Growth & Development Flashcards
Growth
Refers to an increase in physical size
Development
The sequential process by which infants and children gain various skills and functions.
Maturation
Refers to an increase in functionality of various body systems or developmental skills
Newborn Physical Growth: Weight
Average newborn weighs 3.400 kg (7.5 lb) at birth, with boys being slightly heavier than girls.
- May lose 5% to 10% of their body weight over the first week of life.
- The average newborn then gains about 20 to 30 g/day and regains his or her birth weight by 7 to 10 days of age.
Most infants double their birth weight by 4–5 months of age and triple their birth weight by the time they are 1 year old
Newborn Physical Growth: Length
Average newborn is 50 cm (20 in) long at birth
- Grows more quickly in length over the first 6 months, than during the second 6 months.
By 12 months of age, the infant’s length has increased by 50%
Newborn Physical Growth: Head Circumference
Average head circumference of the full-term newborn is 35 cm (13.5 in).
- Head circumference increases rapidly during the first 6 months.
Increases about 10 cm from birth to 1 year of age
Newborn States of Consciousness
1) Deep sleep: Sleeping w/ eyes closed & no movement
2) Light sleep: Sleeping with eyes closed
- Rapid eye movements & irregular movements may be noticed.
3) Drowsiness: Eyes may close or be half-lidded
- Infant may be dozing
4) Quiet-alert state: The infant’s eyes are wide open, and the body is calm
5) Active-alert state: The infant’s eyes are open; body movements occur
6) Crying: The infant cries or screams and it is difficult to gain the infant’s attention
Infant Brain Growth
The brain undergoes tremendous growth during the first 2 years of life.
By 6 months of age, the infant’s brain weighs half that of the adult brain.
At age 12 months, the brain has grown considerably, weighing 2½ times what it did at birth. Usually, the anterior fontanelle remains open until 12 to 18 months of age to accommodate this rapid brain growth.
- However, the fontanelle may close as early as 9 months of age, and this is not of concern in the infant with age-appropriate growth and development.
Myelination of the spinal cord and nerves continues over the first 2 years.
During the first few months of life, reflexive behavior is replaced with purposeful action
Primitive Reflexes
Subcortical and involve a whole-body response
- Moro, root, suck, asymmetric tonic neck, plantar and palmar grasp, step, and Babinski
- Diminish over the first few months of life
Primitive Reflex: Root
When infant’s cheek is stroked, the infant turns to that side, searching with mouth
Appearance: Birth
Disappearance: 3 months
Primitive Reflex: Suck
Reflexive sucking when nipple or finger is placed in infant’s mouth
Appearance: Birth
Disappearance: 2–5 months
Primitive Reflex: Moro
With sudden extension of the head, the arms abduct and move upward and the hands form a “C.”
Appearance: Birth
Disappearance: 4 months
Primitive Reflex: Asymmetric Tonic Neck
While lying supine, extremities are extended on the side of the body to which the head is turned and opposite extremities are flexed (also called the “fencing” position).
Appearance: Birth
Disappearance: 4 months
Primitive Reflex: Palmar Grasp
Infant reflexively grasps when palm is touched
Appearance: Birth
Disappearance: 4–6 months
Primitive Reflex: Plantar Grasp
Infant reflexively grasps with bottom of foot when pressure is applied to the plantar surface
Appearance: Birth
Disappearance: 9 months
Primitive Reflex: Babinski
Stroking along the lateral aspect of the sole and across the plantar surface results in fanning and hyperextension of the toes
Appearance: Birth
Disappearance: 12 months
Primitive Reflex: Step
With one foot on a flat surface, the infant puts the other foot down as if to “step”
Appearance: Birth
Disappearance: 4–8 weeks
Protective Reflexes
Gross motor responses related to maintenance of equilibrium.
These responses are prerequisites for appropriate motor development and remain throughout life once they are established.
Appropriate presence and disappearance of primitive reflexes, as well as development of protective reflexes, are indicative of a healthy neurologic system.
