Test 1: Birth - 3 months old Flashcards
1
Q
Teratogens
A
Agents or factors that cause malformation of an embryo or fetus. Common teratogens include certain drugs, alcohol, and infections.
Relevance: Teratogens can lead to developmental anomalies that may affect physical therapy interventions. Understanding potential teratogens helps therapists anticipate and address developmental issues early.
2
Q
Lanugo
A
Fine, soft hair covering the body of a fetus, usually present around the 5th month of gestation.
Relevance: Lanugo is typically shed before birth. The presence or absence of lanugo in premature infants can give clues about gestational age and development, influencing physical therapy assessments.
3
Q
Quickening
A
The first movements of the fetus felt by the mother, usually occurring around 18-20 weeks of pregnancy.
Relevance: Quickening is a sign of fetal development and activity. Physical therapists may consider fetal movement patterns when evaluating maternal health and advising on exercises.
4
Q
Vernix Caseosa
A
A white, cheesy substance that covers the skin of the fetus, providing protection and lubrication.
Relevance: Vernix caseosa usually disappears after birth. It’s important to note its presence and condition during newborn assessments as it can affect skin care practices.
5
Q
Linea Nigra
A
A dark vertical line that appears on the abdomen of pregnant women due to hormonal changes.
Relevance: This is not directly relevant to physical therapy but understanding maternal changes helps in providing comprehensive care and counseling.
6
Q
Chloasma (Melasma)
A
Dark pigmentation patches on the face of pregnant women, often called the “mask of pregnancy.”
Relevance: Similar to linea nigra, it’s primarily of dermatological concern but understanding these changes helps therapists in holistic care of the pregnant patient.
7
Q
Braxton-Hicks Contractions
A
Irregular, usually painless contractions of the uterus that occur during pregnancy, often described as “practice contractions.”
Relevance: These contractions are a normal part of pregnancy, but distinguishing them from true labor contractions is crucial for physical therapists providing prenatal care and exercises.
8
Q
Relaxin
A
A hormone that increases flexibility in the pelvis and prepares the body for childbirth.
Relevance: Increased flexibility can affect joint stability. Physical therapists need to be aware of relaxin’s effects when designing safe exercise programs for pregnant patients.
9
Q
Nesting Instinct
A
A surge of energy and the urge to prepare the home for the baby’s arrival.
Relevance: This psychological and physical preparation phase may impact a pregnant patient’s activity levels and stress. It can be considered when planning physical activity and stress management strategies.
10
Q
Lightening
A
The dropping of the baby into the pelvis in preparation for birth.
Relevance: Lightening can affect the mother’s posture and mobility. Physical therapists might need to adjust interventions based on changes in the mother’s center of gravity.
11
Q
Effacement
A
The thinning of the cervix during labor.
Relevance: Effacement is part of the labor process, influencing the type of physical support and positioning strategies that may be needed during labor.
12
Q
Crowning
A
The stage during childbirth when the baby’s head becomes visible at the vaginal opening.
Relevance: Physical therapists may assist with perineal support and techniques to manage labor pain during this stage.
13
Q
Episiotomy
A
A surgical incision made in the perineum to facilitate childbirth.
Relevance: Post-episiotomy, physical therapy might focus on pelvic floor rehabilitation and perineal care.
14
Q
Apgar Score
A
A quick test performed on a newborn at 1 and 5 minutes after birth to assess their physical condition and need for immediate medical care.
Relevance: The Apgar score helps determine the newborn’s immediate physical health, which is crucial for planning any early intervention if needed.
15
Q
Fontanelles
A
Soft spots on a baby’s skull where the bones have not yet fused.
Relevance: Fontanelles are assessed for normal development and head shape, which is important for identifying potential cranial abnormalities.
Normal Variance
16
Q
Molding of the Head
A
The shaping of the baby’s head during delivery to fit through the birth canal.
Relevance: Molding is normal and typically resolves within a few days. Physical therapists should monitor head shape and development, especially in cases of prolonged or difficult labor.
Normal Variance
17
Q
Caput
A
Swelling of the baby’s head caused by pressure during delivery.
Relevance: Caput usually resolves without intervention, but therapists should monitor it to ensure proper recovery and head shape.
Normal Variance
18
Q
Cephalohematoma
A
Accumulation of blood between the baby’s skull and the periosteum, typically from a traumatic delivery.
