Health promotion of Infant .pptx

HEALTH
PROMOTION IN INFANT
Mrs. D. Melba Sahaya Sweety RN,RM
PhD Nursing , MSc Nursing (Pediatric Nursing), BSc
Nursing
Associate Professor
Department of Pediatric Nursing
Enam Nursing College, Savar, 1

INTRODUCTION
• The infancy period is one of rapid motor, cognitive, and social development. Through
mutuality with the caregiver (parent), the infant establishes a basic trust in the world and the
foundation for future interpersonal relationships. The critical first month of life, although part
of the infancy period, is often differentiated from the remainder because of the major physical
adjustments to extrauterine existence and the psychological adjustment of the parent.
Adequate growth and development are indicative of health in the infant or young child. Nurses
must be familiar with normal developmental milestones so that they can accurately assess the
infant’s development as well as provide age-appropriate anticipatory guidance to the parents.
2

ORGAN SYSTEM MATURATION
OF INFANT
Organ System Maturation
Neurologic
System
 The nervous system continues to mature throughout infancy, and the
increase in head circumference is indicative of brain growth.
 The brain undergoes tremendous growth during the first 2 years of life.
 By 6 months of age the infant’s brain weighs half that of the adult brain.
 At age 12 months, the brain has grown considerably, weighing 2½ times
what it did at birth. Usually, the anterior fontanel remains open until 12 to
18 months of age to accommodate this rapid brain growth.
 Maturation of the nervous system and continued myelination are
necessary for the tremendous developmental skills that are achieved in
the first 12 months.
 During the first few months of life, reflexive behavior is replaced with
purposeful action. 3

OF INFANT
Neurologic
System
 Selected primitive reflexes present at birth include Moro, root, suck,
asymmetric tonic neck, plantar and palmar grasp, step, and Babinski.
 Except for the Babinski, which disappears around 1 year of age, these
primitive reflexes diminish over the first few months of life, giving
way to protective reflexes
Respiratory
System
 The respiratory rate slows from an average of 30 to 60 breaths in the
newborn to about 20 to 30 in the 12-month-old.
 The newborn breathes irregularly, with periodic pauses.
 In comparison with the adult, in the infant:
• The nasal passages are narrower.
• The trachea and chest wall are more compliant.
• The bronchi and bronchioles are shorter and narrower. 4

OF INFANT
Respiratory
System
• The larynx is more funnel shaped.
• The tongue is larger.
• There are significantly fewer alveoli.
 These anatomic differences place the infant at higher risk for respiratory
compromise.
 The respiratory system does not reach adult levels of maturity until
about 7 years of age.
 The lack of immunoglobulin A (IgA) in the mucosal lining of the upper
respiratory tract also contributes to the frequent infections that occur in
infancy.
Cardiovascular
System
 The heart doubles in size over the first year of life.
5

OF INFANT
Cardiovascular
System
 The heart doubles in size over the first year of life.
 As the cardiovascular system matures, the average pulse rate decreases
from 120 to 140 in the newborn to about 100 in the 1-year-old.
 Blood pressure steadily increases over the first 12 months of life, from
an average of 60/40 in the newborn to 100/50 in the 12-month-old.
 The peripheral capillaries are closer to the surface of the skin, thus
making the newborn and young infant more susceptible to heat loss.
 Over the first year of life, thermoregulation (the body’s ability to
stabilize body temperature) becomes more effective: the peripheral
capillaries constrict in response to a cold environment and dilate in
response to heat.
6

OF INFANT
Gastrointestinal
System
 On average, the first primary teeth begin to erupt between the ages of 6
and 8 months.
 The primary teeth (also termed deciduous teeth) are lost later in
childhood and will be replaced by the permanent teeth.
 The gums around the emerging tooth often swell.
 The lower central incisors are usually the first to appear, followed by
the upper central incisors.
 The average 12-month-old has four to eight teeth.
 Small amounts of saliva are present for the first 3 months of life and
ptyalin is present only in small amounts in the saliva.
 Gastric digestion occurs as a result of the presence of hydrochloric
acid and rennin. 7

OF INFANT
Gastrointestinal
System
 The small intestine is about 270 cm long and grows to the adult length
over the first few years of life .
 The stomach capacity is relatively small at birth, holding about one-
half to 1 ounce. However, by 1 year of age the stomach can
accommodate three full meals and several snacks per day.
 In the duodenum, three enzymes in particular are important for
digestion. Trypsin is available in sufficient quantities for protein
digestion after birth. Amylase (needed for complex carbohydrate
digestion) and lipase (essential for appropriate fat digestion) are both
deficient in the infant and do not reach adult levels until about 5
months of age.
 The liver is also immature at birth. The ability to conjugate bilirubin
8

OF INFANT
Gastrointestinal
System
and secrete bile is present after about 2 weeks of age. Conjugation of
medications may remain immature over the first year of life.
 Other functions of the liver, including gluconeogenesis, vitamin
storage, and protein metabolism, remain immature during the first year
of life.
 Breastfed infants’ stools are usually looser in texture and appear seedy
 Due to the immaturity of the gastrointestinal system, newborns and
young infants often grunt, strain, or cry while attempting to have a
bowel movement.
Genitourinary
System
 In the infant, extracellular fluid (lymph, interstitial fluid, and blood
plasma) accounts for about 35% of body weight and intracellular fluid
accounts for 40%, compared with the adult quantities of 20% and 40%,
9

OF INFANT
Genitourinary
System
respectively . Thus, the infant is more susceptible to dehydration.
 Infants urinate frequently and the urine has a relatively low specific gravity.
 The renal structures are immature and the glomerular filtration rate, tubular
secretion, and reabsorption as well as renal perfusion are all reduced
compared with the adult.
 The glomeruli reach full maturity by 2 years of age.
Integumentary
System
Newborns often experience mottling of the skin (a pink-and-white marbled
appearance) because of their immature circulatory system. Mottling decreases
over the first few months of life.
The young infant’s skin is relatively thinner than that of the adult, with the
peripheral capillaries being closer to the surface. This may cause increased
absorption of topical medications. 10

OF INFANT
Hematopoietic
System
 HgbF has a shorter lifespan than HgbA, infants may experience
physiologic anemia at age 2 to 3 months.
 During the last 3 months of gestation, maternal iron stores are
transferred to the fetus. The newborn typically has 0.3 to 0.5 g of
iron stores available.
 As the high hemoglobin concentration of the newborn decreases
over the first 2 to 3 months, iron is reclaimed and stored. These
stores may be sufficient for the first 6 to 9 months of life but will
become depleted if iron supplementation does not occur.
 Ongoing iron intake is required throughout the first 15 years of
life in order to reach adult levels 11

