MATERNAL HEALTHCARE 2633 - 29 NURSING CARE OF A
FAMILY WITH AN INFANT STUDY GUIDE LATEST UPDATED
2026
Traditionally, infancy includes ages 1 month to 1 year. From birth to 1 month is termed
the
newborn period. In these important months, an infant undergoes such rapid
development that parents sometimes believe their baby looks different and
demonstrates new abilities every day.
With the process of attachment to a primary caregiver, the infant forms a first social
relationship.
Due to the growth and learning potential that occurs, this first year is a crucial one.
Without proper nutrition, a baby will not grow and physically thrive; without proper
stimulation and nurturing care by a consistent caregiver, an infant may not develop
a healthy attachment
relationship or a feeling of security that is essential for future healthy emotional and
social
development (Goldson et al., 2020). Box 29.1 highlights Healthy People 2030 goals
addressing this important developmental stage.
Nursing Process Overview ASSESSMENT
Nursing assessment of an infant begins with an interview with the primary caregiver.
Important areas to discuss include nutrition, elimination, growth patterns, and
development. An infant’s weight, length, and head circumference are important
indicators of growth, so they should be measured and plotted on standardized growth
charts. Growth charts, which plot growth patterns, are available from the Centers for
Disease Control and Prevention (CDC) and the World Health Organization (WHO).
Typical infant appearance is shown in Box 29.2. The physical assessment of an infant
must be done efficiently because a baby gets fussy if there is excessive stimulation.
Observe behavior and temperament prior to the examination. It is best if a caregiver is
present, to make the infant feel secure. Performing the assessment provides the
opportunity to provide
education of any common findings or developmental milestones that are observed. A
general
appearance can be obtained while the infant is being held by the parent/caregiver. If the
infant is initially quiet, assess the respiratory and cardiac system first.
NURSING DIAGNOSIS
Much of the assessment of an infant and family will focus on basic needs such as sleep,
nutrition, and activity and the caregivers’ adjustment to their new role. Examples of
nursing
diagnoses include: Ineffective breastfeeding related to sore nipples Sleep deprivation
(parental) related to providing infant’s care Knowledge deficiency related to typical infant
growth and
development Malnutrition risk, less than body requirements, related to infant’s difficulty
sucking Health-seeking behaviors related to adjusting to parenthood Growth and
development delays
related to lack of stimulating environment Impaired parenting risk related to recent
hospitalization of infant Readiness for enhanced family coping related to increased
financial support Social isolation (parental) related to lack of adequate social support
,Ineffective role performance related to new responsibilities within the family
OUTCOME IDENTIFICATION AND PLANNING
Outcomes established for infant care need to be realistic based on the family’s
individual
circumstances. Parents/caregivers of infants, especially first-time parents, require
education and anticipatory guidance. Suggest activities that are individualized based on
the family’s lifestyle and personal preferences. For example, if assessment data
(flattened occipital area on the infant’s head) indicate that the infant needs more time on
its abdomen (tummy time), demonstrate to
parents how to perform this activity so the infant accepts it and it is done safely. Working
together, these actions should permit the head to return to its shape. Parents/caregivers
might find online referred resources helpful. Further information regarding online
resources may be found in Chapter 28.
IMPLEMENTATION
One of the most important interventions of the infant period is teaching parents about
typical growth and development milestones, such as the expected age range for rolling
over or reaching for objects. Whenever possible, this information should be anticipatory,
so parents can anticipate this new skill and are prepared for changes in development
before they occur. This enables
parents to focus on safety to prevent the infant from rolling off a surface or reaching for
an object that could cause injury.
OUTCOME EVALUATION
Evaluate expected outcomes at each visit to document progress in physical growth and
development. Help parents/caregivers understand progress in the development
regarding the areas of social, language, and fine motor and gross motor skills. There is
a range of expected
achievement of developmental milestones and an identified age when there is a delay in
reaching those milestones. If there is a delay in one of the four areas, further evaluation
is required. It is important to consider relevant prenatal and natal history that may affect
reaching developmental milestones. Prematurity is an example of relevant natal history.
For every week a newborn is born prior to 37 weeks gestation, achievement of
developmental milestones may be delayed by a week without concern. Examples of
expected outcomes include: Parent/caregiver acknowledges feeling fatigued but able to
cope with sleep disturbance from night waking. Parents/caregivers state five actions
they are taking daily to encourage bonding. Parents/caregivers state they are
adjusting to new role as parents. Parents/caregivers verbalize appropriate techniques
they use to stimulate infant. Infant demonstrates age-appropriate growth and
development. Infant’s weight, length, and head circumference are progressing
following previously established percentiles on the growth chart.
