Pride in Parenting: Training Curriculum for Lay Home Visitors
Linda T. Diamond, M.S. and Marion H. Jarrett, Ed.D., editors.

Unit 15
Child Growth and Development: Birth to One Month

In this unit, participants will review developmental milestones of infancy, from birth to one month, learn how to help parents understand this stage of development and interpret infant behavior, share activities that both parents and their babies will enjoy, recognize possible problems in infant growth and development and identify available resources for babies and parenting families.

Unit 15 Handout #1
Changes in Appearance: Birth to One Month

• Growth
• Arms and Legs
• Head
• Skin
• Temperature Control
• Umbilical Cord

Unit 15 Handout #2
What A Healthy Newborn Looks Like

• Skull: The top of a newborn baby’s skull has two soft spots. You can see these spots. One is at the lower center of the forehead, above the eyebrows. The other is near the very top of the head. You will not hurt your baby if you touch these spots.
• Head: A newborn baby’s head usually looks very large. While a baby is being born, there is a lot of pressure on the head. The soft spots allow the head bones to get pushed together when the baby is born. This might cause the head to have a funny shape. It will look better after a while. Your baby may have lots of thick hair or he may have no hair at all.
• Eyes: A newborn baby’s eyes are light in color. They may look crossed. Or they might seem to stare. This is because newborn babies can’t focus their eyes. When your new baby cries, you won’t see any tears. It takes time for the tear ducts to start to work.
• Face: Most newborn babies have fat cheeks, a tiny nose and hardly any chin. The face may look swollen. The eyelids may be puffy.
• Hands: A newborn baby’s hands usually are in a tight fist. If you open your baby’s hands, you’ll see fine lines on the palms. The fingernails will be very thin.
• Body: A new born baby’s body usually has a short neck, tiny shoulders, swollen breasts, a fat belly and thin hips. You’ll also see the "umbilical stump". It will become the belly button.
• Genitals: The sex organs of a newborn usually look big compared to the small size of the baby’s body. This is true for both girls and boys.
• Legs: A newborn baby’s legs usually are pulled up against the belly. This is the way they are when the baby is in the womb. The knees usually are slightly bent. They turn toward the outside.
• Feet: A newborn baby’s foot is not complete at birth. The heel bones are formed, but the other bones will not form until later.
• Skin: A newborn baby’s skin is usually dry and thin. You should be able to see many fine red lines on it. These are veins. Light-skinned babies usually look rosy red. Most black babies look light at birth. Later they get darker in color.

Unit 15 Handout #3
Developmental Milestones

Birth to One Month

• Head turns side to side
• Lifts head momentarily
• Head flops backward if unsupported
• Waves hands and kicks feet when lying on back
• Movements may be jerky
• Explores hands in mouth and together

• Focuses 8 to 12 inches away
• Looks at objects or people
• Eyes wander and occasionally cross

• Startled in response to loud sounds
• May turn toward a familiar sound or voice
• Cries, coos and makes movements

• Quiets when picked up
• Likes to be picked up and held
• Cries and knows someone will come

Unit 15 Handout #4
States of Consciousness

• Deep Sleep State
• Light Sleep State
• Drowsy State
• Quiet-Alert State
• Active-Alert State
• Crying

Deep Sleep – Identified by inactivity and closed, unmoving eyes with regular breathing and pale skin.

Light Sleep – Identified by irregular breathing, flushed skin, and closed, but moving, eyes, Babies move during light sleep.

Drownsy State – Characterized by increased motor activity, startle behavior, and fluttering eye movements. The state that babies enter as they move from a sleep state to an awake state.

Quiet Alert State – Infant’s eyes are open, bright, and alert. Infants look at their surroundings. Very little movement is observed.

Active Alert State – Identified by random spurts of movements. Infant’s eyes are not as bright or focused as in the quiet-alert state. Infants may be fussy.

Crying – Characterized by flushed skin, vigorous activity, and crying.

Recognition of these states has enabled researchers to learn a tremendous amount about infants in the past few years. On average, newborns lie quietly awake for one hour of the day – usually for five to ten minute intervals around feedings. It is only during these short, quiet-alert states that infants appear to perceive the world with all of their senses.

Unit 15 Handout #5

Newborn Reflexes

Mora Reflext or Startle Reflex — When newborns are startled by a sudden change in position or noise, they startle, fling out their arms and legs, with fingers spread wide, and then draw their arms and legs back toward their bodies in a clasping motion.

Palmar Grasp Reflex — When newborn’s palms are stroked, they will close on the object and grasp it.

Tonic Neck Reflex (Fencer Position) — When newborn’s heads are turned to one side, their whole body arches away from the side they are turned to. The arm on that side extends and the opposite arm flexes, giving them the look of a fencer.