Relevance: Cephalohematoma can lead to abnormal head shape or developmental issues; physical therapy might include cranial molding techniques if necessary.
Normal variant
19
Q
Facial Asymmetry
A
Uneven appearance of the face, which can occur due to various factors including birth trauma.
Relevance: Facial asymmetry may affect feeding or developmental milestones, and physical therapists might work with the baby to address any related functional issues.
Normal variant
20
Q
Milia
A
Small white cysts on a newborn’s face caused by clogged sweat glands.
Relevance: Milia are harmless and typically resolve on their own. Physical therapists should be aware of these conditions to avoid unnecessary concern.
Normal variant
21
Q
Conjunctival Hemorrhages
A
Small areas of bleeding in the whites of the eyes, often caused by the pressure of delivery.
Relevance: These usually resolve on their own, but therapists should monitor for any signs of vision or developmental issues.
Normal variant
22
Q
Preauricular Pits
A
Small pits or depressions near the front of the ear, which can be congenital.
Relevance: These are usually benign but may be associated with other congenital anomalies. Physical therapists should be aware in case they are part of a broader pattern of developmental issues.
Normal variant
23
Q
Epstein’s Pearls
A
Small, white cysts found in the mouth of newborns, often on the roof of the mouth or gums.
Relevance: These are benign and usually resolve without treatment. Understanding their appearance helps prevent unnecessary concern.
Normal variant
24
Q
Frenulum Linguae
A
The small band of tissue connecting the underside of the tongue to the floor of the mouth.
Relevance: A short or tight frenulum can affect feeding and speech development. Physical therapists may need to address these issues through oral motor therapy.
Normal variant
25
Mongolian Spots
Blue or gray patches on the skin of some infants, particularly in darker-skinned babies, which usually fade over time.
Relevance: Recognizing Mongolian spots prevents misdiagnosis of bruising or other conditions.
Normal variant
26
Breast Hypertrophy
Enlargement of the breasts, which can occur in both men and women, but also commonly noted in pregnant women.
Relevance: Breast hypertrophy in pregnant women may affect posture and comfort, influencing physical therapy recommendations and interventions.
Normal variant
27
Cutis Marmorata
A mottled, marbled appearance of the skin seen in some newborns, particularly when they are cold or distressed.
Relevance: This condition is usually temporary and associated with newborn circulation. Physical therapists should monitor skin changes to ensure proper circulation and comfort.
Normal variant
28
Facial Nerve Paralysis
Weakness or paralysis of the facial muscles, which can occur due to birth trauma or congenital conditions.
Relevance: Physical therapy may be needed to address motor function, facial exercises, and overall development if facial nerve paralysis is present.
Not considered pathologic unless it persists, most commonly involves only the lower part of the facial nerve
29
Breech Position
A fetal position where the baby is positioned feet-first or buttocks-first rather than head-first.
Relevance: Breech position can affect delivery methods and may require special considerations in physical therapy for both the newborn and the mother.
30
Tibial Bowing
Curvature of the tibia, often seen in newborns and usually resolves with growth.
Relevance: Tibial bowing can impact gait and alignment. Physical therapists monitor these changes and provide interventions if necessary.
31
Genu Recurvatum
Hyperextension of the knee joint.
Relevance: Genu recurvatum may affect mobility and alignment in infants. Physical therapy can include exercises to promote proper alignment and strengthen supporting muscles.
32
Congenital Amniotic Bands
Bands of fibrous tissue from the amniotic sac that can constrict or entangle parts of the developing fetus, leading to various limb or digit deformities.
Relevance: Infants with congenital amniotic bands may present with limb deformities or amputations. Physical therapists may be involved in developing individualized rehabilitation plans to address functional impairments, improve mobility, and support developmental milestones.
33
Intersex/Difference in Sexual Development (DSD)
A range of conditions in which an individual’s sexual anatomy or chromosomal pattern does not fit typical definitions of male or female. This can include ambiguous genitalia or discrepancies between chromosomal and anatomical sex.
Relevance: For infants with intersex traits or DSD, physical therapy might be part of a multidisciplinary approach to address any related physical or functional concerns. This can include supporting developmental milestones, addressing any physical challenges associated with the condition, and working closely with endocrinologists and other specialists.