Growth and Development of an Infant
Infants grow rapidly both in size and in their ability to perform tasks during their first
year. A standard schedule for healthcare visits is for 2-week, 2-month, 4-month, 6-
month, 9-month, and 12-month visits (American Academy of Pediatrics [AAP], 2017).
These visits are important for the infant because they provide the opportunity to
provide immunizations, obtain growth
measurements, and perform health assessments; they are important for caregivers
because they provide an opportunity to ask questions about their child’s growth pattern
and developmental progress. They provide opportunities for healthcare providers to
assess for potential problems
when they first appear. Anticipatory guidance offered at these visits can help caregivers
prepare for the rapid changes that occur during the first year of life. When appropriate,
,encouraging
parents/caregivers to participate in infant/caregiver networking groups is another way to
help increase their knowledge base and confidence level to care for their rapidly
growing infant. There are many apps caregivers can use to document their child’s
growth, feeding, sleep, elimination, and development milestones
(https://www.babyconnect.com/). Many online
resources provide guidance on expected developmental milestones and include an
app to record milestones (https://www.cdc.gov/ncbddd/actearly/milestones-app.html).
This is a free app for children 2 months to 5 years and includes a milestone checklist
specific to the child’s birthdate. Sections include when to act, tips and activities,
milestones, and a child summary. The entries can be shared with a healthcare
provider. Table 29.1 details the usual procedures done at infant health maintenance
visits. The vaccines administered during the first year are discussed in
Chapter 34.
TABLE 29.1 HEALTH MAINTENANCE SCHEDULE, INFANT PERIOD Physical Health
Physical Examination Frequency Developmental milestones including psychosocial
interaction History, observation Every visit Ages and Stages Questionnaire At 9 months
Growth milestones Height, weight, head circumference plotted on standard growth
chart; physical examination
Every visit Vision and hearing History, observation Every visit Physical examination
Every visit Nutritional adequacy History, observation Every visit Parent–child
relationship History, observation Every visit Sleep positioning counseling Discussion
of placing infants on back to sleep; using “tummy time” for play periods during the
day Every visit up to 9 months
Unintentional injury counseling Discussion of safety measures to take with infants
Every visit Dental health History, physical examination Every visit after teeth erupt
Fluoride varnish
Recommended every visit starting at 6 months with tooth eruption Anemia Hematocrit,
hemoglobin 12-month visit Lead screening Point of Care rapid lead screening 12-month
visit
Tuberculosis screening Purified protein derivative (PPD) test (if warranted) If indicated
based on risk Newborn screening Heel blood sample At 2-week visit Immunizations
Review of history and health record; teaching parent about any risks and side effects;
administering immunization in accordance with healthcare agency policies Haemophilus
influenzae Type B Hib 2-, 4-, 6-, and 12-month visits Varicella VAR 12-month visit
Inactivated poliomyelitis virus IPV 2-, 4-, and 6-month visits Pneumococcal disease
PCV 2-, 4-, 6-, and 12-month visits Diphtheria, tetanus and
pertussis (whooping cough) DTaP 2-, 4-, 6-, and 12–15 months Hepatitis B HepB Birth,
2-
month, and 6- or 12-month visits Rotavirus RV 2-, 4-, and possibly at 6-month visit
depending on manufacturer Influenza IIV Yearly at 6-month or later visit Mumps,
measles, and rubella MMR 12- or 15-month visit Varicella Var 12- or 15-month visit
Hepatitis A HepA 12- or 15-month visit Anticipatory Guidance Infant care Active
listening and health teaching Every visit Expected growth and developmental
milestones before next visit Health teaching Every visit
Poison and unintentional injury prevention Educate caregivers about infant safety, such
as using car seats and locking up poisons; provide telephone number of national poison
control center
(800-122-1222) Every visit Problem Solving Any problems expressed by parent during
course of the visit Active listening and health teaching regarding nutrition, exercise,
language development Every visit
, PHYSICAL GROWTH
The physiologic changes that occur in the infant year reflect both the increasing maturity
and growth of body organs.
Weight
In general, infants double their birth weight by 4 to 6 months and triple it by 1 year.
During the first 6 months, infants typically average a weight gain of 2 lb per month.
