Thoughts on Physical Development in Infancy from Hong Kong point of View

The physical development in infancy is considered to be of the very first year upon the infant's birth. For the first four months, the circumference of the infant's head and chest circumference are almost the same size as the abdomen. The circumference of the head will continually increase to about 2cm per month for 2 months and after which will increase to about 1.5 cm till the 4th month. This increase correlates to the growth of the brain.
Breathing-wise, the infant will breathe using his/her abdominal muscles. Posterior fontanel will close by the second month with the anterior fontanel to close to an estimated 1.3cm. The infant's skin remains senstive and very easy to be irritated. He or she is able to cry with tears.

No wonder in Hong Kong, there was a news report about a nurse's failure to check the temperature of water before cleaning the newly borned infant, which caused extreme redness on the infant's skin, especially the private parts. The parents of the infant was extremely upset and angry at the nurse's misapproriated behaviour. For a report on this, please visit http://blogs.bmj.com/bmj/2010/04/30/andrew-burd-on-elbows-and-burning-babies/
I guess the nurse's defence was that (Surprisingly) the baby did not cry after being immersed in the "hot water" for quite some time, hence the nurse did not remove the baby from the water.

Between 4 to 8 months, the circumferences of the infant's chest and head are exact same size, with the head circumference increasing with an estimation of 1 cm per month up till 0.5 cm at the 6 month. Breathing should be adominal at this stage with the breathing rate depending on the activities the infant engages with. Interestingly, teeth begins to appear during this period, with gums becoming red plus swollen, with immense biting of objects and drooling. At this stage, the infant's legs still bowed and bowing decreases as he/she grows older. We can find "baby fat" appearing at this stage with his or her true eye color revealed.

The remaining months for the first year will present the infant's breathing rate and body temerature depending on the activity he or she is engaging with and various environmental conditions. Breathing is stil abdominal with anterior fontanel beginning to close. More teeth appear, starting with the two lower incisors and two upper incisors making him or her more cute. His or her arm and hands gain strength than the arched feet and legs (cephalocaudal development). Hence, his or her hands appear proportionately larger than any other parts. "Baby Fat" will appear on thighs, upper arms and neck. The good news is that he or she could see further objects, estimated 4 to 6m and probably points at them.

The keynotes of Infancy's Physical Development are as follows:

1) Patterns of growth, mainly Cephalocaudal and Proximodistal development
2) Growth rate of height and weight are considerably slower in the 2nd year
of age.
3) In terms of Brain Development for infants, there is extensive growth in the first year and evironmental experiences (Enriched vs. Impoverished environments) are essential for brain development. The Brain's Four Lobes consist of (i) Frontal Lobe (voluntary making and thinking) (ii) Parietal Lobe (body sensations) (iii) Occipital Lobe(vision) and (iv) Temporal Lobe (hearing)

4) Infants sleep like adults after 4 months. The culture affects the infant's sleeping patterns. Regulation of wake-sleep cycle reflects the infant's neurological maturation. Infants engage in half of sleep as contrasted to Adult's fifth of sleep in REM (Rapid Eye Movements)

5) Highest cause of infant death during 4 to 6 weeks is the SIDS (Sudden Infant Death Syndrome)

6) Infant requires a healthy nutrition of around 50 calories per day per pound of weight. Breast-feeding is best and most natural. It gives appropriate weight gain for the infant. Mostly poor countries will use this method of feeding. Malnutrition will cause Marasmus ( removal of body tissues in infant's first year with serious lacking of protein) and Kwashiorkor (Lack of protein and infant's adomen/feet become swollen with water)

7) Immunization is required at infancy. Accident Prevention such as monitoring, awareness of choking hazards, burning risks and other risks are neccessary. Asphyxiation is the number 1 cause of death for infants under 1 year old.

Critique of Scald Baby Incident in Hong Kong

We can understand the pain of the parents, however, as a nurse; we also understand the nurse’s situation. Somehow policies and guidelines are hugely emerged after SARS, best quality with minimal manpower- just like pushing a cow to produce 4 cow’s milk. And to punish or study why that cow is so “unproductive”.



Besides a nurse role, I think preventing unpleasant incidents from happening again is more important than punishment. And re-teaching her is more difficult than to fire her, but I am willing to do that for her if I can.



Who has no fault? I think she has gained enough guilty from that, just give her a second chance.