The diet of a woman both before and during pregnancy has a significant effect on fetal development. Women who do not consume adequate nutrients and calories during pregnancy may not be able to meet the fetus’ nutritional requirements. An increase in weight does not always indicate an increase in nutrients. In addition, the pattern of weight gain is important for tissue growth in a mother and fetus. For women who are at normal weight for height, the recommended weight gain is 25 to 35 pounds over three trimesters (Davidson et al., 2008). As a nurse, you are in a key position to provide women with the education they need about nutrition before conception and throughout an expectant mother’s pregnancy.

Pregnancy presents a developmental challenge that includes physiological, cognitive, and emotional states that are accompanied by stress and anxiety. The expectant woman will soon adopt a parenting role; and relationships within the family will change, whether or not there is a partner involved. Pregnancy can be a period of conflict or support; family dynamics impact fetal development. Parental reactions to pregnancy change throughout the gestational period, with most couples looking forward to the birth and addition of a new family member (Davidson et al., 2008). Listen carefully to concerns expressed by a mother and her partner and offer support through each trimester.

The age of the pregnant woman sometimes plays a role in the health of the fetus and the overall pregnancy. Fetuses of older mothers are at risk for chromosomal defects, and older women may have more difficulty in becoming pregnant (Santrock, 2009). Studies indicate that pregnant adolescents often seek out less prenatal care than women in their 20s and 30s and are at higher risk for complications of pregnancy and labor. Infants of teen mothers are at increased risk for prematurity; low birth weight; and exposure to alcohol, drugs, and tobacco in utero and early childhood (Davidson et al., 2008). Adolescents who have been able to participate in prenatal classes may have improved nutrition and healthier babies.

Fetal growth and hormonal changes during pregnancy often result in discomfort for the expectant mother. Common concerns expressed include problems such as nausea and vomiting, breast tenderness, urinary frequency, heartburn, constipation, ankle edema, and backache. Always anticipate these discomforts and provide self-care education throughout the pregnancy. Discussing the physiological causes of these discomforts and offering suggestions for safe treatment can be very helpful for expectant mothers and contribute to overall health during pregnancy (Davidson et al., 2008).

Some complementary and alternative therapies such as herbal supplements can be harmful during pregnancy. Your assessment should include questions about use of these substances when providing education during pregnancy (Davidson et al., 2008). You can promote maternal and fetal health by providing accurate and complete information about health behaviors that support positive outcomes for pregnancy and childbirth.

After immediate physical evaluation and application of identification bracelets, the nurse promotes the parents’ and newborn’s need for close physical contact. Early parent-child interaction encourages parent-child attachment. Merely placing the family together does not promote closeness. Most healthy newborns are awake and alert for the first half-hour after birth. This is a good time for parent-child interaction to begin. Close body contact, often including breastfeeding, is a satisfying way for most families to start bonding. If immediate contact is not possible, incorporate it into the care plan as early as possible, which means bringing the newborn to an ill parent or bringing the parents to an ill or premature child. Attachment is a process that evolves over the infant’s first 24 months of life, and many psychologists believe that a secure attachment is an important foundation for psychological development in later life (Santrock, 2009).

You perform a comprehensive nursing assessment as soon as the newborn’s physiological functioning is stable, generally within a few hours after birth. At this time the nurse measures height, weight, head and chest circumference, temperature, pulse, and respirations and observes general appearance, body functions, sensory capabilities, reflexes, and responsiveness. Following a comprehensive physical assessment, assess gestational age and interactions between infant and parent that indicate successful attachment (Hockenberry and Wilson, 2011).

The average newborn is 2700 to 4000 g (6 to 9 pounds), 48 to 53 cm (19 to 21 inches) in length, and has a head circumference of 33 to 35 cm (13 to 14 inches). Neonates lose up to 10% of birth weight in the first few days of life, primarily through fluid losses by respiration, urination, defecation, and low fluid intake. They usually regain birth weight by the second week of life; and a gradual pattern of increase in weight, height, and head circumference is evident. Accurate measurement as soon as possible after birth provides a baseline for future comparison (Hockenberry and Wilson, 2011).

Normal physical characteristics include the continued presence of lanugo on the skin of the back; cyanosis of the hands and feet for the first 24 hours; and a soft, protuberant abdomen. Skin color varies according to racial and genetic heritage and gradually changes during infancy. Molding, or overlapping of the soft skull bones, allows the fetal head to adjust to various diameters of the maternal pelvis and is a common occurrence with vaginal births. The bones readjust within a few days, producing a rounded appearance to the head. The sutures and fontanels are usually palpable at birth. Fig. 12-1 shows the diamond shape of the anterior fontanel and the triangular shape of the posterior fontanel between the unfused bones of the skull. The anterior fontanel usually closes at 12 to 18 months, whereas the posterior fontanel closes by the end of the second or third month.

Assess neurological function by observing the newborn’s level of activity, alertness, irritability, and responsiveness to stimuli and the presence and strength of reflexes. Normal reflexes include blinking in response to bright lights, startling in response to sudden loud noises or movement, sucking, rooting, grasping, yawning, coughing, sneezing, palmar grasp, swallowing, plantar grasp, Babinski, and hiccoughing. Assessment of these reflexes is vital because the newborn depends largely on reflexes for survival and in response to its environment. Fig. 12-2 shows the tonic neck reflex in the newborn.