During the second 6 months, weight gain is approximately 1 lb per month. The average
1-year-old male weighs 10 kg (22 lb); the average 1-year-old female weighs 9.5 kg (21
lb). An infant’s weight, however, is
relevant only when plotted on a standard growth chart and compared to that child’s own
growth curve.
Length
An infant increases in length during the first year by 50%, or grows from the average
birth length of 20 in. to about 30 in. (50.8 to 76.2 cm). Length, like weight, is assessed
best if it is
plotted on a standard growth chart. Infant growth is most apparent in the trunk during
the early months. During the second half of the first year, it becomes more apparent as
lengthening of the legs occurs. At the end of the first year, the child’s legs may still
appear disproportionately short, however, and perhaps bowed. For accuracy, measure
infants lying supine on a measuring board even if they are beginning to be able to stand
(see Chapter 34, Box 34.9). Head Circumference By the end of the first year, the brain
already reaches two-thirds of its adult size.
Head circumference
increases rapidly during the infant period to reflect this rapid brain growth. Some infants’
heads appear asymmetric until the second half of the first year, especially if they are
always placed on their back to sleep (as recommended), causing the skull bones to
flatten in the back. Suggest to parents/caregivers they continue to place the infant on
their back for sleep but to spend “tummy time” daily with the infant placed in a prone
position to prevent this flattening. This early head
distortion will gradually correct itself as the child sleeps less and spends more time with
the head in an erect position. Persistence of asymmetry suggests an infant is not
receiving enough
stimulation.
Body
Proportion
Body proportion changes during the first year from that of a newborn to a more typical
infant appearance. By the end of the infant period, the lower jaw is definitely prominent
and remains
that way throughout life. The circumference of the chest is generally less than that of
the head at birth by about 2 cm. It is even with the head circumference in some infants
as early as 6 months and in most by 12 months. Chest circumference is typically not
measured at each visit. The
abdomen remains protuberant until the child has been walking well into the toddler
period.
Cervical, thoracic, and lumbar vertebral curves develop as infants hold up their head,
sit, and walk. Lengthening of the lower extremities during the last 6 months of infancy
readies the child for walking and often is the final growth that changes the appearance
from “baby-like” to
“toddler-like.”
Body Systems
In the cardiovascular system, heart rate slows from 110 to 160 beats per minute to
FAMILY WITH AN INFANT STUDY GUIDE LATEST UPDATED
2026
Traditionally, infancy includes ages 1 month to 1 year. From birth to 1 month is termed
the
newborn period. In these important months, an infant undergoes such rapid
development that parents sometimes believe their baby looks different and
demonstrates new abilities every day.
With the process of attachment to a primary caregiver, the infant forms a first social
relationship.
Due to the growth and learning potential that occurs, this first year is a crucial one.
Without proper nutrition, a baby will not grow and physically thrive; without proper
stimulation and nurturing care by a consistent caregiver, an infant may not develop
a healthy attachment
relationship or a feeling of security that is essential for future healthy emotional and
social
development (Goldson et al., 2020). Box 29.1 highlights Healthy People 2030 goals
addressing this important developmental stage.
Nursing Process Overview ASSESSMENT
Nursing assessment of an infant begins with an interview with the primary caregiver.
Important areas to discuss include nutrition, elimination, growth patterns, and
development. An infant’s weight, length, and head circumference are important
indicators of growth, so they should be measured and plotted on standardized growth
charts. Growth charts, which plot growth patterns, are available from the Centers for
Disease Control and Prevention (CDC) and the World Health Organization (WHO).
Typical infant appearance is shown in Box 29.2. The physical assessment of an infant
must be done efficiently because a baby gets fussy if there is excessive stimulation.
Observe behavior and temperament prior to the examination. It is best if a caregiver is
present, to make the infant feel secure. Performing the assessment provides the
opportunity to provide
education of any common findings or developmental milestones that are observed. A
general
appearance can be obtained while the infant is being held by the parent/caregiver. If the
infant is initially quiet, assess the respiratory and cardiac system first.
