Infancy is the period of life from birth to one year. It is the period of most rapid physical and social growth.

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Infant
Introduction
Infancy is the period of life from birth to one year. It is the period of most rapid physical and social growth. All
body system undergoes progressive growth and maturation and there is concurrent development of skills that
increasingly allows infants to respond and cope with the environment. Acquisition of these fine and gross motor
skills occurs in an orderly head-to-toe and center-to-periphery.
Physical Growth
During infancy elongation of the trunk predominates which is indicated by increase in weight, height, head and
chest circumference. It is period of rapid physical growth.
1) Body weight
 Birth weight doubles by 5to 6 months and triples by 12 months of age.
 During the first year growth is very rapid, especially during the initial 6 months and slows during
the second 6 months.
2) Height
 Height increases by 2.5 cm (1 inch) a month during the first 6 months and half of that during
the second 6 months.
 By 1 year the birth length has increased by almost 50% and is 75 cm.
 This increase occurs mainly in the trunk, rather than in legs and contributes to the characteristic
physique of the infant.
3) Head circumference
 Head growth is also rapid and an important determinant of the brain growth.
 During the first 6 months head circumference increases approximately 1.5 cm a month and
decreases to only 0.5 cm monthly during the second 6 months.
 The average size is 43 cm at 6 months and 46 cm at 12 months. By 1 year, head size has
increased by almost 33%.
 Closure of the cranial sutures occurs, with the posterior fontanel fusing by 6 to 8 weeks of age
and the anterior fontanel closing by 12 to 18 months of age.
 Expanding head size reflects the growth and differentiation of the nervous system. Maturation of
the brain is exhibited in the dramatic developmental achievements of infancy. Primitive reflexes
that influence motor development appear.
4) Chest circumference
 At birth, the antero-posterior and lateral diameter of the chest are equal and chest looks
cylindrical in shape.
 After birth, the lateral diameter increases than anterio-posterior diameter. So at 1 years of
age shape of the chest becomes flat.
 During infancy, the size of the chest increases more rapidly than size of the head .So, at 1 year of
age, chest circumference equals to head circumferences.

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5) Dentition
 In general, primary tooth is erupted in between 6 to 8 months of age. The rest of the teeth are
erupted at the rate of about one tooth per months.
 The lower central incisor erupts first as primary teeth and primary teething is completed by 2
to 2 and half year of age.
Maturation of system
1) Respiratory system.
 Respiratory rate slows and is relatively stable. i.e. 25 to 40 breaths per minute between
6to12 months baby.
 Respiratory Movement continues to be abdominal.
 Several factors predispose the infant to more severe and acute respiratory problems. The
close proximity of the trachea to the bronchi and its branching structures rapidly transmits an
infectious agent from one anatomic location to another. The short, straight Eustachian tube
closely communicates with the ear, allowing infection to ascend from the pharynx to the
middle ear.
 In additional, the inability of the immune system to produce immunoglobulin A (IgA) in the
mucosal lining provides less protection against infection in infancy than during later
childhood.
2) Circulatory system
 The heat rate slows and the rhythm is often sinus arrhythmia.
 Systolic pressure raises during the first 2 months and diastolic pressure decreases during the
first 3 months then gradually rise in value with this blood pressure range is 65-85/45-55 mm
of hag between 0-3 months and 80-100/55-65 mm of hg between 6-12 months of age during
infancy.
3) Hematopoietic System
 Significant changes occur in blood system during infancy. Fetal hemoglobin is present in the
blood system of infants up to the first 5 months and gradually it changes to adult hemoglobin.
 Physiologic anemia develops at the age of 2-3 months due to short life span of fetal red
blood cell as well as high level of fetal hemoglobin suppression to the production of
erythropoietin which is needed to stimulate red blood cell production in an infant.
 Similarly, infants have acquired maternal iron store for the first 6 months and gradually
diminish, which also accounts for lowered hemoglobin levels toward the end of the first 6
months.
4) Digestive system
 The digestive processes are immature at birth. Gastro-intestinal maturation starts to develop
only after 2-3months when baby can voluntary chew, hold or spit out food despite being an