Persistence of primitive reflexes beyond the usual age of disappearance may indicate an abnormality of the neurologic system and should be investigated
Protective Reflex: Neck Righting
Neck keeps head in upright position when body is tilted
Appearance: 4–6 months
Disappearance: Persists
Protective Reflex: Parachute (Sideways)
Protective extension with the arms when tilted to the side in a supported sitting position
Appearance: 6 months
Disappearance: Persists
Protective Reflex: Parachute (Forward)
Protective extension with the arms when held up in the air and moved forward
- The infant reflexively reaches forward to catch himself or herself
Appearance: 6–7 months
Disappearance: Persists
Protective Reflex: Parachute (Backward)
Protective extension w/ the arms when tilted backward
Appearance: 9–10 months
Disappearance: Persists
Respiratory System Maturation in the Newborn & Infant
Respiratory Rate: Slows from 30-60 breaths (newborn)–> 20-30 breaths (12-month old)
Irregular w/ periodic pauses–> pattern becomes more regular & rhythmic
In comparison w/ adults, infants:
- Narrower nasal passages
- Trachea and chest wall are more compliant
- Bronchi & bronchioles are shorter and narrower.
- Larynx is more funnel-shaped
- Tongue is larger
- Significantly fewer alveoli
Infants are at HIGHER RISK for RESPIRATORY COMPROMISE!!
Cardiovascular System Maturation in the Newborn & Infant
Heart doubles in size over the 1st yr of life
Average pulse rate decreases from 120 to 140 in the newborn to about 100 in the 1-year-old
BP steadily increases over the first 12 months of life, from an average of 60/40 in the newborn to 100/50 in the 12-month-old
Susceptible to heat loss: Peripheral capillaries are closer to the surface of the skin
Over the first year of life, thermoregulation becomes more effective: The peripheral capillaries constrict in response to a cold environment and dilate in response to heat.
GI System Maturation in the Newborn & Infant: Teeth
Vast majority of newborns do not have teeth at birth, nor do they develop them in the first month of life.
On average, the first primary teeth begin to erupt between the ages of 6 and 8 months
Primary teeth are lost later in childhood and will be replaced by the permanent teeth.
- Gums around the emerging tooth often swell. The lower central incisors are usually the first to appear, followed by the upper central incisors
The average 12-month-old has 4-8 teeth
GI System Maturation in the Infant & Newborn: Digestion
Small amounts of saliva are present for the first 3 months of life
- Ptyalin is present only in small amounts in the saliva
Stomach: Capacity is relatively small at birth, holding about one half to 1 oz.
- By 1 year of age, the stomach can accommodate three full meals and several snacks per day
Amylase (needed for complex carbohydrate digestion) and lipase (essential for appropriate fat digestion) are both deficient in the infant and do not reach adult levels until about 5 months of age
Liver is immature at birth
GI System Maturation in the Infant & Newborn: Stool
Meconium: 1st stool, result of digestion of amniotic fluid swallowed in utero
- Dark green to black
- Sticky
In the first few days of life, the stools become yellowish or tan
Formula-Fed: Consistency of peanut butter
Breast-Fed: Loose in texture, “seedy”
Iron Supplements: Black or very dark green stool
Newborns have as many as 8-10 stool/day or 1 stool every day or two
Infrequent stooling is considered normal if the BM remains soft
Newborns and young infants often grunt, strain, or cry while attempting to have a BM
Genitourinary Maturation in the Infant & Newborn
Infant total-body water is greater percentage weight than an adult.
Infants frequently urinate.
Urine has low specific gravity (low concentration).
Higher risk of dehydration
Integumentary System Changes in Infants & Newborns
In utero, the infant is covered with vernix caseosa, which protects the developing infant’s skin
- Vernix production stops at birth
- Early Gestational Age: Infant is covered in vernix
- Late Gestational Age: Vernix may be found in the folds of the skin, axilla, and groin areas
Lanugo (fine downy hair) covers the body
Acrocyanosis: Blueness of hands & feet
- Decreases over the first few days of life
- Central cyanosis: blueness to the face, mouth or torso is always CONCERNING!!
Hematopoietic System Changes in Infants & Newborns
Physiological Anemia of Infnacy: Erythrocyte production decreases significantly, resulting in a relatively low hemoglobin and hematocrit around 2 to 3 months of age
During the last 3 months of gestation, maternal iron stores are transferred to the fetus.