In accordance with the recommendations of the American Academy of Pediatrics (AAP), position infants for sleep on their backs to decrease the risk of sudden infant death syndrome (SIDS) (Hockenberry and Wilson, 2011; Santrock, 2008). Newborns establish their individual sleep-activity cycle, and parents develop sensitivity to their baby’s cues. Studies have found that parents position their infants at home in the same positions they observed in the hospital setting; thus nurses must demonstrate correct positioning on the back to reduce the incidence of SIDS (Davidson et al., 2008). Co-sleeping or bed sharing has also been reported to possibly be associated with an increased risk for SIDS (Hockenberry and Wilson, 2011; Santrock, 2008). Safeguards include proper positioning; removing stuffed animals, soft bedding, and pillows; and avoiding overheating the infant. Individuals should avoid smoking during pregnancy and around the infant because it places the infant at greater risk for SIDS (Hockenberry and Wilson, 2011).

During the first month of life most parents and newborns normally develop a strong bond that grows into a deep attachment. Interactions during routine care enhance or detract from the attachment process. Feeding, hygiene, and comfort measures consume much of infants’ waking time. These interactive experiences provide a foundation for the formation of deep attachments. Early on older siblings need to have opportunity to be involved in the newborn’s care. Family involvement helps support growth and development and promotes nurturing (Fig. 12-3).

Steady and proportional growth of the infant is more important than absolute growth values. Charts of normal age- and gender-related growth measurements enable the nurse to compare growth with norms for a child’s age. Measurements recorded over time are the best way to monitor growth and identify problems. Size increases rapidly during the first year of life; birth weight doubles in approximately 5 months and triples by 12 months. Height increases an average of 2.5 cm (1 inch) during each of the first 6 months and about 1.2 cm ( inch) each month until 12 months (Hockenberry and Wilson, 2011).

Throughout the first year the infant’s vision and hearing continue to develop. Some infants as young as months are able to link visual and auditory stimuli (Santrock, 2009). Patterns of body function also stabilize, as evidenced by predictable sleep, elimination, and feeding routines. Some reflexes that are present in the newborn such as blinking, yawning, and coughing remain throughout life; whereas others such as grasping, rooting, sucking, and the Moro or startle reflex disappear after several months.

Gross-motor skills involve large muscle activities and are usually closely monitored by parents who easily report recently achieved milestones. Newborns can only momentarily hold their heads up, but by 4 months most infants have no head lag. The same rapid development is evident as infants learn to sit, stand, and then walk. Fine-motor skills involve small body movements and are more difficult to achieve than gross-motor skills. Maturation of eye-and-hand coordination occurs over the first 2 years of life as infants move from being able to grasp a rattle briefly at 2 months to drawing an arc with a pencil by 24 months. Development proceeds at a variable pace for each individual but usually follows the same pattern and within the same time frame (Table 12-1).

The complex brain development during the first year is demonstrated by the infant’s changing behaviors. As he or she receives stimulation through the developing senses of vision, hearing, and touch, the developing brain interprets the stimuli. Thus the infant learns by experiencing and manipulating the environment. Developing motor skills and increasing mobility expand an infant’s environment and, with developing visual and auditory skills, enhance cognitive development. For these reasons Piaget (1952) named his first stage of cognitive development, which extends until around the third birthday, the sensorimotor period. Today’s researchers have many more methods available to study the cognitive development of infants, and they believe that infants are far more competent than Piaget was able to discern by observation alone (Santrock, 2009) (see Chapter 11).

Infants need opportunities to develop and use their senses. Nurses need to evaluate the appropriateness and adequacy of these opportunities. For example, ill or hospitalized infants sometimes lack the energy to interact with their environment, thereby slowing their cognitive development. Infants need to be stimulated according to their temperament, energy, and age. The nurse uses stimulation strategies that maximize the development of infants while conserving their energy and orientation. An example of this is a nurse talking to and encouraging an infant to suck on a pacifier while administering the infant’s tube feeding.

The average toddler grows 6.2 cm (2.5 inches) in height and gains approximately 5 to 7 pounds each year (Santrock, 2009). The rapid development of motor skills allows the child to participate in self-care activities such as feeding, dressing, and toileting. In the beginning the toddler walks in an upright position with a broad stance and gait, protuberant abdomen, and arms out to the sides for balance. Soon the child begins to navigate stairs, using a rail or the wall to maintain balance while progressing upward, placing both feet on the same step before continuing. Success provides courage to attempt the upright mode for descending the stairs in the same manner. Locomotion skills soon include running, jumping, standing on one foot for several seconds, and kicking a ball. Most toddlers ride tricycles, climb ladders, and run well by their third birthday.

Fine-motor capabilities move from scribbling spontaneously to drawing circles and crosses accurately. By 3 years the child draws simple stick people and is usually able to stack a tower of small blocks. Children now hold crayons with their fingers rather than with their fists and can imitate vertical and horizontal strokes. They are able to manage feeding themselves with a spoon without rotating it and can drink well from a cup without spilling. Toddlers can turn pages of a book one at a time and can easily turn doorknobs (Hockenberry and Wilson, 2011).

According to Erikson (1963) a sense of autonomy emerges during toddlerhood. Children strive for independence by using their developing muscles to do everything for themselves and become the master of their bodily functions. Their strong wills are frequently exhibited in negative behavior when caregivers attempt to direct their actions. Temper tantrums result when parental restrictions frustrate toddlers. Parents need to provide toddlers with graded independence, allowing them to do things that do not result in harm to themselves or others. For example, young toddlers who want to learn to hold their own cups often benefit from two-handled cups with spouts and plastic bibs with pockets to collect the milk that spills during the learning process.

The newly developed locomotion abilities and insatiable curiosity of toddlers make them at risk for injury. Toddlers need close supervision at all times and particularly when in environments that are not childproofed (Fig. 12-5).

Stay updated, free articles. Join our Telegram channel

Join