34
Gestational age in weeks
4 (embryo)
Fetal Size and Development
1/8 inch (4 mm.)
fertilized egg implants on endometrium of uterus: single chambered heart beating; cell differentiation occurs; susceptible to teratogens
35
Gestational age in weeks
4 (embryo)
Maternal Changes
basal body temperature remains elevated after ovulation; nausea/morning sickness (~50% have); fatigue; no menstruation or slight spotting; breasts feel tight and tingly; can have positive pregnancy test
36
Gestational age in weeks
8
Fetal Size and Development
1 inch (28 mm.)
1 gram
very rudimentary facial features forming; arm and leg buds; highly susceptible to teratogens; primitive functioning of systems; placenta and umbilical cord forming; head makes up nearly half of embryo's length, genetic expression of sex differentiation begins
37
Gestational age in weeks
8
Maternal Changes
morning sickness worse now; mucus plug forms in cervix; breasts larger; uterus softens; frequent urination
38
Gestational age in weeks
12 (fetus)
Fetal Size and Development
3 1/2" (9 cm) 1/2 oz. (15 gm.)
eyelids formed, closed; genitals forming; finger/ toe nails forming; fingers well developed; kicks legs, closes fingers, bends wrist, turns head; frowns, opens/ closes mouth; organ differentiation occurring
39
Gestational age in weeks
12 (fetus)
Maternal Changes
morning sickness lessens by end of month; bladder pressure lessens; fetal heart tones audible by Doppler
40
Gestational age in weeks
16
Fetal Size and Development
6 1/2" (16 cm.)
4 oz. (100 gm.)
functioning liver and thyroid gland; blood forming in marrow; hair forming on head; lanugo is forming; skeletal ossification occurs and is visible on x-ray (though x-ray should be avoided); fetus begins to move about freely; placenta formed completely
41
Gestational age in weeks
16
Maternal Changes
uterus contracts (but she is unable to feel); blood volume and cardiac output increases; quickening
42
Gestational age in weeks
20
Fetal Size and Development
10" (25 cm.)
10 oz. (300 gm)
vernix caseosa forms on skin; period of rapid growth; finger/toe nails are formed completely; favorite position to sleep in; periods of sleep/awake like newborn; blood supply to lungs increases
43
Gestational age in weeks
20
Maternal Changes
fetal heart tones clearly audible by stethoscope; definite "quickening" noticed by this point.
44
Gestational age in weeks
24
Fetal Size and Development
12" (30 cm.)
1 1/4 lbs. (600 gm.)
skin less transparent and and wrinkled; vernix continues to accumulate; body well proportioned; eyebrows/eyelashes developing; baby can hear sounds; baby stretches, kicks and sucks thumb
45
Gestational age in weeks
24
Maternal Changes
period of rapid weight gain; stretch marks; drop in hemoglobin; linea nigra forms but will disappear/lighten after delivery; chloasma will appear but disappears after delivery; we know these latter 2 events are due to hormonal influences, but it is unclear why they occur.
46
Gestational age in weeks
28
Fetal Size and Development
14" (35-37 cm.)
2 1/2 lbs. (1000 gm.)
testes begin to descend in male fetus; eyelids open; fingerprints set; storage of subcutaneous fat begins; rapid growth continues; bones are developed but are soft and flexible; lungs have matured enough to support respiration outside the uterus (barely, more on this later)
47
Gestational age in weeks
28
Maternal Changes
blood volume is highest at this stage; weight gain continues; breathing may be difficult at times; heartburn; Braxton-Hicks contractions are stronger
48
Gestational age in weeks
32
Fetal Size and Development
16" (40-42 cm.)
4 lbs. (1700-
1800 gm.)
greater subcutaneous fat; period of rapid growth; body covered with vernix; storage of iron, nitrogen, and other nutrients
49
Gestational age in weeks
32
Maternal Changes
pelvic joints begin to relax due to relaxin; stretch marks deepen; heartburn common
50
Gestational age in weeks
36
Fetal Size and Development
18" (45-47 cm.)
5 lbs. (2000- 2500 gm.)
skin thicker and less wrinkled; subcutaneous fat accumulates; storage of maternal immunities from her past diseases
51
Gestational age in weeks
36
Maternal Changes
shortness of breath; ankle swelling; frequent urination; varicose veins more pronounced; baby settles into final position in mom's pelvis, usually head down
52
Gestational age in weeks
(term 38-42 weeks)
Fetal Size and Development
18-22" (48-55 cm.)