OF INFANT
Immunologic
System
 Newborns receive large amounts of IgG through the placenta
from their mothers. This confers immunity during the first 3
to 6 months of life for antigens to which the mother was
previously exposed.
 Infants then synthesize their own IgG, reaching
approximately 60% of adult levels at age 12 months.
 IgM is produced in significant amounts after birth, reaching
adult levels by 9 months of age.
 IgA, IgD, and IgE production increases very gradually,
maturing in early childhood. 12

INFANCY DEVELOPMENTAL CHART
Achievements
During Infancy
Tasks for the Family Health Supervision
Outcomes
■Good physical
health and growth
■ Regular sleep
pattern
■ Self-quieting
behavior
■ Sense of trust
■ Family adaptation
to infant
■ Meet infant’s
nutritional needs
■ Establish regular
eating and sleeping
schedule
■ Prevent early
childhood caries (baby
bottle tooth decay)
■ Prevent injuries and
abuse
■ Formation of
partnership
(“therapeutic
alliance”) between
health professional
and parents
■ Preparation of
parents for new role
■ Optimal nutrition
■ Injury prevention
Health professionals should assess the achievements of the infant and
provide guidance to the family on anticipated tasks. The effects are
demonstrated by health supervision outcomes.
13

INFANCY DEVELOPMENTAL CHART
Achievements
During Infancy
Tasks for the Family Health Supervision
Outcomes
■ Attachment
between infant
and parents
■ Healthy
sibling
interactions
■ Obtain appropriate
immunizations
■ Promote normal development
■ Promote warm, nurturing
parent-infant relationship
■ Promote responsiveness and
social competence
■ Encourage vocal interactions
with parents, siblings, and others
■ Encourage play with toys,
siblings, parents, and others
■ Encourage safe exploration of
the environment
■ Satisfactory growth
and development
■ Immunizations
■ Promotion of
developmental potential
■ Prevention of
behavioral problems
■ Promotion of family
strengths
■ Enhancement of
parental effectiveness
14

STRENGTHS DURING
INFANCY
• Health professionals should remind families of their strengths during the health
supervision visit. Strengths and issues for infant, family, and community are
interrelated and interdependent.
Infant Family Community
■ Is welcomed at birth
by parents
■ Has good physical
health and nutrition
■ Grows normally
■ Has normal eating,
bowel, sleep patterns
■ Meets infant’s basic needs (food,
shelter, clothing, health care)
■ Provides strong, nurturing family
■ Provides a safe, childproof
environment (smoke alarms, infant
safety seat)
■Enjoys and develops loving
relationship with infant
■ Provides support to new
parents (parenting classes,
support groups)
■ Provides educational
opportunities for parents
■ Provides support for families
with special needs
■ Provides outreach to identify
15

STRENGTHS DURING
INFANCY
■ Has positive, cheerful,
friendly temperament
■ Feels parents’
unconditional love
■ Responds to parents and
others
■ Is attached to parents and
trusts them
■ Smiles, vocalizes
■ Is adaptable
■ Has self-comforting
behaviors
■ Responds to infant’s developmental
needs
■ Responds to and encourages infant‘s
interactive behaviors
■ Offers emotional support and
comfort when needed
■ Encourages safe exploration ■ Sets
appropriate limits
■ Parents are physically and mentally
healthy
uninsured or underinsured
children and facilitates
enrollment in health
insurance programs and
access to care
■ Provides affordable,
quality child care
■ Provides an
environment free of
hazards
■ Ensures that
neighborhoods are safe
16

STRENGTHS DURING
INFANCY
■ Explores environment
actively
■ Plays with toys
■ Achieves developmental
milestones
■ Parents have a strong
relationship with each other
and opportunities to nurture
their relationship
■ Parents share care of infant
■ Siblings are interested in and
involved with infant in age
appropriate ways
■ Has support of extended
family and others
■ Provides affordable housing
and public transportation
■ Develops integrated systems
of health care
■ Fluoridates drinking water
■ Promotes community
interactions (neighborhood
watch programs, support
groups, community centers)
■ Promotes positive
ethnic/cultural environment
17

ISSUES DURING INFANCY
Preterm birth
■ Congenital
disabilities
■ Feeding
problems ■ Food
or drug allergies
■ Sleep
problems
■ Sleeping with
bottle
■ Parents or other family
members with serious
problems (abusive,
depressed,
overprotective, mentally
ill, incarcerated)
■ Severe marital
problems
■ Frequently absent
parent
■ Unsafe
neighborhood
■ Inadequate
housing
■ Environmental
hazards
■ Poverty
■ Discrimination and
prejudice
Health professionals should address problems, stressors, concerns, and
other issues that arise during health supervision. Strengths and issues for
infant, family, and community are interrelated and interdependent.
18

■ Early childhood
caries (baby bottle
tooth decay)
■ Fussing, crying,
colic, irritability
■ Infections, illnesses
■ Constipation,
diarrhea
■ Undernutrition
(failure to thrive)
■ Iron-deficiency
anemia
■ Chronic illness
■ Domestic violence
(verbal, physical, or
sexual abuse)
■ Rotating “parents”
(parents‘ male or female
partners)
■ Inadequate child care
■ Family health
problems (illness,
chronic illness,
disability)
■ Substance use
(alcohol, drugs,
tobacco)
■ Community violence
■ Few opportunities for
employment
■ Lack of affordable,
quality child care
■ Lack of programs for
families with special needs
(WIC, early intervention)
■ Isolation in a rural
community
■ Lack of educational
programs and social
services for adolescent
parents 19

■
Development
al delay
■ Financial insecurity ■ Homelessness
■ Family transitions (move, births,
divorce, remarriage, death)
■ Lack of knowledge about infant
development
■ Lack of parenting skills or parental self-
esteem, especially in adolescent parent
■ Inability to cope with stress of multiple
roles
■ Sleep deprivation, lack of time for self
■ Intrusive family members
■ Lack of social support/help with
newborn and siblings
■ Neglect or rejection of child
■ Lack of social,
educational, cultural,
and recreational
opportunities
■ Lack of access to
immunizations and to
medical and oral
health services
■ Inadequate public
services (lighting,
transportation, garbage
removal)
■ Inadequate fluoride
in drinking water 20