NURSING DIAGNOSIS
Much of the assessment of an infant and family will focus on basic needs such as sleep,
nutrition, and activity and the caregivers’ adjustment to their new role. Examples of
nursing
diagnoses include: Ineffective breastfeeding related to sore nipples Sleep deprivation
(parental) related to providing infant’s care Knowledge deficiency related to typical infant
growth and
development Malnutrition risk, less than body requirements, related to infant’s difficulty
sucking Health-seeking behaviors related to adjusting to parenthood Growth and
development delays
related to lack of stimulating environment Impaired parenting risk related to recent
hospitalization of infant Readiness for enhanced family coping related to increased
financial support Social isolation (parental) related to lack of adequate social support
,Ineffective role performance related to new responsibilities within the family
OUTCOME IDENTIFICATION AND PLANNING
Outcomes established for infant care need to be realistic based on the family’s
individual
circumstances. Parents/caregivers of infants, especially first-time parents, require
education and anticipatory guidance. Suggest activities that are individualized based on
the family’s lifestyle and personal preferences. For example, if assessment data
(flattened occipital area on the infant’s head) indicate that the infant needs more time on
its abdomen (tummy time), demonstrate to
parents how to perform this activity so the infant accepts it and it is done safely. Working
together, these actions should permit the head to return to its shape. Parents/caregivers
might find online referred resources helpful. Further information regarding online
resources may be found in Chapter 28.
IMPLEMENTATION
One of the most important interventions of the infant period is teaching parents about
typical growth and development milestones, such as the expected age range for rolling
over or reaching for objects. Whenever possible, this information should be anticipatory,
so parents can anticipate this new skill and are prepared for changes in development
before they occur. This enables
parents to focus on safety to prevent the infant from rolling off a surface or reaching for
an object that could cause injury.
OUTCOME EVALUATION
Evaluate expected outcomes at each visit to document progress in physical growth and
development. Help parents/caregivers understand progress in the development
regarding the areas of social, language, and fine motor and gross motor skills. There is
a range of expected
achievement of developmental milestones and an identified age when there is a delay in
reaching those milestones. If there is a delay in one of the four areas, further evaluation
is required. It is important to consider relevant prenatal and natal history that may affect
reaching developmental milestones. Prematurity is an example of relevant natal history.
For every week a newborn is born prior to 37 weeks gestation, achievement of
developmental milestones may be delayed by a week without concern. Examples of
expected outcomes include: Parent/caregiver acknowledges feeling fatigued but able to
cope with sleep disturbance from night waking. Parents/caregivers state five actions
they are taking daily to encourage bonding. Parents/caregivers state they are
adjusting to new role as parents. Parents/caregivers verbalize appropriate techniques
they use to stimulate infant. Infant demonstrates age-appropriate growth and
development. Infant’s weight, length, and head circumference are progressing
following previously established percentiles on the growth chart.
Growth and Development of an Infant
Infants grow rapidly both in size and in their ability to perform tasks during their first
year. A standard schedule for healthcare visits is for 2-week, 2-month, 4-month, 6-
month, 9-month, and 12-month visits (American Academy of Pediatrics [AAP], 2017).
These visits are important for the infant because they provide the opportunity to
provide immunizations, obtain growth
measurements, and perform health assessments; they are important for caregivers
because they provide an opportunity to ask questions about their child’s growth pattern
and developmental progress. They provide opportunities for healthcare providers to
assess for potential problems
when they first appear. Anticipatory guidance offered at these visits can help caregivers
prepare for the rapid changes that occur during the first year of life. When appropriate,
,encouraging
parents/caregivers to participate in infant/caregiver networking groups is another way to
help increase their knowledge base and confidence level to care for their rapidly
growing infant. There are many apps caregivers can use to document their child’s
growth, feeding, sleep, elimination, and development milestones
(https://www.babyconnect.com/). Many online
resources provide guidance on expected developmental milestones and include an
app to record milestones (https://www.cdc.gov/ncbddd/actearly/milestones-app.html).
This is a free app for children 2 months to 5 years and includes a milestone checklist
specific to the child’s birthdate. Sections include when to act, tips and activities,
milestones, and a child summary. The entries can be shared with a healthcare
provider. Table 29.1 details the usual procedures done at infant health maintenance
visits. The vaccines administered during the first year are discussed in
Chapter 34.
