always have someone with the child.
      • If the child has eaten a sufficient amount of food, they can be excused from the table.
      • Distract the child with crayons or special place mats if they have not eaten enough food.
    • Picky eaters have specific preferences regarding color, taste, texture, or smell.
      • They typically eat enough for growth and development.
    • Feeding disorders result in weight loss for over a month.
      • Children with feeding disorders refuse to eat or drink a variety of foods and liquids to maintain adequate growth and development.
      • The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), labels this behavior as “avoidance/resistance to food intake” that occurs before 6 years old.
    • A GI tract study should be done before using appetite-increase strategies.
    • Use orexigenic medications (appetite stimulators), consistent feeding expectations and environments, and gradual exposure to new smells, textures, and tastes to help children accept new foods.

    Daycare

    • Many children receive care outside the home setting.
    • The number of women with infants working is growing rapidly.
    • Daycare arrangements should meet the family's preferences, cultural perspective, financial constraints, and special needs.
    • Nurses can be supportive and advocate for families when finding appropriate childcare.
    • The decision of putting a child in daycare can be difficult and lead to feelings of guilt.
    • Successful alternative childcare arrangements depend on specific guidelines for each facility.
      • Frequent visits to the facility are recommended.
      • Maintain continuous communication with staff members.
    • Daycare for toddlers differs from that for preschoolers.
      • Toddlers have shorter attention spans.
      • Toddlers engage in parallel play instead of group play.
      • Closer supervision is required for toddlers' safety.
    • Various types of childcare exist.
      • Relatives, friends, neighbors, and advertised services.
      • Private businesses (for profit) subject to state regulations:
        • Physical layout, child-to-caretaker ratio, and education level of staff.
      • In-home care for sick children.
      • Employer-assisted services: referrals and reimbursement programs.
      • Government-assisted services for low-to-middle-income families.
    • All daycare facilities must meet safety standards through inspections.

    Injury Prevention

    • Accidents are the leading cause of death and disability in children.
    • Nurse's responsibility includes reviewing injury prevention at every clinic visit.
    • Demonstrate safety measures to the child and family members.
    • Community nurses should set good examples and be aware of available emergency facilities.
    • Consumer education is crucial.
      • The federal government and private agencies attempt to regulate variables that cause injury.
        • Nonflammable material for children's sleepwear.
        • Childproof caps on medication bottles.
        • Maximum temperatures for home hot water heaters.
        • Smoke detectors in public places.
        • Regulations on cribs.
      • Nurses should reinforce this type of information.
    • Car safety is paramount.
      • Placing a child in the front seat near the passenger airbag is dangerous.
      • Infants and small children must be in a car seat with the seatbelt secured properly.
      • Children under 2 years old should be in rear-facing car seats with a five-point harness.
      • Booster seats are necessary for children who outgrow car seats until the safety belt fits properly.
      • Once the child is large enough for the safety belt to fit, they can use it (over 36.6kg (80lbs), taller than 142.5cm (57 inches), and the belt should go across the shoulder and lap).
    • Home and public building safety:
      • New homes must have smoke and carbon monoxide detectors.
      • Older homes are encouraged to install these detectors.
      • Public buildings have mandatory safety codes.
    • Many children live in substandard housing with minimal supervision.
      • Nurses should educate parents on the importance of reducing incidents of death and disability.

    Toys and Play

    • The Children's Protection and Toy Safety Act was passed in 1970 to stop the distribution unsafe toys.
    • Teach parents how to inspect for routine damage and choose age-appropriate toys suitable for their child's capabilities.
    • Stay informed about toy recalls.
    • Expensive toys are not necessary.
      • Toddlers prefer pots and pans, supervised water play, dancing, crayons, finger paints, and picture books.
    • Tricycles and push or pull toys are better choices than wind-up toys.
      • Walking and running are developmental tasks at this age.
    • Supervision and safety maintenance are essential for positive play experiences.
    • Toddlers are becoming aware of their expanding environment.
      • They are shifting away from egocentric thinking (everything relating to themselves).
    • Toddlers engage in parallel play.
      • They play next to their peers, but not with them.
    • Cooperative play gradually develops at this age.
      • Imagination and sharing skills are developing.
      • Toddlers often believe all toys are theirs, leading to frustration and temper tantrums.
      • Calmly distract the child when they are frustrated, rather than immediately removing them from the play area.
    • Nurses should assess special needs children for safety precautions.
      • Children with visual, motor, or intellectual impairments, convulsive disorders, or diabetes mellitus require extensive instruction based on their specific needs.
      • Immobile children need protection from sunburn, wind, rain, mosquitoes, and other disease vectors.
      • Provide education on using electric outlet covers, cabinet locks, and drawer locks to create a hazard-free and childproof environment.

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    Explore key milestones and characteristics of infant development, including weight changes, object permanence, and sleep patterns. Understand the implications of co-sleeping and the challenges of colic in infants. This quiz will help you grasp essential knowledge for parenting and early childhood care.

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