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adequate ability of the baby to digest, absorb and metabolize human milk but drooling is
common because of the poorly coordinated swallowing reflex.
 Regarding digestive enzymes, infant has small amount of ptyalin, hydrochloric acid and
rennin for digestion of milk. Similarly, the enzyme like amylase, lipase and trypsin are very
limited in amount during first 5 months of age.
 The stomach capacity us limited to about 90 to 150 ml at 1 month of age to 210 to 360 ml at
1 years of age.
 The emptying time is short, about 2 to 3 hours and peristalsis movement is rapid. That's why
infants need frequent small feedings i.e. three meals per day with an evening bottle.
 The liver is the most immature of all the gastrointestinal organs throughout infancy. The
ability to conjugate bilirubin and secrete bile is achieved after the first couple of weeks of
life. However, the capacities of gluconeogensis, formation of amino acids remain relatively
immature for the first year of life.
5) Immunologic system.
 The immunologic system undergoes numerous changes during the first year.
 The full-term newborn receives significant amounts of maternal IgG, which for
approximately 3 months confers immunity against antigens to which the mother was
exposed.
 During this time the infant begins to synthesize IgG; approximately 40% of adult levels are
reached by 1 year of age. Significant amounts of IgM are produced at birth and adult levels
are reached by 9 months of age.
 The production of IgA, IgD, and IgE is much more gradual and maximum levels are not
attained until early childhood.
6) Thermo-regulation
 During infancy, the peripheral capillaries are responsive to changes in surrounding temperature
to regulate heat loss.
 Thermogenesis causes the muscles and muscle fibers to contract, generating metabolic heat to
regulate temperature throughout the body. Likewise adipose tissue during the first 6 months
insulates the body against heat loss.
 The average temperature of 1-3 months baby is 99.4◦F and that will slightly rise between 9-12
months of age.
7) Renal system/ Fluid and electrolyte
 At birth, 75% of total body weight is composed by water and there is excessive extracellular
fluid. With the increasing age, the percentage of body water and extracellular fluid decrease to
40% and reaches the adult level at 20%.
 That's why, infants are prone to develop dehydration very frequently even in mild diarrhea.
Renal (urinary) system remains immature during infancy.
 Urine is voided frequently with low specific gravity (1.000-1.0110) due to low filtration
capacity of glomeruli. The total amount of urine passed is 270-450 ml per day with involuntary
urinary process.
8) Sensory changes during infancy

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 Auditory acuity is at adult levels during infancy.
 Visual acuity begins to improve and binocular fixation is established. Binocularity or the fixation
of two ocular images into one cerebral picture (fusion), begins to develop by 6 weeks of age and
should be well established by age 4 months.
Developmental Milestone
Development milestone is the various behavioral achievement or abilities indicating particularly at
developmental stage. It is related to child's physical growth and maturation of the body system and
environmental stimuli as his learning process.
Three main categories of developmental milestones are;
1. Motor behavior
a. Gross motor behavior
b. Fine motor behavior
2. Language behavior
3. Personal and social behavior
Motor behavior
a) Gross motor behavior
 Infant gross motor development consists of head controlling, rolling, sitting, and locomotion.
 Major development are:
Age Milestones
At 3 months of age Neck holding
Between 4 to 5 months of age Crawling
At 5 months of age Sitting with support and rolls over
At 8 months of age Sitting without support
At 9 months of age Standing with support
At 10 months of age Standing without support
At 12 months of age Walking with support
At 13 months of age Walking without support
b) Fine Motor Development
 During infancy, the fine motor development includes coordination of eyes, hand-eye, hand-
mouth and skills for manipulation with hands.
 Major developments are;
S.N Age Milestone
1 By 3 months of age Grasping an object
2 By 4 months of age Grasps ring when placed in hand
3 By 5 months of age Reach out to an objects and holds it with both hands
4 By 6 months of age Able to hold feeding bottle or own feet and pull them

