Promoting and Protecting the Health of
Infant, Toddler and Preschool Populations
Traditionally, pregnancy has been divided into three periods called trimesters, each of which lasts about 3 months.
Each trimester includes certain landmarks for developmental changes in the mother and the fetus.
During the intrauterine stage of development, the embryo or fetus relies on the maternal blood flow through the placenta to meet its basic survival needs.
The health of the mother is essential for proper growth and development.
Neonates and infants
(Birth to 1 year)
Physical Development
A neonate’s basic task is adjustment to the environment outside the uterus, which requires breathing, sleeping, sucking, eating, swallowing, digesting, and eliminating.
At birth, most babies weigh from 2.7 to 3.8 kg, babies usually gain weight at the rate of 150 to 210 g weekly for 6 months.
Exclusive breast-feeding in the first 4 to 6 months may be helpful in preventing excessive weight gain
LENGTH
The average length of a European American newborn in the United States is about 50 cm. Female babies are, on average, smaller than male babies.
HEAD AND CHEST CIRCUMFERENCE:
At birth the average infant’s head circumference is 35 cm and generally varies only 1 or 2 cm.
The chest circumference of the newborn is usually less than the head circumference by about 2.5 cm.
VISION
The newborn can follow large moving objects and blinks in response to bright light and sound. The pupils of the newborn respond slowly, and the eyes cannot focus on close objects.
HEARING
Newborns with intact hearing will react with a startle to a loud noise, a reaction called the Moro reflex. Within a few days, they are able to distinguish different sounds.
Reflexes of the newborn are unconscious, involuntary responses of the nervous system to external and internal stimuli. Reflexes normally present at birth are the sucking, rooting, Moro, palmar grasp, plantar, tonic neck, stepping, and Babinski reflexes
Health Promotion Guidelines for Infants HEALTH EXAMINATIONS
Screening of newborns for hearing loss at 1 month of age, diagnosis by 3 months of age, with intervention and treatment by 6 months of age
• Physical exam at 2 weeks and at 2, 4, 6, 9, and 12 months PROTECTIVE MEASURES
• Immunizations: diphtheria, tetanus, acellular pertussis (DTaP), inactivated poliovirus vaccine (IPV), pneumococcal (PVC), Haemophilus influenzae type B (HIB), hepatitis B (HepB), hepatitis A (HepA), rotavirus, and influenza vaccines as recommended.
Varicella and measles-mumps-rubella (MMR) are not given before 12 months of age.
• Fluoride supplements for infants over 6 months of age if there is inadequate water fluoridation (less than 0.3 parts per million)
Screening for tuberculosis
• Screening for metabolic conditions including phenylketonuria (PKU)
• Prompt attention for illnesses
• Appropriate skin hygiene and clothing
INFANT SAFETY
• Importance of supervision
• Car seat, crib with a firm mattress, playpen, bath, and home environment safety measures
• No stuffed animals, pillows, or blankets in the crib
• Position the infant on the back for sleep
• Feeding measures (e.g., avoid propping bottle)
• Provide toys with no small parts or sharp edges
• Eliminate toxins in the environment (e.g., tobacco, chemicals, radon, lead, mercury)
• Use smoke and carbon monoxide (CO) detectors in home
NUTRITION
• Exclusive breast-feeding to 4 to 6 months
• Solid foods between 4 and 6 months
• Need for iron supplements at 4 to 6 months
• Continued breast-feeding to age 12 months
• Breast-feeding and bottle-feeding techniques
• Formula preparation
• Feeding schedule
ELIMINATION
• Characteristics and frequency of stool and urine elimination
• Diarrhea and its effects
REST/SLEEP
• Establish routine for sleep and rest patterns
SENSORY STIMULATION
• Touch: holding, cuddling, rocking
• Vision: colorful, moving toys
• Hearing: soothing voice tones, music, singing
• Play: toys appropriate for development
TODDLERS (1 TO 3 YEARS)
Toddlers develop from having no voluntary control to being able to walk and speak. They also learn to control their bladder and bowels, and they acquire a wide variety of information about their environment.
WEIGHT
Two-year-olds can be expected to weigh approximately four times their birth weight.
The 3-year-old should weigh about 13.6 kg.
HEIGHT
A toddler’s height can be measured as height or length. Height is measured while the toddler stands between 2 and 3 years it slows to 6 to 8 cm
Health Risks: Toddlers experience significant health problems due to injuries, visual
problems, dental caries, and respiratory and ear infections.
Health Promotion Guidelines for Toddlers
HEALTH EXAMINATIONS
• At 15 and 18 months and then as recommended by the primary care provider
• Dental visits starting at age 3 or earlier
PROTECTIVE MEASURES
• Immunizations: continuing DTaP, IPV, pneumococcal, MMR, varicella, Haemophilus influenzae type B, hepatitis B, hepatitis A, influenza, and meningococcal vaccines as recommended
Screenings for tuberculosis and lead poisoning
• Fluoride supplements if there is inadequate water fluoridation
TODDLER SAFETY
• Importance of constant supervision and teaching child to obey commands
• Home environment safety measures (e.g., lock medicine cabinet)
• Outdoor safety measures (e.g., close supervision near water and on sidewalks
• Appropriate toys
• Eliminate toxins in environment (e.g., tobacco, pesticides,
herbicides, mercury, lead, arsenic in playground materials)
• Use smoke and carbon monoxide (CO) detectors in home
NUTRITION
• Importance of nutritious meals and snacks
• Teaching simple mealtime manners
• Dental care
ELIMINATION
• Toilet training techniques
REST/SLEEP
• Dealing with sleep disturbances
PLAY
• Providing adequate space and a variety of activities
• Encouraging regular, vigorous physical activity
• Toys that allow “acting on” behaviors and provide motor and sensory stimulation
DEVELOPMENT IN ACTIVITIES OF DAILY LIVING
• Feed self.
• Eat and drink a variety of foods.
• Begin to develop bowel and bladder control.
• Exhibit a sleep pattern appropriate for age.
• Dress self.