3. Growth Physical and
Development
• INTRODUCTION
• The term infant derives from the Latin word
infants, meaning ‘’unable to speak or
speechless.’’ Infant is the time period after 28
days of birth up to one year.
• At no other time in life are physical changes
and developmental achievements as dramatic
as during infancy.
4. Introduction(Contd…)
All major body systems undergo
progressive maturation.
There is concurrent development of
skills that increasingly allow infants
to respond to and cope with the
environment.
5. Introduction ( Contd…)
• Acquisition of these fine and gross motor
skills occurs in an orderly head- to –toe and
center- to- periphery (cephalocaudal-
proximodistal) sequence.
6. Growth and Development of
Infants
• Physical Growth/biological development
Biologic growth during infancy includes changes
in weight, length, head and chest circumference,
vital signs, reflexes, dentition and physiologic
functioning.
7. Physical Growth (Contd…)
Age Group Physical Growth
1 month Weight gain of 150 to 210g
weekly for first 6 months.
Length increase by 1.5 cm
monthly for first 6 months
Doll’s eye reflex and dance
reflex for first 6 months
Head circumference
increases
Obligatory nose breathing
(most infants)
9. Physical Growth (Contd…)
4 months Drooling begins
Moro, tonic neck, and rooting reflexes have disappeared
5 months Beginning signs of tooth eruption
Birth weight doubles
10. Physical Growth (Contd…)
6 months Growth rate may begin to decline
Weight gain of 90 to 150 g weekly for next 6
months
Height gain of 1.25 cm monthly for next 6
months
Teething may begin with eruption of two
lower central incisors
Chewing and bitting occur
11. Physical Growth (Contd…)
7 months Eruption of upper central incisors
8 months Begins to show regular patterns in bladder
and bowel elimination
Parachute reflex appears
12. Physical Growth(Contd…)
9 months Eruption of upper lateral incisor may begin
10 months Labyrinth-righting reflex is strongest (when infant is
in prone or supine position;is able to raise head)
13. Physical Growth( Contd…)
11 months Eruption of lower lateral incisor may begin
12 months Birth weight tripled
Birth length increased by 50 %
Head and chest circumference equal (head
circumference 46 cm)
Has six to eight deciduous teeth
Anterior fontanel almost closed
Landau reflex fading
Babinski reflex disappears
Lumbar curve develops
14. Physiological Changes
/Maturation of Body System
RESPIRATORY SYSTEM
• Respiratory system becomes more mature
than neonate.
• Anatomical structure of upper respiratory tract
remains small, relatively dedicate and provides
in adequate protection against infectious
agents.
15. Physiological Changes(Contd…)
• The close proximity of the trachea to the
bronchi and its branching structures rapidly
transmits infectious agents from one anatomic
location to another.
• The short , straight eustachian tube closely
communicates with the ear.
• It allows infection to ascend from the pharynx
to the middle ear.
16. Physiological Changes(Contd…)
• Respiratory movement is abdominal
respiratory rate is 30-40 breath/ minute.
• The volume of dead space is large requiring
the infant to breathe double than adult.
• By one year, lining of the airway is developed
as that of adults.
17. CIRCULATORY/
CARDIOVASCULAR SYSTEM
• Complete closure of the fetal shunts may take
several months so physiological murmur may
be present.
• Apex beat is felt at the 4th intercostal space or
just lateral to the mid- clavicular line.
18. Circulatory ( Contd…)
• The heart rate slows, and the rhythm is often
sinus arrhythmia.
• Heart rate is decreases from 120-140 beats
/minute during newborn and 100 beats/ minute
at 1 year.
• Blood pressure also changes during infancy.
19. Circulatory ( Contd …)
• Systolic pressure rises during the first 3
months then gradually rises to values close to
those at birth.
• Fluctuations in blood pressure occur during
varying states of activity and emotion.
• Blood pressure at 0-3 month :65-85/45-55 mm
of Hg, at 3-6 month :70-90/50-65 mm of Hg,
at 6-12 month:80-100/55-65 mm Hg.
20. HEMATOPOIETIC SYSTEM
• Significant hematopoietic changes occur
during the first year of life.
• Fetal hemoglobin( HgbF) which is maternally
derived iron stores are present for the first 5
to 6 months of life and after that hemoglobin
level is gradually diminished .
• A common result at 3 to 6 months old is
physiologic anemia.
21. DIGESTIVE SYSTEM
• Digestive system is relatively immature at
birth.
• Adequate ability to digest , absorb and
matabolize human milk.
• The enzyme amyase (ptyaline) is present in
small amounts.
• In stomach , the action of hydrochloric acid
and rennin acts specifically on the casein in
milk to cause the formation of curds.
22. (Digestive Contd…)
• Stomach capacity 90-150 ml at one month ,
210-360 ml at one year.
• There is short emptying time of stomach i.e. 2-
3 hours.
• Rapid peristalsis movementand decrease
peristalsis after 8 month.
• Bowel pattern become stable after 6 months
and 2 times per day.
23. Digestive ( Contd…)
• The liver is the most immature of all the
gastrointestinal organs throughout infancy.
• Maturation of the sucking , swallowing and
breathing breflexes and the eruption of teeth.
• Tooth eruption start between 6-8 month of age
and lower central incisor is the first erupted
teeth.
24. RENAL/ URINARY SYSTEM
• Complete maturity of the kidneys occurs
during the latter half of the second year.
• Before this time, the filtration capacity of the
glomeruli is reduced.
• Urine is voided frequently and has a low
specific gravity(1.008 to 1.012).
25. Renal (Contd…)
• At term , most infants produce and excrete
approximately 15 to 60 ml/kg/24 hours.
• An output of less than 0.5 ml/kg/hour after 48
hours of age is considered to be oliguria.
• Fluid and electrolyte
• A shift in the total body fluid occurs.
26. Renal (Contd…)
• At birth ,78% of a term infant’s body weight is
water , and abundance of extracellular fluid
(ECF).
• The amount of ECF is decreased from 44% at
term to 20% in adulthood.
27. Renal (Contd…)
• At infancy, high proportion of ECF
predisposes to a more rapid loss of total body
fluid.
• The immaturity of the renal structures also
predisposes to dehydration and electrolyte
imbalance.
28. NERVOUS SYSTEM
• With increased size of head, brain grown 70-
90% of total size by 2 years.
• All brain cells are present by the end of the
first year.
29. Nervous (Contd…)
• Mature of the brain steam and spinal cord
follow cephalo-caudal and proximal distal
laws.
• Neonatal primitive reflexes are gradually
turned into voluntary purposeful movement.
30. ENDOCRINE SYSTEM
• Endocrine system is structurally adequate but
not functionally.
• Corticotrophins (ACTH) are produced in
limited quantities during infancy.
31. Endocrine (Contd…)
• During infancy , there is lack of homeostatic
control and functional deficiencies
• such as fluid and electrolytes imbalance ,
glucose concentration, amino-acid metabolism
etc.
32. IMMUNE SYSTEM
• Baby at term receive maternal
immunoglobulin G (Ig G) up to first 3 months.
• Begins the synthesize IgG by 3 months and
reaches upto 40% of adult levels by 9 month to
one year.
33. Immune System (Contd…)
• The function and quantity of T-lymphocytes
and lymphokinase is low in early infancy, so
IgG protect against E. coli and polio virus.
• The production of IgA and immunoglobulins
D and E (IgD and IgE ) is less and maximum
levels are not attained until early childhood.
34. Thermoregulation
• During infancy, thermoregulation becomes
more efficient.
• Tha ability of the skin to contract and of
muscles to shiver in response to cold increases.
• Peripheral capillaries are responsible to
changes in surrounding temperature to
regulate heat loss.
35. Thermoregulation (Contd…)
• Shivering (thermogenesis) causes the muscles
and muscle fibers to contract , generating
metabolic heat.
• Brown fat insulated the body against heat loss
during first 6 month.
• Sensory
36. Thermoregulation (Contd…)
• Touch:
touch is developed during infancy. It has
physiologic impact with psychological and
socio-cultural meaning for baby.
37. Sensory
• Ear:
• at birth, baby can respond to loud noise. At 2-3
weeks, baby can turn head towards sound
made at ear level.
• At 3-4 weeks , baby can locate sound by
turning head.
• At 8-12 weeks, baby can learn to control and
adjust own response to sound as listening for
the sound.
38. Sensory (Contd…)
• Eye:
• binocular fixation is established during
infancy. Visual equity at birth is 20/100.
• There is present of pupillary and corneal
reflexes.
39. REFERENCES
• Shrestha Tumla . Essential child health nursing.
1st edition. Medhavi publication; 2012.
• Sharma Rimpal. Essential of pediatric nursing. 1st
edition. Jaypee publication; 2013
• Wong Perry, Hockenberry and Lowdermilk
Wilson. Maternal Child Nursing Care. 3rd edition.
Mosby Elsevier Publications
• Ghai OP. Essential Pediatrics. New Delhi: 7th
edition. CBS Publishers & Distributors; 2009.
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