ANTICIPATORY
GUIDANCE FOR THE
INFANT FAMILY
21

ANTICIPATORY GUIDANCE
FOR THE INFANT FAMILY
1, Promotion of Healthy and Safe Habits
(i) Injury and Illness Prevention
Continue to use a rear-facing infant safety seat that is properly secured in the
back seat of the car each time.
Never place your baby’s safety seat in the front seat of a vehicle with a passenger
air bag. The back seat is the safest place for children of any age to ride.
Continue to put your baby to sleep on his back or side; advise your relatives and
child care providers to so the same.
For healthy babies, back sleeping is preferred and reduces the risk of sudden
infant death syndrome (SIDS). 22

Do not use soft bedding (blankets, comforters, quilts, pillows), soft toys, or toys
with loops or string cords.
Keep the room temperature comfortable and be sure your baby doesn’t get too
warm while sleeping.
Continue to keep your baby’s environment free of smoke.
Make your home and car nonsmoking zones.
Keep your baby out of chronically moldy, water damaged environments.
Never leave your baby alone or with a young sibling or a pet.
Test the water temperature with your wrist to make sure it is not hot before
bathing your baby. 23

Do not leave your baby alone in a tub of water or on high places such as
changing tables, beds, sofas, or chairs.
Always keep one hand on your baby.
Wash your hands frequently, especially after diaper changes and before feeding
your baby.
Install smoke alarms if not already in place and make sure they work properly.
Test them monthly.
Keep your baby out of direct sunlight.
 Never, never shake your baby. Be aware of the damage shaking can cause.
Do not drink hot liquids or smoke while holding your baby. 24

Keep toys with small parts or other small or sharp objects out of reach.
Learn first aid and infant cardiopulmonary resuscitation (CPR).
Contact your health professional to assess early signs of illness: • Fever of
100.4ºF/38.0ºC or higher (rectal temperature) • Seizure • Skin rash or purplish
spots • Any change in activity or behavior that makes you uncomfortable •
Unusual irritability, lethargy • Failure to eat • Vomiting • Diarrhea • Dehydration
Know what to do in case of emergency: • When to call the health professional •
When to go to the emergency department
Fourth Month Infant:
Keep sharp objects (e.g., scissors, knives) out of reach.
Do not give your baby plastic bags or latex balloons. 25

Use safety locks on cabinets.
Do not put your baby in an infant walker at any age.
Sixth Month Infant:
Install safety devices on drawers and cabinets in your baby’s play areas.
Install gates at the top and bottom of stairs, and place safety locks and guards on
windows.
Remove dangling telephone, electrical, blind, or drapery cords near your baby’s
crib or play areas.
Keep small appliances out of your baby’s reach.
Place plastic plugs in electrical sockets. 26

Keep pet food and dishes out of reach. Do not permit your baby to approach the
dog or other pets while they are eating.
Do not put your baby in an infant walker at any age
Ninth Month Infant:
Keep all poisonous substances, medicines, cleaning agents, health and beauty aids,
and paints and paint solvents locked in a safe place out of your baby’s sight and
reach. Never store poisonous substances in empty jars or soda bottles.
(B) Nutrition
Be sure that your baby is gaining weight.
If you are breastfeeding: Be sure that breastfeeding is of appropriate frequency and
duration. Eat healthy foods and drink plenty of liquids. Talk with the
27

health professional about any problems you are having with breastfeeding.
Talk with the health professional about giving your breastfed baby a daily
supplement of vitamin D if you are vitamin D–deficient or if your baby does not
receive adequate exposure to (indirect) sunlight.
 If you are bottle feeding: Be sure that your baby receives a sufficient amount of
iron-fortified formula at the appropriate frequency.
Hold your baby in a semi-sitting position to feed him.
Do not warm expressed breastmilk or formula in containers or jars in a
microwave oven.
Continue to breastfeed or to use iron-fortified formula for the first year of your
baby’s life. This milk will continue to be his major source of nutrition. 28

Delay the introduction of solid foods until your baby is ready, usually at about 4 –
6 months of age.
Do not give your baby honey during the first year. It is a source of spores that can
cause botulism in infancy.
Sixth Month Infant:
Begin to introduce a cup for water or juice.
Limit juice to 2 to 4 ounces per day.
When your baby is developmentally ready, introduce one new solid food at a
time. Wait 1 week or more before offering each new food to see if there are any
adverse reactions. Start with an iron fortified, single-grain cereal such as rice.
29

Gradually increase the variety of foods offered, starting with puréed vegetables and
fruits and then meats.
 Serve solid food two or three times per day. Let your baby indicate when and
how much she wants to eat.
Avoid giving your baby foods that may be inhaled or cause choking (e.g., no
peanuts, popcorn, hot dogs or sausages, carrot sticks, celery sticks, whole grapes,
raisins, corn, whole beans, hard candy, large pieces of raw vegetables or fruit,
tough meat).
Always supervise your baby while she is eating. Learn emergency procedures for
choking.
Be sure that your caregiver is feeding your baby appropriately. 30

Ninth Month Infant:
Gradually increase the variety and amount of table foods offered to your baby.
The foods should be soft, moist, and easy to eat (e.g., tuna fish; cooked, mashed
vegetables; spaghetti and sauce).
Encourage your baby to feed himself as much as possible. Continue to offer your
baby drinks in a cup.
(C) Oral Health
To avoid developing a habit that will harm your baby’s teeth, do not put him to
bed with a bottle containing juice, milk, or other sugary liquid.
Do not prop the bottle in his mouth. Bacteria that cause early childhood caries
(baby bottle tooth decay) can be passed on to your baby through your saliva.31

ANTICIPATORY GUIDANCE FOR
THE INFANT FAMILY
To protect your baby’s teeth and prevent decay, practice good family oral health
habits (e.g., brushing, flossing)
Sixth Month Infant:
Do not put your baby to bed with a bottle containing juice, milk, or other sugary
liquid, prop the bottle in her mouth, or allow drinking from a bottle at will during
the day.
Clean your baby’s gums and teeth daily. Use a clean, moist washcloth to wipe the
gums. Use a soft toothbrush to clean the teeth with water only, beginning with the
eruption of her first tooth.
Give your baby fluoride supplements as recommended by your dentist, based on
the level of fluoride in your baby’s drinking water. 32