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to mouth
5 By 7 months of age Palmer grasp, transfer objects from one hand to the
other
6 By 9 months of age Pincer grasp, holding small objects between index
finger and thumb
7 By 12 months of age Baby tries to feed himself with a spoon and spills the
contents.
Language Development
 Baby's brain is very open to learning and quickly absorbs the language around.
 Infant first means of communication is crying.
 Summary of language development is given below.
S.N Age Milestones
1 At birth Cry
2 By 1 month of age Turn head to sound
3 By 1 and half months of age Produce throaty sound
4 By 2 months Makes single vowel sound such as "eh", "uh"
5 By 3 months of age Cooing
6 Between 3-6 months of age Babbles play with sounds
7 By 6 months of age Monosyllables (ma,ma)
8 By 9 months of age Bisyllables (mama)
9 By 10 months of age Understand bye and claps hands and understand the
meaning of "No"
10 By 12 months of age Two words with meaning, obey simple commands.
Personal Development
 Personal and social development focused on interpersonal skills of the infants.
 Infancy is the period of establishing attachment with parents usually the mother.
 The infants demonstrate the following adaptive skills.
S.N Age Milestones
1 By 2 months of age Displays a social smile
2 By 3 months of age Recognizes social interaction
3 By 4 months of age Enjoys social interaction
4 By 5 months of age Smiles at mirror image
5 By 6 months of age Begins to fear strangers
6 By 8 months of age Show stranger anxiety
7 By 12 months of age Show emotion like jealously and affection
Personality Development

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1. Psychosocial development (Erikson)
 According to Erikson, infant is concerned with acquiring a sense of trust while overcoming a
sense of mistrust.
 The trust that develops is a trust of self, of others and of the world.
 Infants "trust" that their feeding, comfort, stimulation and caring need will be met. The crucial
element for the achievement of this task is the quality of both the parent (caregivers) – child
relationship and the care the infants receives. The provision of food, warmth and shelter by itself
is inadequate for the development of a strong sense of self.
 Failure to learn "Delayed gratification" leads to mistrust. Mistrust can result either from too
much or too little frustration. If parents always meet their children needs before the children
signal their readiness, infants will never learn to test their ability to control the environment. If
the delay is prolonged, infants will experience constant frustration and eventually mistrust
others in their efforts to satisfy them. Therefore consistency of care is essential.
 The trust acquired in infancy provides the foundation for all succeeding phases.
2. Psychosexual development
 According to Sigmund Freud, infancy period is the period of oral stage of psychosexual
development.
 Obtain gratification by taking everything "in" and slowly shifted to oral to anal stage with
emphasis on bowel control.
 They gains neuromuscular control over the anal sphincter.
3. Cognitive Development (Piaget)
 The first stage in Piaget's stages of cognitive development is the "sensorimotor stage".
 This stage lasts from birth to two years old.
 During this stage, behaviors lack a sense of thought and logic.
 During the sensorimotor phase infant progress from reflex behaviors to simple repetitive acts to
imitative activity.
 Three crucial events take place during this phase.
 The first event involves separation, the second major accomplishment is achieving the concept
of object permanence, and the last major intellectual achievement of this period is the ability to
use symbols or mental representation.
 The sensorimotor stage has six sub stages that explain the gradual development of infants from
birth to age 2. Once the child gains the ability to mentally represent reality, the child begins the
transition to the preoperational stage of development.
1. Birth to one month
 Each child is born with inherited reflexes that they use to gain knowledge and understanding
about their environment. Examples of these reflexes include grasping and sucking.
2. 1–4 months
 The second stage marks the beginning of the replacement of reflexive behavior with voluntary
act.
 The beginning of accommodations is evident.