7.5 lbs. (3400 gm.)
lanugo shed; body contours plump; cartilage in nose and ears well developed; male testes descended; less active since less room to move; finger and toe nails developed; eyes may have slate blue color--will have permanent color by age 3 mos. At birth: breathing rate is 35-50 b/min. and is rapid, shallow and abdominal; HR (heart rate) is 90-160 b/min, body temperature control is not well developed.
53
Gestational age in weeks
(term 38-42 weeks)
Maternal Changes
weight loss of 2-3 lbs, 3-4 days before labor, so shoes and rings are less tight; nesting instinct; lightening occurs; this happens about 2 weeks before labor in 1st pregnancies, but right before labor in subsequent pregnancies; with it comes less shortness of breath but more frequent urination and hips get wobbly, so is hard for mom to move around
54
Birth Stage 1
Early Preliminary
Preliminary
Accelerated Phase
Transition Phase
55
Birth Stage 1 Early Preliminary
Contractions: mild, irregular wave
Duration: 30-60 sec.
Interval: 5-20 minutes
Cervix: early effacement, recorded in %
Normal symptoms may include "bloody show"; rupture of membranes
56
Birth Stage 1 Preliminary
Contractions: stronger, more regular
Duration: 45-60 sec.
Interval: 2-4 minutes
Cervix—complete effacement
Dilatation: 0-3 cm.
Normal symptoms may include abdominal cramps, backache, rupture of membranes
57
Birth Stage 1 Accelerated Phase
Contractions: stronger, longer
Duration: 50-60 sec
Interval: 2-4 minutes
Cervix: dilatation 3-8 cm. (or 4-6 cm.)
Normal symptoms include rupture of membranes, increased backache.
58
Birth Stage 1 Transition Phase
is most intense, but shortest, phase; usually lasting 5-20 contractions, or 30 to 90 minutes
Contractions: increased intensity, erratic, some overlapping
Duration: 60-90 sec.
Interval: 1-2 minutes (or 2-3 minutes)
Cervix: dilatation 8-10 cm. (or 7-10 cm.)
Normal symptoms include amnesia (forgets proper breathing for pain control), cramps in legs, generalized discomfort, nausea and possible vomiting, shaking and trembling, hiccups, hot or cold flashes, severe backache, increased rectal pressure, pulling or stretching sensation of perineum, rupture
59
Birth Stage 2
Delivery of the baby
Contractions: strong and regular
Duration: 50-60 sec. (or 60-90 sec.)
Interval: 2-3 minutes (or 3-5 minutes)
Cervix: complete dilatation to 10 cm.; contractions push baby down and out
Normal symptoms include burning or stretching of perineum; exhaustion after each push; events include crowning, episiotomy
60
Birth Stage 3
Delivery of the placenta
A few minutes after baby is expelled, uterine contractions begin again at regular intervals; after about 8 minutes the placenta is expelled; the woman may need to push slightly to expel the placenta, but not as much as with baby; placenta is checked for integrity (no holes or tears) to be sure all is removed. At this point the Episiotomy is repaired.
61
Gross Motor Milestones 0-3 months (Sitting and Rolling)
Rolling: Rolls from supine to side lying and prone to side lying (initially by accident)
Sitting: Does not sit independently. When held in position, initially head bobs/is fully forward.
Progresses to sitting position with head control, however trunk remains kyphotic, shoulders in front of hips
Month 1: Minimal head control, total forward flexion
Months 2-3: Able to maintain midline head orientation
62
Gross Motor Milestones 0-3 months (Standing)
When held in standing, will take some weight through legs (positive support reflex)
No/minimal head/trunk control
63
Gross Motor Milestones 0-3 months (Prone)
Month 1: will be able to slightly elevate and rotate head to be able to clear the airway and breath
Months 2-3: forearm propping, prone pivoting emerges. Hip flexors need to lengthen to be able to do this. Full extension required (hip, thoracic, lumbar, and cervical extension).
64
Gross Motor Milestones 0-3 months (Supine)
Month 1: reciprocal and symmetrical kicking occurring
Months 2-3: symmetrical kicking of both legs dominates volitional kicking movements. This helps the baby build muscles of the trunk
65
Overview of Gross Motor Skills
Rotates head with progressively improving control, rolls to side by accident initially, beginning to roll from supine to prone.
Flexion pattern dominated
66
Fine Motor and Upper Extremity Milestones 0-3 months (Reaching)
Months 0-2: visual regard for objects emerges and becomes more consistent
Months 1-4: swipes at objects, attention to hand and alternating attention from hand to object emerges.
