INFANCY (1-12 MONTHS)

INFANCY (1-12 MONTHS)

I.              Development

a.     Erickson

                                          i.    Trust vs. Mistrust

1.     FEARS: Stranger anxiety; loud noises, falls, sudden movement in the environment.

2.     PLAY: SOLITARY:reflect development and awareness ofthe environment.

3.     AGE APPROPRIATE TOYS

4.     Birth – 3 months: mobiles, mirrors, music boxes, rattles,stuffed animals without detachable parts

5.     4-6 Months: squeeze toys, busy boxes and play gyms

6.     7-9 Months: cloth-textured toys, splashing toys, large blocks and large balls

7.     10-12 Months: durable books, with large pictures, large building blocks,  nesting cups, and push-pull toys

DEVELOPMENTAL MILESTONES OF AN INFANT

1-4 MONTHS    

            1^st month                       turns head from side to side

                                                Midline vision

                                                Development of reflexes

                                                Cooing (1-2 months)

            2^nd month                      cooing

                                                Social smile

                                                Laugh

      3^rd month                      head lag disappears

                                          Fading of reflexes

                                          Familiarize environment

                                          Babbles (from 3-5 months)

      4^th month                       disappearance of reflexes

                                          Interact with the environment

                                          Babbles

5-6 MONTHS

      5^th month                       rolls from front to back and vice versa

                                          Smiles at the mirror

                                          Grasp voluntarily

                                          Babbles

      6^th month                       birthweight doubles

                                          Start of stranger anxiety

                                          Eruption of the 1^st tooth (lower mandibular central incisor)

                                          Imitate sounds

                                          1^st solid food

     

7-9 MONTHS

      7^th month                       sit with support

                                          Crawls with belly on the floor

                                          Verbalize vowels

      8^th month                       peak of stranger anxiety

                                          Sit without support

                                          Dada and mama for the first time

      9^th month                       crawls with belly off the floor

                                          Pulls up to stand

                                          Start of the pincer grasp

                                          Understand the word “NO”

10-12 MONTHS

      10^th month                     holds on to furniture while walking (cruising)

                                          Pincer grasp is well develop

                                          Say and understand mama and dada

      11^th month                     walks with assistance

      12^th month                     walks without assistance

                                          BW triples

                                          BL increased by 50%

                                          Say 4-10 words in correct context

13-16 MONTHS                   Masters walking

16-18 MONTHS                   throws a ball overhand

                                          Imitates household chores

2 years old              ran, walk backwards and hop on one foot

TOYS FOR THE INFANT

1-3 months              rattle

4-6 months              squeeze toys

7-9 months              large balls

                                          Large blocks

10-12 months                      push and pull toys

                                          Large blocks

Clay is not included! – it is toxic

STOOLS

1. MECONIUM      - 1^st 48h; “thick, black green and sticky”
2. TRANSITIONAL – 3^rd day; meconium combined with yellow-brown to greenish brown milk stool
3. MILK – 4 days and more
1. Breastfed – golden yellow
2. Bottlefed – brown

REFLEXES

NEONATAL REFLEXES

Neonatal reflexes or primitive reflexes are the inborn behavioral patterns that develop during uterine life. They should be fully present at birth and are gradually inhibited by higher centers in the brain during the first three to 12 months of postnatal life. These reflexes, which are essential for a newborn's survival immediately after birth, include sucking, swallowing, blinking, urinating, hiccupping, and defecating. These typical reflexes are not learned; they are involuntary and necessary for survival.

1. sucking reflex

-       is triggered by placing a finger or the mother's nipple in the infant's mouth. The neonate will suck on the finger or nipple forcefully and rhythmically and the sucking is coordinated with swallowing. Like the rooting reflex, it is inhibited by the third to fourth month.

2. moro or startle reflex

-       occurs when an infant is lying in a supine position and is stimulated by a sudden loud noise that causes rapid or sudden movement of the infant's head. This stimulus results in a symmetrical extension of the infant's extremities while forming a C shape with the thumb and forefinger. This is followed by a return to a flexed position with extremities against the body. Inhibition of this reflex occurs from the third to the sixth month.