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 Infants incorporate and adapt their reactions to the environment and recognize the stimulus that
produces a response.
 Previously they would cry until the nipple was brought to the mouth. Now, they associate the
nipple with the sound of the parent's voice. They accommodate this new piece of information
and adapt by stopping to cry when they hear the voice before receiving nipples.
 What is taking place is a realization of causality and a recognition of an orderly sequence of
events.
3. 5–8 months
 Three new processes of human behavior occur i.e. Imitation requires the differentiation of
selected acts from several events. By the second half of the first year, infants can imitate sounds
and simple gestures.
 Play becomes evident as they take pleasure in performing an act after they have mastered it.
 Affect (outward manifestation of emotion and feeding) is seen as infants begin to develop a
sense of permanency.
 Object permanence is a critical component of parent-child attachment and is seen in the
development of stranger anxiety at 6 to 8 months of age.
4. 8–12 months
 During this stage, coordination of previous achievements and their applications to the new
situations for adding new intellectual skills to their expanding repertoire.
 This stage is largely transitional.
 They also begin to understand object permanence, which is the realization that objects
continue to exist when removed from view.
 Additional, increasing motor skills allow for greater exploration of the environment. They
begin to discover that hiding an object does not mean that it is gone but that removing an
obstacle will reveal objects. For example: The baby wants a rattle but the blanket is in the way.
The baby moves the blanket to get the rattle.
 This marks the beginning of intellectual reasoning.
 Furthermore, they can experience an event by observing it, and they begin to associate symbols
with events. e.g. "Bye-bye" with" Daddy goes to work".
 At a conclusion, behaviors will be displayed for a reason rather than by chance. They begin to
understand that one action can cause a reaction.
4. Moral development (Kohl-berg)
 According to Kohl-berg, no moral concepts or rules exist at this age.
 Moral development is in the beginning stage i.e. pre-conventional mortality level.
 In this level, children will make moral judgment only on the basis of what will bring them a
reward (right act and punishment).
 Basically moral is focused on the good is what I like and want.

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Developmental Tasks
The developmental tasks of an infant are as follows:
1. Establish body functions.
2. Learn to eat solid food along with liquid food.
3. Use emotional expressions to indicate his needs and wishes by crying and smiling.
4. Learn to understand the environment through exploration.
5. Relate emotionally to the parents and sibling.
6. Develop the feeling and desire for affection and responses from others.
Promotions of optimal Growth and Development
Babies thrive well when all of their needs are fulfilled consistently and with love and care. A baby goes through
so many changes that can be hard for you to keep up with all the things experts say you "should be" doing to
promote healthy growth and development. To keep your baby healthy, loving, holding, feeding, changing diaper
and talking to the baby are the things to be considered. Main focus should be given in the following area to keep
infant's growth and development as optimum level.
1. Nutrition
 For the first 5-6 months of age, breast milk is the best and the most adequate food for the infants.
Along with breast feeding add vitamin D (400IU daily) if the mother's supply is deficient or the infant is
not exposed to frequent sunlight. Solid food should not be given because their digestive system is not
well developed to digest solid food.
 Encourage the mother for exclusive breast feeding up to 6 months of age is the best to keep them
healthy.
 After 6 months, breast milk alone is not adequate for the child to meet his growing needs. So the
introduction solid foods rich in iron as rice feeding ceremony or weaning. The fetal iron reserve
gradually finishes by this age and breast milk is poor source of iron.
 Cooked rice is a good first solid food for starting weaning. Give with 1-2 teaspoon of rice twice daily
and gradually increase the amount for 5-7 days. After 5-7 days, add mixed dry cereal with fruit juice.
 Sarbootam pitho, lito, Jaulo, khichadi, massed fruits are the diet introduced during after 6 months.
 Infants should be provided feeding on demand. Family food should be introduced gradually.
2. Growth Assessment
 Growth assessment during infancy is very important clue for early detection of deviation from normal
health.
 Routinely growth assessments are recommended monthly for first 6 months and bimonthly for the
second 6 months, every 3 monthly during the second year, every 6 monthly during the third year and
annually thereafter.
 Different methods are used for assessing growth and development during infancy which include.
 Physical assessment and examination.