TABLE 29.1 HEALTH MAINTENANCE SCHEDULE, INFANT PERIOD Physical Health
Physical Examination Frequency Developmental milestones including psychosocial
interaction History, observation Every visit Ages and Stages Questionnaire At 9 months
Growth milestones Height, weight, head circumference plotted on standard growth
chart; physical examination
Every visit Vision and hearing History, observation Every visit Physical examination
Every visit Nutritional adequacy History, observation Every visit Parent–child
relationship History, observation Every visit Sleep positioning counseling Discussion
of placing infants on back to sleep; using “tummy time” for play periods during the
day Every visit up to 9 months
Unintentional injury counseling Discussion of safety measures to take with infants
Every visit Dental health History, physical examination Every visit after teeth erupt
Fluoride varnish
Recommended every visit starting at 6 months with tooth eruption Anemia Hematocrit,
hemoglobin 12-month visit Lead screening Point of Care rapid lead screening 12-month
visit
Tuberculosis screening Purified protein derivative (PPD) test (if warranted) If indicated
based on risk Newborn screening Heel blood sample At 2-week visit Immunizations
Review of history and health record; teaching parent about any risks and side effects;
administering immunization in accordance with healthcare agency policies Haemophilus
influenzae Type B Hib 2-, 4-, 6-, and 12-month visits Varicella VAR 12-month visit
Inactivated poliomyelitis virus IPV 2-, 4-, and 6-month visits Pneumococcal disease
PCV 2-, 4-, 6-, and 12-month visits Diphtheria, tetanus and
pertussis (whooping cough) DTaP 2-, 4-, 6-, and 12–15 months Hepatitis B HepB Birth,
2-
month, and 6- or 12-month visits Rotavirus RV 2-, 4-, and possibly at 6-month visit
depending on manufacturer Influenza IIV Yearly at 6-month or later visit Mumps,
measles, and rubella MMR 12- or 15-month visit Varicella Var 12- or 15-month visit
Hepatitis A HepA 12- or 15-month visit Anticipatory Guidance Infant care Active
listening and health teaching Every visit Expected growth and developmental
milestones before next visit Health teaching Every visit
Poison and unintentional injury prevention Educate caregivers about infant safety, such
as using car seats and locking up poisons; provide telephone number of national poison
control center
(800-122-1222) Every visit Problem Solving Any problems expressed by parent during
course of the visit Active listening and health teaching regarding nutrition, exercise,
language development Every visit
, PHYSICAL GROWTH
The physiologic changes that occur in the infant year reflect both the increasing maturity
and growth of body organs.
Weight
In general, infants double their birth weight by 4 to 6 months and triple it by 1 year.
During the first 6 months, infants typically average a weight gain of 2 lb per month.
During the second 6 months, weight gain is approximately 1 lb per month. The average
1-year-old male weighs 10 kg (22 lb); the average 1-year-old female weighs 9.5 kg (21
lb). An infant’s weight, however, is
relevant only when plotted on a standard growth chart and compared to that child’s own
growth curve.
Length
An infant increases in length during the first year by 50%, or grows from the average
birth length of 20 in. to about 30 in. (50.8 to 76.2 cm). Length, like weight, is assessed
best if it is
plotted on a standard growth chart. Infant growth is most apparent in the trunk during
the early months. During the second half of the first year, it becomes more apparent as
lengthening of the legs occurs. At the end of the first year, the child’s legs may still
appear disproportionately short, however, and perhaps bowed. For accuracy, measure
infants lying supine on a measuring board even if they are beginning to be able to stand
(see Chapter 34, Box 34.9). Head Circumference By the end of the first year, the brain
already reaches two-thirds of its adult size.
Head circumference
increases rapidly during the infant period to reflect this rapid brain growth. Some infants’
heads appear asymmetric until the second half of the first year, especially if they are
always placed on their back to sleep (as recommended), causing the skull bones to
flatten in the back. Suggest to parents/caregivers they continue to place the infant on
their back for sleep but to spend “tummy time” daily with the infant placed in a prone
position to prevent this flattening. This early head
distortion will gradually correct itself as the child sleeps less and spends more time with
the head in an erect position. Persistence of asymmetry suggests an infant is not
receiving enough
stimulation.
Body
Proportion
Body proportion changes during the first year from that of a newborn to a more typical
infant appearance. By the end of the infant period, the lower jaw is definitely prominent
and remains
that way throughout life. The circumference of the chest is generally less than that of
the head at birth by about 2 cm. It is even with the head circumference in some infants
as early as 6 months and in most by 12 months. Chest circumference is typically not
measured at each visit. The
abdomen remains protuberant until the child has been walking well into the toddler
period.
Cervical, thoracic, and lumbar vertebral curves develop as infants hold up their head,
sit, and walk. Lengthening of the lower extremities during the last 6 months of infancy
readies the child for walking and often is the final growth that changes the appearance
from “baby-like” to
“toddler-like.”
Body Systems
In the cardiovascular system, heart rate slows from 110 to 160 beats per minute to