Rooting & Sucking — When the cheeks of newborns are touched, they turn toward the direction of the stroking object and the sucking reflex follows. When the insides of their mouths are touched, they start to suck.

Newborns have many other reflexes: a stepping reflex, a hand-to-mouth reflex, a swimming reflex, and more.

Unit 15 Handout #6
Developmental Health Watch

If, during the second, third, or fourth weeks of your baby's life, he shows any signs of developmental delay, notify your pediatrician.

• Sucks poorly and feeds slowly
• Doesn't blink when shown a bright light
• Doesn't focus and follow a nearby object moving side to side
• Rarely moves arms and legs; seems stiff
• Seems excessively loose in the limbs, or floppy
• Lower jaw trembles constantly, even when not crying or excited
• Doesn't respond to loud sounds

Unit 15 Handout #7
PIP Training
Site Visit Observation

Name of Setting:
Age of Child Observing:
Number of Children:
Number of Adults:

1. Observe the environment carefully; look at facilities, materials and personnel. In what way(s) is it appropriate for:

a. Children’s play and interaction:
b. Daily caretaking:
c. Safety:

Is it inappropriate in any way?

a. Children’s play and interaction:
b. Daily caretaking:
c. Safety:

2. Describe the personality or interaction style of the baby you observe.

3. What do the caregivers do to encourage the baby’s development?

4. For the specific baby you observe, what skills do you see s/he has?

a. Motor:
b. Cognitive:
c. Emotional:
d. Social:
e. Communication:

5. Do you notice that the child has preferences?

Unit 15 Handout #8
Safety Check

• Your baby should ride in a properly installed, federally approved car seat every time he is in the car. At this age, he should ride in the rear-facing position. Children should always be in the back seat of any vehicle.

• When bathing the baby in the sink, seat him on a washcloth to prevent slipping, and hold him under the arms.
• Adjust the temperature of your water heater to less than 120 degrees so the hot water can't scald him.

• Never leave your baby unattended on any surface above the floor. Even at this young age, he can suddenly extend his body and flip over the edge.

• If you use baby powder, shake it out away from your infant's face so he doesn't inhale it.
• Keep the crib free of all small objects (safety pins, small parts of toys, etc.) that he could swallow.
• Never leave plastic bags or wrappings where your baby can reach them.

• Dress your baby in clothing treated with flame-retardant chemicals.
• Install smoke detectors in the proper places throughout your home.

• Never leave your baby alone in the house, yard, or car.

• Don't attach pacifiers, medallions, or other objects to the crib or body with a cord.
• Don't place a string or necklace around the baby's neck.

• Be careful not to jiggle or shake the baby's head too vigorously.
• Always support the baby's head and neck when moving his body.

Unit 15 Training Aid #1

Scenarios

ROLE PLAY - Growth and Development: Birth to One Month

My baby does not sleep much during the day, but he is fairly content. But around dinner time, he starts to cry. He will cry for 2 or 3 hours and nothing I can do helps. Sometimes I feel like just leaving him in the apartment and getting out of there. What can I do?

ROLE PLAY - Growth and Development: Birth to One Month

When I hold my baby, his head flops backward. I think he should be able to hold it up by now, so I try to make him do it. Do you think something is wrong with him?

ROLE PLAY - Growth and Development: Birth to One Month

My baby sleeps in a crib in my room. He wakes up lots of times during the night and makes little whimpering sounds. I pick him up to see what is the matter and sometimes change his diaper or feed him. It is then really hard to get him to go back to sleep. What should I do?

ROLE PLAY - Growth and Development: Birth to One Month

I can’t get my baby to nurse. She starts out sucking well and seems to be hungry and wants milk. But after a short time, she starts to look around at what is going on the room and stops and starts sucking for short periods. She then gets really frantic. She seems hungry, but can’t suck long enough to get enough milk. What should I do?

Unit 15 Overhead #1
Role Play Feedback

1. What do you think you the Parenting Support Specialist did well?
2. What could the Parenting Support Specialist have changed or done differently?
3. What other things do you think the Parenting Support Specialist might say or do to help a mother in this situation?

Unit 15 Unit Test
Child Growth and Development: Birth to One Month

1. List three changes in the infant’s physical appearance during birth to one month that might be of concern to a mother.

Motor:
Cognitive:
Emotional:
Social:
Communication:

Unit 15

Post-Unit Evaluation
Unit Covered: _____
Date: _____

1. Do you feel we covered all the information in this unit that we said we were going to?
2. What did you like best about the unit?
3. What did you like least about the unit?
4. Was the information in this unit presented clearly? If not, please explain.
5. In which skill areas do you feel you need more practice or help?
6. How can we make this unit better?
7. Any additional comments?