-       An asymmetrical response with this reflex may indicate a fractured clavicle or a birth injury to the nerves of the arm.

-       Absence of this reflex in the neonate is an ominous implication of underlying neurological damage.

3. tonic reflex
1. Asymmetrical tonic neck reflex (sometimes called the tonic labyrinthine reflex) is activated as a result of turning the head to one side. As the head is turned, the arm and leg on the same side will extend while the opposite limbs bend, in a pose that mimics a fencer. The reflex should be inhibited by six months of age in the waking state. If this reflex is still present at eight to nine months of age, the baby will not be able to support its weight by straightening its arms and bringing its knees beneath its body.
2. Symmetrical tonic neck reflex occurs with either the extension or flexion of the infant's head. Extension of the head results in extension of the arms and flexion of the legs, and a flexion of the head causes flexion of the arms and an extension of the legs. This reflex becomes inhibited by the sixth month to enable crawling

4. palmar grasp

-       Grasping reflex occurs as the palmar reflex when a finger is placed in the neonate's palm and the neonate grasps the finger. The palmar reflex disappears around the sixth month. Similarly, the plantar reflex occurs by placing a finger against the base of the neonate's toes and the toes curl downward to grasp the finger. This reflex becomes inhibited around the ninth to tenth month.

5. rooting reflex

-       is stimulated by touching a finger to the infant's cheek or the corner of the mouth. The neonate responds by turning the head toward the stimulus, opening the mouth and searching for the stimulus. This is a necessary reflex triggered by the mother's nipple during breastfeeding. It is usually inhibited by the third to fourth month.

6. extrusion reflex

-

7. Babinski or plantar reflex is triggered by stroking one side of the infant's foot upward from the heel and across the ball of the foot. The infant responds by hyperextending the toes; the great toe flexes toward the top of the foot and the other toes fan outward. It generally becomes inhibited from the sixth to ninth month of post natal life.
8. Blink reflex is stimulated by momentarily shining a bright light directly into the neonate's eyes causing him or her to blink. This reflex should not become inhibited.
9. Pupillary reflex occurs with darkening the room and shining a penlight directly into the neonate's eye for several seconds. The pupils should both constrict equally; this reflex should not disappear.
10. Galant reflex - is stimulated by placing the infant on the stomach or lightly supporting him or her under the abdomen with a hand and, using a fingernail, gently stroking one side of the neonate's spinal column from the head to the buttocks. The response occurs with the neonate's trunk curving toward the stimulated side. This reflex can become inhibited at any time between the first and third month.
11. Stepping reflex - is observed by holding the infant in an upright position and touching one foot lightly to a flat
12. Prone crawl reflex can be stimulated by placing the neonate prone (face down) on a flat surface. The neonate will attempt to crawl forward using the arms and legs. This reflex will be inhibited by three to four months of age.

Reflex	Stimulation	Response	Duration
SOURCE: Table after Child Development, 6th ed. Wm. C. Brown Communications, Inc., 1994.
Babinski	Sole of foot stroked	Fans out toes and twists foot in	Disappears at nine months to a year
Blinking	Flash of light or puff of air	Closes eyes	Permanent
Grasping	Palms touched	Grasps tightly	Weakens at three months; disappears at a year
Moro	Sudden move; loud noise	Startles; throws out arms and legs and then pulls them toward body	Disappears at three to four months
Rooting	Cheek stroked or side of mouth touched	Turns toward source, opens mouth and sucks	Disappears at three to four months
Stepping	Infant held upright with feet touching ground	Moves feet as if to walk	Disappears at three to four months
Sucking	Mouth touched by object	Sucks on object	Disappears at three to four months
Swimming	Placed face down in water	Makes coordinated swimming movements	Disappears at six to seven months
Tonic neck	Placed on back	Makes fists and turns head to the right	Disappears at two months