All development is connected. You cannot reach for something you cant see
67
Fine Motor and Upper Extremity Milestones 0-3 months (Grasping)
Months 0-3: hands are predominantly closed, at 3 months midline grasping hands together emerges, quickly becomes frequent
- Why? Life happens in front of you, hands are interesting to babies
Months 2-7: ulnar grasp (object between ring and little finger and palm emerges)
68
Fine Motor and Upper Extremity Milestones 0-3 months (Release)
Month 0-1: No volitional release, dominated by reflex
Months 1-4: involuntary release, grasp reflex may begin to integrate
69
Fine Motor and Upper Extremity Milestones 0-3 months (Feeding)
Reflex driven (root, suck, and swallowing reflexes)
70
Social and Emotional Milestones 0-3 months
Month 1: Visual preference for humans develop, reflex driven smile
Months 2-3: Listens to voices, smiles purposefully in response to caregiver face or voice, mutual gaze and visual tracking becomes more consistent
71
Sensory Milestones 0-3 months (vision and hearing)
Vision: 0-3 months vision continues to develop, initially 20/800 acuity at birth, limited to about 12 inches from face
- Most important things are 12 inches from their face
- Infant can see high contrast, patterns, colors yellow and red.
Hearing: more sensitive than adult hearing, less able to filter extraneous sounds via cognitive function
72
Cognitive and Language Milestones 0-3 months
Piaget's stages of development begins with Sensorymotor stage
Pre-linguistic period, crying is the earliest form of communication
73
Agents or factors that cause malformation of an embryo or fetus. Common teratogens include certain drugs, alcohol, and infections.
Relevance: Teratogens can lead to developmental anomalies that may affect physical therapy interventions. Understanding potential teratogens helps therapists anticipate and address developmental issues early.
Teratogens
74
Fine, soft hair covering the body of a fetus, usually present around the 5th month of gestation.
Relevance: Lanugo is typically shed before birth. The presence or absence of lanugo in premature infants can give clues about gestational age and development, influencing physical therapy assessments.
Lanugo
75
The first movements of the fetus felt by the mother, usually occurring around 18-20 weeks of pregnancy.
Relevance: Quickening is a sign of fetal development and activity. Physical therapists may consider fetal movement patterns when evaluating maternal health and advising on exercises.
Quickening
76
A white, cheesy substance that covers the skin of the fetus, providing protection and lubrication.
Relevance: Vernix caseosa usually disappears after birth. It’s important to note its presence and condition during newborn assessments as it can affect skin care practices.
Vernix Caseosa
77
A dark vertical line that appears on the abdomen of pregnant women due to hormonal changes.
Relevance: This is not directly relevant to physical therapy but understanding maternal changes helps in providing comprehensive care and counseling.
Linea Nigra
78
Dark pigmentation patches on the face of pregnant women, often called the "mask of pregnancy."
Relevance: Similar to linea nigra, it’s primarily of dermatological concern but understanding these changes helps therapists in holistic care of the pregnant patient.
Chloasma (Melasma)
79
Irregular, usually painless contractions of the uterus that occur during pregnancy, often described as "practice contractions."
Relevance: These contractions are a normal part of pregnancy, but distinguishing them from true labor contractions is crucial for physical therapists providing prenatal care and exercises.
Braxton-Hicks Contractions
80
A hormone that increases flexibility in the pelvis and prepares the body for childbirth.
Relevance: Increased flexibility can affect joint stability. Physical therapists need to be aware of relaxin’s effects when designing safe exercise programs for pregnant patients.
Relaxin
81
A surge of energy and the urge to prepare the home for the baby's arrival.
Relevance: This psychological and physical preparation phase may impact a pregnant patient’s activity levels and stress. It can be considered when planning physical activity and stress management strategies.
Nesting Instinct
82
The dropping of the baby into the pelvis in preparation for birth.
Relevance: Lightening can affect the mother’s posture and mobility. Physical therapists might need to adjust interventions based on changes in the mother’s center of gravity.
Lightening
83
The thinning of the cervix during labor.
Relevance: Effacement is part of the labor process, influencing the type of physical support and positioning strategies that may be needed during labor.
Effacement
84
The stage during childbirth when the baby’s head becomes visible at the vaginal opening.
Relevance: Physical therapists may assist with perineal support and techniques to manage labor pain during this stage.