THE INFANT FAMILY
(D) Infant Care
Discuss any questions or concerns you have about
 Skin and nail care: bathing, soaps, lotions, diaper area preparations, detergent
 Crying and colic
 Thumb sucking and pacifiers
 Normal sleep patterns, sleeping arrangements
 Bowel movements: Patterns may vary
 Use of thermometer: A rectal temperature of 100.4ºF/38.0ºC is considered a
fever. Use of a rectal thermometer is preferred; temperature should not be taken
by mouth until 4 years of age. 33

THE INFANT FAMILY
2, Promotion of Parent-Infant Interaction
 Learn about your baby’s temperament (e.g., active, quiet, sensitive, demanding, easily
distracted) and how it affects the way he relates to the world.
 Try to console your baby, but recognize that he may not always be consolable regardless of
what you do. Crying may increase during the next few weeks, including a possible peak of
approximately 3 hours per day at 6 weeks of age. Ask about strategies to console your
baby.
 Nurture your baby by holding, cuddling, and rocking him, and by talking and singing to
him.
 Spend time playing and talking with him during his quiet, alert states.
Fourth Month Infant:
 Read to your baby. 34

THE INFANT FAMILY
 Play music and sing to him.
 Play games such as pat-a-cake, peek-a-boo, so-big.
 Encourage play with age-appropriate toys.
 Establish a bedtime routine and other habits to discourage night waking. Encourage your
baby to learn to console himself by putting him to bed awake.
 Begin to help your baby learn self-consoling techniques by providing him with the same
transitional object—such as a stuffed animal, blanket, or favorite toy—at bedtime or in
new situations.
 Talk with the health professional about your baby’s temperament and how you are dealing
with it.
Sixth Month Infant:
 Provide opportunities for safe exploration.
35

THE INFANT FAMILY
Continue to provide regular structure and routines for your baby to increase her sense of
security.
Encourage your baby’s vocalizations. Talk to him during dressing, bathing, feeding,
playing, and walking.
Ninth Month Infant:
Talk with the health professional about any problems your baby is having with
separation anxiety
Read to your baby. Give him cloth and hard cardboard picture books.
Play music and sing songs with your baby
Establish simple rules (e.g., “don’t touch”) and set limits by using distraction or
separating your baby from the object or stimulus. 36

THE INFANT FAMILY
3,Promotion of Constructive Family Relationships and Parental
Health
 For the mother returning to work: Discuss ways to continue breastfeeding, and feelings
about leaving your baby.
Continue to try to rest and take time for yourself. Talk to your health professional if you
are feeling depressed, overwhelmed, or overtired.
Spend some individual time with your partner.
Keep in contact with friends and family members.
Avoid social isolation.
Encourage your partner to participate in the care of the baby.
Continue to provide attention to the other children in the family, appropriately engaging
37

THE INFANT FAMILY
them in the care of the baby.
Have your postpartum checkup. If you decide to become pregnant again, your
next baby will be healthier if there is adequate spacing between the pregnancies.
Discuss family planning with the health professional and with your partner.
Ninth Month Infant:
Talk with the health professional about the siblings’ reactions to the baby’s
explorations
Choose babysitters and caregivers who are mature, trained, responsible, and
recommended by someone you trust.
 Encourage your partner’s involvement in health supervision visits and infant
care.
38

COMMON INJURY
PREVENTION FOR
INFANT
39

INJURY PREVENTION
FOR INFANT
Risk for Injury Prevention
Birth to Fourth Month
Aspiration  Aspiration is not as great a danger to this age group, but parents should begin
practicing safeguarding early.
 Never shake baby powder directly on infant; place powder in hand and then
on infant's skin; store container closed and out of the infant's reach.
 Hold infant for feeding; do not prop bottle.
 Know emergency procedures for choking.
 Use pacifier with one-piece construction and loop handle.
Burns  Install smoke detectors in home.
 Do not use microwave oven to warm formula; always check temperature of
liquid before feeding.
 Check bathwater.
 Do not pour hot liquids when infant is close by, such as sitting on lap. 40

INJURY PREVENTION
FOR INFANT
Burns  Beware of cigarette ashes that may fall on infant.
 Do not leave infant in sun for more than a few minutes; keep exposed areas
covered.
 Wash flame-retardant clothes according to label directions. Use cool-mist
vaporizers.
 Do not leave child in parked car.
 Check surface heat of car restraint before placing child in seat
Suffocation
and
Drowning
 Keep all plastic bags stored out of infant's reach; discard large plastic
garment bags after tying in a knot.
 Do not cover mattress with plastic.
 Use firm mattress and loose blankets with no pillows. Make certain crib
design follows federal regulations and mattress fits snugly-crib slats 2.375
inches (6 cm) apart 41

INJURY PREVENTION
FOR INFANT
Suffocation and
Drowning
 Position crib away from other furniture and away from radiators.
 Do not tie pacifier on a string around infant's neck. Remove bibs at
bedtime.
 Never leave infant alone in bath.
 Do not leave infant younger than 12 months old alone on adult or
youth mattress or beanbag-type seats.
Motor Vehicles  Transport infant in federally approved, rear-facing car seat,
preferably in back seat.
 Do not place infant on seat (of car) or in lap.
 Do not place child in a carriage or stroller behind a parked car.
 Do not place infant or child in front passenger seat with an air bag.
 Do not leave infant unattended in car. 42

INJURY PREVENTION
FOR INFANT
Falls  Use crib with fixed, raised rails.
 Never leave infant alone on a raised, unguarded surface.
 When in doubt as to where to place child, use floor.
 Restrain child in infant seat, and never leave child unattended while
the seat is resting on a raised surface.
 Avoid using a high chair until child can sit well with support.
Accidental
Poisoning
 Poisoning is not as great a danger to this age group, but parents
should begin practicing safeguards early
Bodily Damage  Keep sharp or jagged objects, such as knives and broken glass, out
of child's reach.
 Keep diaper pins closed and away from infant 43

INJURY PREVENTION
FOR INFANT
Four to Seven Month
Aspiration  Keep buttons, beads, syringe caps, and other small objects out of infant's
reach.
 Keep floor free of any small objects.
 Do not feed infant hard candy, nuts, food with pits or seeds, or whole or
circular pieces of hot dog.
 Exercise caution when giving teething biscuits because large chunks may
be broken off and aspirated.
 Do not feed infant while he or she is lying down.
 Inspect toys for removable parts.
 Keep baby powder, if used, out of reach.
 Avoid storing cleaning fluid, paints, pesticides, and other toxic substances
within infant's reach. 44

