Early Infancy 0 to 6 Months

PHYSICAL ASPECTS Rapid growth rate is a characteristic feature of young infants, for whom the major work is eating. After a 5 to 10 percent loss over the first 3 days of life, term infants regain birth weight by 10 days of age. A 20- to 30-g/day weight gain is the best overall sign of health. Normal infants double their birth weight by 5 months. Young infants have a high surface area to body mass ratio with a proportionally large head, resulting in a high rate of heat loss and risk of hypothermia. The normal anterior fontanelle is slightly depressed when a child is upright. Young infants are obligate nose breathers and may experience partial airway obstruction with abnormal positioning or viral upper respiratory tract infections. Normal neonates may exhibit periodic breathing, or 5 to 10 s pauses followed by tachypnea, due to immature central control of respiration. Both cardiac output and minute ventilation are relatively rate dependent in early infancy. A heart rate greater than 180/min and a respiratory rate greater than 60/min should be considered abnormal. Blood pressure is well maintained by compensatory mechanisms at this age, with hypotension a very late finding in shock. The pulmonary vascular bed dilates over the first 6 weeks of life, so that congenital heart lesions resulting in a left-to-right shunt, for example, ventricular septal defect, will present after this age. Finally, the primary series of immunizations, including diphtheria-pertussis-tetanus (DPT), oral poliovirus (OPV), and Haemophilus influenzae type b (HIb), are completed by 6 months of age (Table 111-3). The rotavirus vaccine had been added to the primary immunization series, but recent reports of possible association with intussusception have resulted in temporary cessation of use.

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