- Healthy newborns typically have sufficient iron stores at birth
As the high hemoglobin concentration of the newborn decreases over the first 2 to 3 months, iron is reclaimed and stored.
- Stores may be sufficient for the first 6 to 9 months of life but will become depleted if iron supplementation does not occur
Immunological Changes in Infants & Newborns
Newborns receive IgG from mothers
- Confers immunity during the first 3 to 6 months of life for antigens to which the mother was previously exposed
Fever for infant is 100.4 F (gets full sepsis workup)
Developmental Age Groups
Infant: 1- 12 months
Toddler: 1-3 years
Preschooler: 3-6 years
School Age: 6 years-12 years
Adolescent: 12- 20 years
Infant Growth & Development
Physical Growth: Grow very rapidly in 1st 12 months of life
- Wt, lt, & Head circumference are closely monitored
- Simple to Complex
Body Systems:
- Many body systems are immature at birth
Gross & Fine Motor:
- GROSS motor skill develop in Cephalocaudal Fashion
- FINE motor skills develop in Proximodistal fashion
Learning:
- Psychosocial and cognitive
- Language and communication
- Social/emotional domains
Denver Developmental Screening
Brief assessment that identifies children
who warrant more intensive assessment
and testing
NOT A DIAGNOSTIC TOOL!!!
Used as early step to identify developmental tasks the child can perform
Assessing Growth & Development of Premature Infants
Use infants adjusted age to determine expected outcomes
How to Determine Adjusted Age: Subtract the number of weeks the infant was premature from the infant’s chronological age
Plot growth parameters & assess developmental milestones based on age
1) A 6-month-old was born at 28 weeks’ gestation (born 12 weeks or 3 months early). What is the infant’s adjusted age?
Adjusted Age: 3 months
1) Subtract 3 months from his chronologic age of 6 months
6 months-3 months = 3 months
2) A 4-month-old was born at 32 weeks’ gestation
(born 8 weeks or 2 months early). What is the infant’s adjusted age?
Adjusted Age: 2 months
1) Subtract the number of weeks the infant was premature from the infant’s chronological age
2) Subtract 2 months from his chronologic age of 4 months
4 months-2 months = 2 months
Infant Piaget’s & Erikson’s Stage of Development
Erikson’s: Trust vs. Mistrust (Birth - 1 yr)
- Trust: Infant’s needs are being consistently met
- Mistrust: Caregiver is inconsistent in meeting the infant’s needs in a timely manner
Piaget’s: Sensorimotor (Birth- 2 years)
- Infant uses senses and motor skills to learn about the world.
- Object permanence
- Purposeful movements
- Symbols and events begin to become associated: Imitate gestures
Object Permanence
If an object is hidden from the infant’s sight, he or she will search for it in the last place it was seen, knowing it still exist
Begins to develop between 4 and 7 months of age and is solidified by about 8 months of age
Vital in developing self-image
- By age 12 months, the infant knows he or she is separate from the parent or caregiver
- Self-image is also promoted through the use of mirrors.
By 12 months of age, infants can recognize themselves in the mirror
Infant Gross Motor Skills Development: Head, Shoulders, Knees, & Toes
Develop Cephalocaudally
Head: (1 month) Lifts Head to side when prone
Shoulders:
- 2 months: Raises head and chest, improved head control.
- 4 months: Lifts head and looks around.
Rolls from prone to supine.
- 5 months: Rolls from supine to prone and back again.
Sits with back upright when supported
- 6 months: Tripod sits
- 8 months: Sits unsupported
Knees:
9 months: Crawls, abdomen off floor
Toes:
- 10 months: Pulls to stand, Cruises
- 12 months Sits from standing position, Walks independently
Cephalocaudal
From head to tail
Fine Motor Skill Development in Infants
Develops in a proximodistal fashion
1 month: Fists mostly clenched, Involuntary hand movements
3 months: Holds hand in front of face, hands open
4 months: Bats at objects
5 months: Grasps rattle
6 months: Releases object in hand to take another
7 months: Transfers object from one hand to the other
8 months: Gross pincer grasp (rakes)
9 months: Bangs objects together
10 months: Fine pincer grasp, Puts objects into container and takes them out
11 months:
