Newborn Growth and Development

• Promoting optimal growth and development occurs during the first year of life.

Biological Development

• A newborn gains 150-200 g of weight per week until 5-6 months of age.
• A newborns birth weight doubles by 6 months.
• A newborn triples their birth weight by 1 year.
• A newborns height increases 2.5 cm per month for 6 months.
• Growth occurs in newborn babies in spurts rather than gradual patterns.

Fine Motor Development

• A newborn can grasp objects with their hands between 2-3 months of age.
• A newborn can transfer objects between their hands at 7 months of age.
• A newborn develops a crude pincer grasp at 8 months, and a refined pincer grasp at 11 months of age.
• A newborn can remove objects from a container at 11 months.
• A newborn can build a tower of 2 blocks at 12 months.

Gross Motor Development

• A newborn has well established head control by 4–6 months of age.
• A newborn rolls over between 5-6 months of age.
• A newborn sits unsupported at 8 months of age, and with support at 7 months.
• A newborn moves from prone to sitting position at 10 months.

Mobility

• Directional development of mobility is cephalocaudal.
• Newborns can creep at 6 to 7 months, crawl at 9 months, walk with help at 11 months, and walk on their own at 12 months.
• Babies can bear full weight on their feet by 7 months.
• Babies can maneuver from sitting to kneeling position.
• Babies can stand by holding onto furniture at 9 months.
• Babies can take step at 10 months.
• Babies creep on hands and knees at 9 months.

Additional milestones by 12 months of age:

• Pulling themselves into a standing position.
• Understanding the word "No."
• Some may sleep in with parents in certain cultures.
• They will have 6 teeth (age in months -6).
• They can have water liberally.

Psychosocial Development

• The first period of Erikson’s phases includes an infant acquiring a sense of trust while overcoming a sense of mistrust.
• This period lasts from birth to 1 year.
• During the first 3-4 months, food intake is a baby's most important social activity.
• Reaching out through grasping is a baby's next modality.
• A more active stage is next, including biting.
• Babies develop trust when their needs are met consistently and predictably, and they are comforted.
• Attachment can be secure or insecure.

Characteristics of Secure Attachment

• As children, secure attachments are able to separate from parents, seek comfort from their parents when frightened, great parents return with positive emotions and perfer parents to strangers.
• As adults, secure attachments are able to have trusting relationships, have high self-esteem, are comfortable sharing feelings with friends and partners, and seek out social support.

Insecure/Ambivalent Attachment Style

• People with insecure attachment styles may have developed some type of mistrust as a child due to parental absence or sporadic care.
• As children, insecure attachments may be wary of strangers, become greatly distressed when parents leave, and may not appear to comforted when their parents return.
• As adults, insecure attachments may be reluctant to become close to others, worry their partner does not love them, and become very distraught when relationships end.
• Erikson theorized that if a child does not learn to trust in the first 18 months of life, all areas of their life will be affected.

Cognitive Development

• Piaget theory (1952) includes the sensorimotor phase.
• From birth to 1 month, babies engage in the reflex stage.
• From 1-4 months, babies engage in primary circular reaction stage.
• From 4-8 months, babies engage in secondary circular reaction stage.
• Deliberate movements lead to a response reaction.
• Babies begin to engage in imitation, play and affect. Also reflexes vs. voluntary acts

Development of Body Image

• Babies start understanding object permanence
• By the end of first year recognize that they are distinct from parents

Social Development

• Separation anxiety
• Stranger fear
• Language development
• Play
• Behaviors related to fear of strangers include clinging to the parent and turning away from the stranger.

Coping with Concerns Related to Normal Growth and Development

• Separation and stranger fear
• Alternative child care arrangements
• Limit-setting and discipline
• Thumb-sucking and use of a pacifier
• Teething
• Infant shoes

Promoting Optimum Health During Infancy

• A breast milk should be the only food for a baby for the first 6 months of life.
• In months 6-12 its appropriate to select and prepare solid foods, introduce solid foods, begin the weaning process for both bottle and breast feeding.

Sleep and Activity

• Infants are naturally active.
• Walkers, swings, and playpens are not necessary.
• Sleep problems must be managed.
• The concept of graduated extinction is of value in managing nighttime crying.
• It's important to question whether the Ferber method could be abusive.

Dental Health

• Good maternal dental health during pregnancy
• Cleaning initiated at eruption of primary teeth
• Consider fluoride at 6 months of age
• Prevention of dental cavities

Immunizations from Birth to 6 Months

• Hepatitis A and B viruses
• Diphtheria (throat/ respiratory system)
• Tetanus (motor neurons)
• Pertussis (Whooping cough)
• Polio (viral/ fecal-oral route/paralysis
• Measles, mumps, rubella (current outbreak in BC)
• Vaccinations also help prevent blindness, encephalitis, extreme dehydration, ear infections, and pneumonia.
• The WHO has declared in 2019 that vaccine hesitancy is one of the top 10 threats to global health.
• Vaccine hesitancy reverses any progress made in treating vaccine-preventable diseases.
• Additional vaccinations include Pneumococcus, Haemophilus influenzae type B, Varicella (chickenpox), Influenza, and Meningococcus.
• Recommendations are available for selected immunizations for selected groups of children to address Rotavirus and the human papillomavirus.
• Reactions and contraindications should always be considered along with compliance and administration.
• VAERS Vaccine Adverse Event Reporting System is used to report adverse reactions after vaccine administration.
• Vaccine Information Statements provide details to parents before vaccine administration.
• Updated information is provided to the child's parent or guardian before vaccination.

Injury Prevention

• Aspiration of foreign objects
• Suffocation
• Motor vehicle injuries
• Falls
• Poisoning
• Burns
• Drowning
• Bodily damage
• Shaken baby syndrome & intentional injury

Feeding Difficulties

• Regurgitation and spitting up.
• Colic (paroxysmal abdominal pain requiring therapeutic management)
• Growth failure.
• Organic failure to thrive (FTT) and nonorganic FTT are no longer used.
• Classifications, diagnosis, and prognosis are all assessed.
• The "colic carry" may be comforting to an infant with colic.

Positional Plagiocephaly

• Positional Plagiocephaly can occur after following the "Back to Sleep" campaign since 1999.
• Babies needs tummy time for their heads to grow properly.
• Diagnostic evaluation and therapeutic and nursing care management can address this issue.

Disorders of Unknown Etiology

• Sudden infant death syndrome (SIDS)
• Etiology and nursing care management strategies can be learned.
• Finding the infant may require arriving at the emergency department and returning home.