Crowning
85
A surgical incision made in the perineum to facilitate childbirth.
Relevance: Post-episiotomy, physical therapy might focus on pelvic floor rehabilitation and perineal care.
Episiotomy
86
A quick test performed on a newborn at 1 and 5 minutes after birth to assess their physical condition and need for immediate medical care.
Relevance: The Apgar score helps determine the newborn’s immediate physical health, which is crucial for planning any early intervention if needed.
Apgar Score
87
Soft spots on a baby’s skull where the bones have not yet fused.
Relevance: Fontanelles are assessed for normal development and head shape, which is important for identifying potential cranial abnormalities.
Normal Variance
Fontanelles
88
The shaping of the baby’s head during delivery to fit through the birth canal.
Relevance: Molding is normal and typically resolves within a few days. Physical therapists should monitor head shape and development, especially in cases of prolonged or difficult labor.
Normal Variance
Molding of the Head
89
Swelling of the baby’s head caused by pressure during delivery.
Relevance: Caput usually resolves without intervention, but therapists should monitor it to ensure proper recovery and head shape.
Normal Variance
Caput
90
Accumulation of blood between the baby’s skull and the periosteum, typically from a traumatic delivery.
Relevance: Cephalohematoma can lead to abnormal head shape or developmental issues; physical therapy might include cranial molding techniques if necessary.
Normal variant
Cephalohematoma
91
Uneven appearance of the face, which can occur due to various factors including birth trauma.
Relevance: Facial asymmetry may affect feeding or developmental milestones, and physical therapists might work with the baby to address any related functional issues.
Normal variant
Facial Asymmetry
92
Small white cysts on a newborn’s face caused by clogged sweat glands.
Relevance: Milia are harmless and typically resolve on their own. Physical therapists should be aware of these conditions to avoid unnecessary concern.
Normal variant
Milia
93
Small areas of bleeding in the whites of the eyes, often caused by the pressure of delivery.
Relevance: These usually resolve on their own, but therapists should monitor for any signs of vision or developmental issues.
Normal variant
Conjunctival Hemorrhages:
94
Small pits or depressions near the front of the ear, which can be congenital.
Relevance: These are usually benign but may be associated with other congenital anomalies. Physical therapists should be aware in case they are part of a broader pattern of developmental issues.
Normal variant
Preauricular Pits
95
Small, white cysts found in the mouth of newborns, often on the roof of the mouth or gums.
Relevance: These are benign and usually resolve without treatment. Understanding their appearance helps prevent unnecessary concern.
Normal variant
Epstein's Pearls
96
The small band of tissue connecting the underside of the tongue to the floor of the mouth.
Relevance: A short or tight frenulum can affect feeding and speech development. Physical therapists may need to address these issues through oral motor therapy.
Normal variant
Frenulum Linguae
97
Blue or gray patches on the skin of some infants, particularly in darker-skinned babies, which usually fade over time.
Relevance: Recognizing Mongolian spots prevents misdiagnosis of bruising or other conditions.
Normal variant
Mongolian Spots
98
Enlargement of the breasts, which can occur in both men and women, but also commonly noted in pregnant women.
Relevance: Breast hypertrophy in pregnant women may affect posture and comfort, influencing physical therapy recommendations and interventions.
Normal variant
Breast Hypertrophy
99
A mottled, marbled appearance of the skin seen in some newborns, particularly when they are cold or distressed.
Relevance: This condition is usually temporary and associated with newborn circulation. Physical therapists should monitor skin changes to ensure proper circulation and comfort.
Normal variant
Cutis Marmorata
100
Weakness or paralysis of the facial muscles, which can occur due to birth trauma or congenital conditions.
Relevance: Physical therapy may be needed to address motor function, facial exercises, and overall development if facial nerve paralysis is present.
Not considered pathologic unless it persists, most commonly involves only the lower part of the facial nerve
Facial Nerve Paralysis
101
A fetal position where the baby is positioned feet-first or buttocks-first rather than head-first.
Relevance: Breech position can affect delivery methods and may require special considerations in physical therapy for both the newborn and the mother.
Breech Position
102
Curvature of the tibia, often seen in newborns and usually resolves with growth.
Relevance: Tibial bowing can impact gait and alignment. Physical therapists monitor these changes and provide interventions if necessary.
Tibial Bowing
103
Hyperextension of the knee joint.