INJURY PREVENTION
FOR INFANT
Suffocation  Keep all latex balloons out of reach.
 Remove all crib toys that are strung across crib or play yard when child
begins to push up on hands or knees or is 5 months old.
Burns  Keep water faucets out of reach.
 Place hot objects (cigarettes, candles, incense) on high surface out of
child's reach.
 Limit exposure to sun; apply sunscreen.
Falls  Restrain in a high chair.
 Keep crib rails raised to full height.
Motor
Vehicles
 Transport infant in federally approved, rear-facing car seat, preferably in
back seat. 45

INJURY PREVENTION
FOR INFANT
Motor
Vehicles
 Do not place infant on seat (of car) or in lap.
 Do not place child in a carriage or stroller behind a parked car.
 Do not place infant or child in front passenger seat with an air bag.
 Do not leave infant unattended in car.
Accidental
Poisoning
 Make certain that paint for furniture or toys does not contain lead.
 Place toxic substances on a high shelf or in locked cabinet.
 Hang plants or place on high surface rather than on floor.
Bodily
Damage
 Give toys that are smooth and rounded, preferably made of wood or
plastic.
 Avoid long, pointed objects as toys.
 Avoid toys that are excessively loud. Keep sharp objects out of infant's
reach 46

INJURY PREVENTION
FOR INFANT
Eight to Twelve Month
Aspiration  Keep buttons, beads, syringe caps, and other small objects out of infant's reach.
 Do not feed infant hard candy, nuts, food with pits or seeds, or whole or circular
pieces of hot dog.
 Exercise caution when giving teething biscuits because large chunks may be broken
off and aspirated.
 Inspect toys for removable parts.
 Keep baby powder, if used, out of reach.
 Avoid storing cleaning fluid, paints, pesticides, and other toxic substances within
infant's reach.
 Keep small objects off floor, off furniture, and out of reach of children.
 Take care when feeding solid table food to give very small pieces.
 Do not use beanbag toys or allow child to play with dried beans.
47

INJURY PREVENTION
FOR INFANT
Bodily
Damage
 Give toys that are smooth and rounded, preferably made of wood or plastic.
 Avoid long, pointed objects as toys.
 Avoid toys that are excessively loud. Keep sharp objects out of infant's
reach
 Avoid placing televisions or other large objects on top of furniture, which
may be overturned when infant pulls self to standing position.
Falls  Avoid walkers, especially near stairs.
 Ensure that furniture is sturdy enough for child to pull self to standing
position and cruise.
 Fence stairways at top and bottom if child has access to either end.
 Dress infant in safe shoes and clothing (soles that do not “catch” on floor,
tied shoelaces, pant legs that do not touch floor). 48

INJURY PREVENTION
FOR INFANT
Suffocation
and
Drowning
 Keep doors of ovens, dishwashers, refrigerators, coolers, and front-loading
clothes washers and dryers closed at all times.
 If storing an unused large appliance, such as a refrigerator, remove the door.
 Supervise contact with inflated balloons; immediately discard popped
balloons and keep uninflated balloons out of reach.
 Fence swimming pools and other bodies of standing water, such as
decorative fountains; lock gate to swimming pools so that only adult can
access.
 Always supervise when near any source of water, such as cleaning buckets,
drainage areas, toilets.
 Keep bathroom doors closed.
 Eliminate unnecessary pools of water.
 Keep one hand on child at all times when in tub.
49

INJURY PREVENTION
FOR INFANT
50
Accidental
Poisoning
 Administer medications as a drug, not as a candy.
 Do not administer medications unless prescribed by a practitioner.
 Return medications and poisons to safe storage area immediately after use;
replace caps properly if a child-protector cap is used.
Burns  Place guards in front of or around any heating appliance, fireplace, or
furnace.
 Keep electrical wires hidden or out of reach.
 Place plastic guards over electrical outlets; place furniture in front of
outlets.
 Keep hanging tablecloths out of reach (child may pull down hot liquids or
heavy or sharp objects).

COMMON DISEASE
PREVENTION FOR
INFANT
51

COMMON DISEASE PREVENTION FOR INFANT
Vitamin Imbalances
Risk Factors:
 Cystic fibrosis and short bowel syndrome may cause vitamin deficiencies of
the fat-soluble vitamins A and D
 Preterm infants may develop rickets in the second month of life as a result of
inadequate intake of vitamin D, calcium, and phosphorus.
 Children receiving high doses of salicylates may have impaired vitamin c
storage
 Environmental tobacco smoke exposure has been implicated in decreased
concentrations of vitamin A, E, and C in infants
 Children with thalassemia are reported to have vitamins A, D, E, and K, folate,
calcium, and magnesium, inadequacies.
 Infants are risk to affect Vitamin D–deficiency rickets. 52

Populations at risk for vitamin D deficiency include:
• Children who are exclusively breastfed by mothers with an inadequate intake
of vitamin D or are exclusively breastfed longer than 6 months without
adequate maternal vitamin D intake or supplementation
• Children with dark skin pigmentation who are exposed to minimal sunlight
because of socioeconomic, religious, or cultural beliefs or housing in urban
areas with high levels of pollution, or who live above or below a latitude of 33
degrees north and south where sunlight does not produce vitamin D
• Children with diets that are low in sources of vitamin D and calcium
• Individuals who use milk products not supplemented with vitamin D (e.g.,
yogurt,* raw cow's milk) as the primary source of milk
• Children who are overweight or obese
53

Preventive Measures
Exclusive breastfeeding: Since the exclusively breastfed babies receive
400 IU of vitamin D beginning shortly after birth to prevent rickets and
vitamin D deficiency
Vitaminsupplementation: Non-breastfed infants who are taking less than
1 L/day of vitamin D–fortified formula should also receive a daily
vitamin D supplement of 400 IU
vitamin A supplementation
54

Mineral Imbalances
Risk Factors:
 Cow’s milk: An imbalance in the intake of calcium and phosphorous may occur in
infants who are given whole cow's milk instead of infant formula; neonatal tetany
may be observed in such cases
 children who are receiving or have received radiation and chemotherapy for
cancer; children with human immunodeficiency virus (HIV), sickle cell disease,
cystic fibrosis, gastrointestinal (GI) malabsorption, or nephrosis; and extremely
low birth weight (ELBW) and very low birth weight (VLBW) preterm infants are
having risk fort greater risk for growth failure, especially in relation to bone
mineral deficiency as a result of the treatment of the disease, decreased nutrient
intake, or decreased absorption of necessary minerals
 Low levels of zinc can cause nutritional failure to thrive (FTT)
55