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 Growth chart to assess deviation from and normal pattern of growth and development (weight,
height, immunization status).
 History taking
 Presentation of baby i.e. loose skin elasticity
3. Immunization (Infection prevention)
 Immunization against preventable disease during infant period is very essential to reduce the less than
five morbidity, mortality and handicapped.
 To make immunization more effective government of Nepal has been implementing expanded
programme of immunization (EPI) throughout the country and immunization schedule as bellow.
4. Prevention of accidents and safety precautions
 Accidents are one of the leading causes of death during infancy because of
 Mechanical suffocation causes most of accidental deaths in children under 1 year of age.
 Aspiration of small objects and ingestion of poisonous substances occur most often during
second half of the first year and into early childhood.
 Trauma from rolling off a bed or falling down stair can occur at any time.
 Safety precaution and prevention of accident during infancy
 Never leave an infant alone in unprotected place to prevent fall.

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 Keep side rails grill and gate on open spaces, opening of stair, windows.
 Never give very small things to the child.
 Toys should not have removable small parts which can be aspirated or put into the ear or nose.
 Keep coins, buttons, bead, marbles out of reach of children.
 Never feed solid foods that are difficult to chew e.g. piece of bone, meat.
 Keep the stove or fire source and hot things for away from the child.
 Never leave the infant near water source like water tub, ponds. Keep door of the bathroom locked
and don not collect water in bucket or big bowel.
 Do not keep hot object liquid in reach of infant.
 Do not hold the baby while cooking or handling hot objects/ things and do not keep the baby on
kitchen.
 Keep the electrical outlet an equipment hidden or out of reach of the baby.
 Keep plastic bag out of reach of children.
 Keep toxic substances like insecticides, cleaning agents, drugs out of reach of the baby.
 Avoid smoking near children
 Keep sharp objects like knives, garden tools and other sharp instrument safely.
5. Play and stimulation
 Play and toys are essential component off infant care. Play during infant represents the various social
modalities observed during cognitive development.
 Through play and toys infants learn;
 Helps to gain motor skills, co-ordination of body movement and hand eye coordination.
 Learn about physical world and associate names with objects.
 Release surplus energy.
 Help to develop tactile, auditory, visual and simulation.
 Learn moral values and develop idea of sharing.
 Relief of stress and tension, control over threatening events.
 After 4 months of age infant enjoys the colourful objects. After 6 months of age infants likes hearing
different sounds.
 While choosing play material, we should consider the developmental stage of the infant as well as it
should be safe, assist child to achieve mastery, enhance social and personality development.
6. Sleep
 Total daily sleep requirement of the infant is about 15 hours per day. Adequate sleep is essential for the
secretion of growth hormones.
 Some children may have sleep problems such as trouble falling sleep, more day sleeping, frequently
awaking at night etc. the best way to prevent sleep problem is to encourage the parents to establish
consistent bedtime rituals.
7. Dental health

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 Dental health care is another area of concern during infancy to keep optimum growth and development
of the infant. That include;
 Dental hygiene begins as soon as the primary teeth erupt.
8. Anticipatory guidance/care of mother.
 Child rearing is not an easy task, it presents challenges to parents. Many problems may arise and
parents should know how to deal with these problems and how to prevent it. So the parents need to be
taught on various components of infant care such as nutrition, immunization, personal hygiene, and
injury prevention. Nurses are in position to render assistance and suggestion to the parents.
 The major areas for parental guidance/ instruction are as follows:
1. Exclusive breastfeeding during early infancy and introduction of complementary feeding during
later infant.
2. The infants need for play, stimulation in healthy environment. Avoidance of emotional
deprivation and trauma.
3. Need for the safety measures and injury prevention due to increasing motor skill and curiosity.
4. Need for immunization growth monitoring and record.
5. Encourage parents to avoid long separation of child from parents but leave the child for same
time.
6. Guide parents about initiation of discipline for infants increasing nobilities and other
developmental activities (no physical punishment).
7. Maintenance of hygiene and other general care.
8. Acceptance of children as they are with their different characteristic, especially avoiding gender
bias.