Protein Energy Malnutrition
Causes:
 Diarrhea (gastroenteritis),
 Bottle feeding (in poor sanitary conditions),
 Inadequate knowledge of proper child care practices,
 Parental illiteracy,
 Economic and political factors,
 Climate conditions, and cultural and religious food preferences.
 Poverty
The most extreme forms of malnutrition, or protein-energy malnutrition (PEM),
are kwashiorkor and marasmus.
56

Kwashiorkor has been defined as primarily a deficiency of protein with
an adequate supply of calories.
Marasmus results from general malnutrition of both calories and protein
Causes:
 Inadequate breast feeding by the mother due to inadequate nutrition.
 Stopping breastfeeding early in case of working mothers.
 Inadequate supplementation of other foods.
 Ignorance of weaning and weaning foods.
 Inverted or cracked nipples in mother.
 Traditional methods such as not offering colostrum.
57

Clinical manifestation
Kwashiorkor:
 The main sign is pitting edema, usually starting in the legs and feet. •
 Due to edema children may look healthy so that their parents view them as
well fed.
 Children appear smaller than their age
 Mild to gross edema
 Skin is pale, dry and flaky, hair turns reddish
 Desquamation and dyspigmentation (buttocks, perineum and upper thigh)
Muscles wasting 58

Kwashiorkor:
 Cheliosis and angular stomatitis
 Flag sign (alternate bands of hypopigmented and normally pigmented hair
pattern)
 Irritability with sad, intermittent cry
 Children frequently have digestive problems
 Anorexia, abdominal distension, watery or semisolid
 Anemia , Cold, pale extremities due to circular insufficiency
 Very thin limbs, liver may be enlarged 59

1. Marasmus:
 Severe wasting of muscles,Wrinkled skin, loose skin of buttocks
 A large face over a shrunken body
 Eyes are sunken, cheeks are hollow giving a prematurely aged look
 Edema is absent, abdomen is curved inwards
 Skin is dry, loose and wrinkled due to loss of fat below the skin
 Hair may be normal or dry, thin and light colored.
 Muscles are wasted and have poor tone
 Bones are prominent due to absence of fat around them
60

Prevention:
 At national level • Nutritional supplementation. • Nutritional
surveillance. • Nutritional planning.
 At community level • Health and nutritional education. • Promotion of
education and literacy. • Growth monitoring. • Family planning
programme.
 At family level • Exclusive breast feeding. • Appropriate weaning. •
Vaccination. • Adequate birth spacing.
61

Food Sensitivity
A food allergy is defined by the National Institute of Allergy and Infectious
Diseases as “an adverse health effect arising from a specific immune
response that occurs reproducibly on exposure to a given food”
Food intolerance is said to exist when a food or food component elicits a
reproducible adverse reaction but does not have an established or likely
immunologic mechanism
Clinical Manifestation of Food Allergy
Systemic: Anaphylactic, growth failure
GI: Abdominal pain, vomiting, cramping, diarrhea
Respiratory: Cough, wheezing, rhinitis, infiltrates
Cutaneous: Urticaria, rash, atopic dermatitis
62

Guideline to prevent Food Sensitivity
• Infants should be exclusively breastfed until 4 to 6 months old.
• Soy formula is not recommended to prevent the development of food allergy.
• Introduction of complementary foods should not be delayed beyond 6 months old.
• Hydrolyzed formula (vs. cow's milk) may be used in at-risk infants to prevent
or modify food allergy.
• Maternal diet during pregnancy or lactation should not be restricted to
prevent food allergy.
• Children should be vaccinated with the measles, mumps, and rubella
(MMR) and measles, mumps, rubella, and varicella (MMRV) vaccines
(even with an egg allergy).
• Patients with severe egg allergy reactions should not receive the
influenza vaccine without consulting the primary practitioner for an
analysis of the risks vs. benefits . 63

Cow Milk Allergy
Cow's milk allergy (CMA) is a multifaceted disorder representing adverse
systemic and local GI reactions to cow's milk protein
Clinical Manifestations
 Gastrointestinal : Diarrhea, Vomiting, Colic, Wheezing,
Gastroesophageal reflux, Blood streaked, mucous, loose stools
 Respiratory : Rhinitis, Bronchitis Asthma, Sneezing, Coughing,
Chronic nasal discharge, Asthma exacerbation
 Cutaneous : Urticaria, Atopic dermatitis (AD)
 Systemic: Anaphylaxis
 Other Signs and Symptoms: Eczema, Excessive crying, Pallor
(from anemia secondary to chronic blood loss in
gastrointestinal [GI] tract) Fussiness, irritability 64

Cow Milk Allergy
Management:
 Elimination of cow's milk–based formula and all other dairy
products For infants fed cow's milk formula, this primarily involves
changing the formula to a casein hydrolysate milk formula
(Pregestimil, Nutramigen, or Alimentum) in which the protein has
been broken down into its amino acids through enzymatic
hydrolysis.
 When solid foods are started, parents need guidance in avoiding
milk product. Carefully reading all food labels helps avoid
exposure to prepared foods containing milk products. Although
labeled as nondairy, milk, cream, and butter substitutes may
contain cow's milk protein 65

Failure to Thrive
Failure to thrive (FTT), or growth failure, is a sign of inadequate
growth resulting from an inability to obtain or use calories required
for growth.
FTT has no universal definition, although one of the more common
criteria is a weight (and sometimes height) that falls below the fifth
percentile for the child's age
Causes:
 Inadequate caloric intake: Incorrect formula preparation,
neglect, food fads, lack of food availability, breastfeeding
problems, behavioral problems affecting eating, or central
nervous system problems affecting intake 66

Failure to Thrive
 Inadequate caloric absorption: Food allergy, malabsorption,
pyloric stenosis, GI atresia, inborn errors of metabolism
 Excessive caloric expenditure: Hyperthyroidism, malignancy,
congenital heart disease, chronic pulmonary disease or chronic
immunodeficiency
 A combination of infant organic disease, dysfunctional parenting
behaviors, and/or poor parent-infant bonding .
 Infants who are born preterm and with VLBW or ELBW, as
well as those with intrauterine growth restriction (IUGR), are
often referred for growth failure within the first 2 years of life
67

Failure to Thrive
• Growth failure
• Developmental delays—social, motor, adaptive, language
• Undernutrition ,Apathy ,Withdrawn behavior
• Feeding or eating disorders, such as vomiting, feeding resistance,
anorexia, pica, rumination
• No fear of strangers (at age when stranger anxiety is normal)
• Avoidance of eye contact
• Wide-eyed gaze and continual scan of the environment (“radar gaze”) •
Stiff and unyielding or flaccid and unresponsive
•Minimal smiling
68

Failure to Thrive
Management:
The goal is to provide sufficient calories to support “catch-up”
growth—a rate of growth greater than the expected rate for age
In addition to adding caloric density to feedings, the child may
require multivitamin supplements and dietary supplementation with
high-calorie foods and drinks
In some cases, family therapy may be required.
Behavior modification technique
Four primary goals in the nutritional management of children
with FTT are to correct nutritional deficiencies
69

Diaper Dermatitis
Diaper dermatitis is common in infants and one of several acute
inflammatory skin disorders caused either directly or indirectly by
wearing diapers. The peak age of occurrence is 9 to 12 months old,
and the incidence is greater in bottle-fed infants than in breastfed
infants.
Causes:
 Diaper dermatitis is caused by prolonged and repetitive contact
with an irritant (e.g., urine, feces, soaps, detergents, ointments,
friction).
 Although the irritant in the majority of cases is urine and
feces, a combination of factors contributes to irritation.
70

Diaper Dermatitis
 Prolonged contact of the skin with diaper wetness produces higher
friction, greater abrasion damage, increased transepidermal
permeability, and increased microbial counts. Healthy skin is less
resistant to potential irritants.
Prevention
 Keep skin dry.
 Use superabsorbent disposable diapers to reduce skin wetness.
 Change diapers as soon as soiled—especially with stool—
whenever possible, preferably once during the night.
 Expose healthy or only slightly irritated skin to air, not heat, to dry
completely. 71

Diaper Dermatitis
 Apply ointment, such as zinc oxide or petrolatum, to protect skin,
especially if skin is very red or has moist, open areas.
 Avoid removing skin barrier cream with each diaper change; remove
waste material and reapply skin barrier cream.
 To completely remove ointment, especially zinc oxide, use mineral oil;
do not wash vigorously.
 Avoid over washing the skin, especially with perfumed soaps or
commercial wipes, which may be irritating.
 May use a moisturizer or non-soap cleanser, such as cold cream
or Cetaphil, to wipe urine from skin.
 Gently wipe stool from skin using a soft cloth and warm water.
 Use disposable diaper wipes that are detergent- and alcohol-free. 72

Atopic Dermatitis (Eczema)
Atopic dermatitis (AD) is a type of pruritic eczema that usually
begins during infancy and is associated with an allergic contact
dermatitis with a hereditary tendency (atopy)
Infantile (infantile eczema): Usually begins at 2 to 6 months of age;
generally undergoes spontaneous remission by 3 years of age
Causes:
 Family history of eczema, asthma, food allergies, or allergic
rhinitis.
 The cause is unknown but appears to be related to abnormal
function of the skin, including alterations in perspiration,
peripheral vascular function, and heat tolerance.
73

Distribution of Lesions : Generalized, especially cheeks, scalp, trunk, and
extensor surfaces of extremities
Appearance of Lesions : Erythema, Vesicles, Papules, Weeping, Oozing,
Crusting, Scaling Often symmetric
Other Physical Manifestations Intense itching, Lymphadenopathy,
especially near affected sites, Increased palmar creases (many cases) ,
Atopic pleats (extra line or groove of lower eyelid) , Prone to cold hands
, Pityriasis alba (small, poorly defined areas of hypopigmentation) ,
Facial pallor (especially around nose, mouth, and ears) , Bluish
discoloration beneath eyes (“allergic shiners”) , Increased susceptibility
to unusual cutaneous infections (especially viral) 74

Management:
 The major goals of management are to hydrate the skin, relieve pruritus, prevent
and minimize flare-ups or inflammation, and prevent and control secondary
infection.
 Enhancing skin hydration and preventing dry, flaky skin A tepid bath with a mild
soap (Dove or Neutrogena), no soap, or an emulsifying oil followed immediately
by application of an emollient (within 3 minutes) assists in trapping moisture and
preventing its loss
 Sometimes colloid baths, such as the addition of 2 cups of cornstarch to a tub of
warm water, provide temporary relief of itching and may help the child sleep if
given before bedtime. Cool wet compresses are soothing to the skin and provide
antiseptic protection
 Oral antihistamine drugs (such as, hydroxyzine or diphenhydramine) usually 75

Management:
relieve moderate or severe pruritus. Nonsedating antihistamines, such as
loratadine (Claritin) or fexofenadine (Allegra), may be preferred for
daytime pruritus relief
Low-, moderate-, or high-potency topical corticosteroids are prescribed,
depending on the degree of involvement.
Seborrheic Dermatitis
Seborrheic dermatitis is a chronic, recurrent, inflammatory reaction of the
skin that occurs most commonly on the scalp (cradle cap) but may
involve the eyelids (blepharitis), external ear canal (otitis externa),
nasolabial folds, and inguinal region. 76

Seborrheic Dermatitis
Causes: Unknown
Clinical Manifestations:
The lesions are characteristically thick, adherent, yellowish, scaly, oily patches
that may or may not be mildly pruritic.
Management:
 Shampooing should be done daily with a mild soap or commercial baby
shampoo; medicated shampoos are not necessary, but an antiseborrheic
shampoo containing sulfur and salicylic acid may be used.
 Shampoo is applied to the scalp and allowed to remain on the scalp until the
crusts soften. Then the scalp is thoroughly rinsed.
 A fine tooth comb or a soft facial brush helps remove the loosened crusts
from the strands of hair after shampooing. 77

Colic (Paroxysmal Abdominal Pain)
The condition is defined by the rule of threes: crying and fussing for
more than 3 hours a day occurring more than 3 days per week and for
more than 3 weeks in a healthy infant
Causes:
 Too rapid feeding, overeating, swallowing excessive air, improper
feeding technique (especially in positioning and burping), and
emotional stress or tension between the parent and child.
 Maternal smoking, inadequate parent–infant interaction, firstborn
status, lactase deficiency, difficult infant temperament, difficulty
regulating emotions, and abnormal GI motility
 Inadequate amounts of lactobacilli
78

Colic (Paroxysmal Abdominal Pain)
Management:
• The use of drugs, including sedatives, antispasmodics,
antihistamines, and antiflatulents, is sometimes recommended.
Simethicone (Mylicon) may also help allay the
symptoms of colic.
• Oral administration of Lactobacillus reuteri to colicky
breastfed infants decreased crying symptoms within 21 days of
initiation.
• Dietary changes including the elimination of cow's milk
protein in the infant's diet may be effective
79

Sleep Problems
The two major categories are the dyssomnias: the child has trouble
either falling or staying asleep at night or has difficulty staying awake
during the day.
The second category, parasomnias, is characterized as confusional
arousals, sleepwalking, sleep terrors, nightmares, and rhythmic
movement disorders. These typically occur in children 3 to 13 years old
and often spontaneously resolve in adolescence
Selected Sleep Disturbances During Infancy
Nighttime Feeding :
• Child has a prolonged need for middle-of-night bottle or
breastfeeding. 80

Sleep Problems
• Child goes to sleep at breast or with a bottle.
• Awakenings are frequent (may be hourly).
• Child returns to sleep after feeding; other comfort measures (e.g.,
rocking or holding) are usually ineffective
Management:
• Increase daytime feeding intervals to 4 hours or more (may need to be
done gradually).
• Offer last feeding as late as possible at night; may need to gradually
reduce amount of formula or length of breastfeeding.
• Offer no bottles in bed. Put to bed awake.
81

Sleep Problems
• When child is crying, check at progressively longer intervals each
night; reassure child but do not hold, rock, take to parent's bed, or give
bottle or pacifier.
Developmental Nighttime Crying
Child 6 to 12 months old with undisturbed nighttime sleep now wakes
abruptly; may be accompanied by nightmares
Management:
• Reassure parents that this phase is temporary.
• Enter room immediately to check on child but keep reassurances brief.
• Avoid feeding, rocking, taking to parent's bed, or any other routine
that may initiate trained nighttime crying. 82

Sudden Infant Death Syndrome
Sudden infant death syndrome (SIDS) is defined as the sudden death of
an infant younger than 1 year old that remains unexplained after a
complete postmortem examination, including an investigation of the
death scene and a review of the case history
Other names: Sudden unexpected early neonatal death (SUEND) and
sudden unexpected infant death (SUID)
Causes: the cause remains unknown
Maternal Risk factors:
• Maternal smoking, Co-sleeping, or an infant sharing a bed with an
adult or older child on a non-infant bed, has been reported to have a
positive association with SIDS. 83

• Prone sleeping may cause oropharyngeal obstruction or affect thermal
balance or arousal state. Rebreathing of carbon dioxide by infants in
the prone position is also a possible cause of SIDS
• A prolonged Q-T interval or other arrhythmias
• Soft bedding (such as, waterbeds, sheepskins, beanbags, pillows, and
quilts) should be avoided for infant sleeping surfaces. Bedding items
such as stuffed animals and toys should be removed from the crib
while the infant is asleep. Head covering by a blanket has also been
found to be a risk factor for SIDS,
Infant Risk Factors
• Low birth weight or preterm birth 84

• Low Apgar scores
• Recent viral illness
• Siblings of two or more SIDS victims
• Male gender
• Infants of American Indian or African-American ethnicity
Prevention:
Educating families about the risk of prone sleeping position in infants
from birth to 6 months old, avoiding smoking during pregnancy and near
the infant; using the supine sleeping position; avoiding soft, moldable
mattresses, blankets, and pillows; avoiding bed sharing; breastfeeding;
and avoiding overheating during sleep. 85

Positional Plagiocephaly
• The term plagiocephaly connotes an oblique or asymmetric head;
• Positional plagiocephaly, deformational plagiocephaly, or
nonsynostotic plagiocephaly implies an acquired condition that occurs
as a result of cranial molding during infancy, usually as a result of
lying in the supine position
• Because infants' sutures are not closed, the skull is pliable; and when
infants are placed on their backs to sleep, the posterior occiput flattens
over time
• A typical bald spot develops, which is usually transient. As a result of
prolonged pressure on one side of the skull, that side becomes
misshapen; mild facial asymmetry may develop 86

Causes:
Congenital or acquired torticollis may cause plagiocephaly; other causes
of deformational plagiocephaly include certain craniofacial syndromes
Prevention:
• Prevention of positional plagiocephaly may begin shortly after birth by
placing the infant to sleep supine and alternating the infant's head
position nightly
• avoiding prolonged placement in car safety seats and swings, and
• using prone positioning or “tummy time” for approximately 30 to 60
minutes per day when the infant is awake
87

• Treatment of torticollis and plagiocephaly initially involves exercises
to loosen the tight muscle and switching head position sides during
feeding, carrying, and sleep.
• If the plagiocephaly is not resolved within 4 to 8 weeks of physical
therapy, a customized helmet may be worn to decrease the pressure on
the affected side of the skull
• The helmet is worn 23 hours a day for a prescribed period (usually 3
months). Repositioning and physical therapy are said to be more
effective when used before the infant can roll over or move his or her
head alone (i.e., before approximately 3 to 4 months old)
88

Apparent Life-Threatening Event
An apparent life-threatening event (ALTE), formerly referred to as aborted
SIDS death or near-miss SIDS, generally refers to an event that is sudden and
frightening to the observer in which the infant exhibits a combination of
apnea; change in color (pallor, cyanosis, redness); change in muscle tone
(usually hypotonia); and choking, gagging, or coughing and that usually
involves a significant intervention and even CPR by the caregiver who
witnesses the event
Management:
Treatment of recurrent apnea (without an underlying organic problem)
usually involves continuous home monitoring of cardiorespiratory rhythms
and in some cases the use of methylxanthines (respiratory stimulant drugs,
such as caffeine). 89

CONCLUSION
Infancy encompasses the period from birth to age 12 months. The infant exhibits
tremendous growth, doubling the birthweight by 6 months of age and tripling it
by 12 months of age. Most organ systems are immature at birth and develop and
mature over the first year of life. Child development is orderly, sequential, and
predictable, progressing in a cephalocaudal and proximo –distal fashion.
The infant is mastering the psychosocial task of Trust versus Mistrust. Cognitive
development in infancy is sensorimotor; infants use their senses and progressing
motor skills to master their environment. The 12-month-old babbles expressively
and uses two or three words with meaning. Promotion of safety is of key
importance throughout infancy.
90

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