Relevance: Genu recurvatum may affect mobility and alignment in infants. Physical therapy can include exercises to promote proper alignment and strengthen supporting muscles.
Genu Recurvatum
104
Bands of fibrous tissue from the amniotic sac that can constrict or entangle parts of the developing fetus, leading to various limb or digit deformities.
Relevance: Infants with congenital amniotic bands may present with limb deformities or amputations. Physical therapists may be involved in developing individualized rehabilitation plans to address functional impairments, improve mobility, and support developmental milestones.
Congenital Amniotic Bands
105
A range of conditions in which an individual’s sexual anatomy or chromosomal pattern does not fit typical definitions of male or female. This can include ambiguous genitalia or discrepancies between chromosomal and anatomical sex.
Relevance: For infants with intersex traits or DSD, physical therapy might be part of a multidisciplinary approach to address any related physical or functional concerns. This can include supporting developmental milestones, addressing any physical challenges associated with the condition, and working closely with endocrinologists and other specialists.
Intersex/Difference in Sexual Development (DSD)
106
1/8 inch (4 mm.)
fertilized egg implants on endometrium of uterus: single chambered heart beating; cell differentiation occurs; susceptible to teratogens
Gestational age in weeks
4 (embryo)
Fetal Size and Development
107
basal body temperature remains elevated after ovulation; nausea/morning sickness (~50% have); fatigue; no menstruation or slight spotting; breasts feel tight and tingly; can have positive pregnancy test
Gestational age in weeks
4 (embryo)
Maternal Changes
108
1 inch (28 mm.)
1 gram
very rudimentary facial features forming; arm and leg buds; highly susceptible to teratogens; primitive functioning of systems; placenta and umbilical cord forming; head makes up nearly half of embryo's length, genetic expression of sex differentiation begins
Gestational age in weeks
8
Fetal Size and Development
109
morning sickness worse now; mucus plug forms in cervix; breasts larger; uterus softens; frequent urination
Gestational age in weeks
8
Maternal Changes
110
3 1/2" (9 cm) 1/2 oz. (15 gm.)
eyelids formed, closed; genitals forming; finger/ toe nails forming; fingers well developed; kicks legs, closes fingers, bends wrist, turns head; frowns, opens/ closes mouth; organ differentiation occurring
Gestational age in weeks
12 (fetus)
Fetal Size and Development
111
morning sickness lessens by end of month; bladder pressure lessens; fetal heart tones audible by Doppler
Gestational age in weeks
12 (fetus)
Maternal Changes
112
6 1/2" (16 cm.)
4 oz. (100 gm.)
functioning liver and thyroid gland; blood forming in marrow; hair forming on head; lanugo is forming; skeletal ossification occurs and is visible on x-ray (though x-ray should be avoided); fetus begins to move about freely; placenta formed completely
Gestational age in weeks
16
Fetal Size and Development
113
uterus contracts (but she is unable to feel); blood volume and cardiac output increases; quickening
Gestational age in weeks
16
Maternal Changes
114
10" (25 cm.)
10 oz. (300 gm)
vernix caseosa forms on skin; period of rapid growth; finger/toe nails are formed completely; favorite position to sleep in; periods of sleep/awake like newborn; blood supply to lungs increases
Gestational age in weeks
20
Fetal Size and Development
115
fetal heart tones clearly audible by stethoscope; definite "quickening" noticed by this point.
Gestational age in weeks
20
Maternal Changes
116
12" (30 cm.)
1 1/4 lbs. (600 gm.)
skin less transparent and and wrinkled; vernix continues to accumulate; body well proportioned; eyebrows/eyelashes developing; baby can hear sounds; baby stretches, kicks and sucks thumb
Gestational age in weeks
24
Fetal Size and Development
117
period of rapid weight gain; stretch marks; drop in hemoglobin; linea nigra forms but will disappear/lighten after delivery; chloasma will appear but disappears after delivery; we know these latter 2 events are due to hormonal influences, but it is unclear why they occur.
Gestational age in weeks
24
Maternal Changes
118
14" (35-37 cm.)
2 1/2 lbs. (1000 gm.)
testes begin to descend in male fetus; eyelids open; fingerprints set; storage of subcutaneous fat begins; rapid growth continues; bones are developed but are soft and flexible; lungs have matured enough to support respiration outside the uterus (barely, more on this later)
Gestational age in weeks
28
Fetal Size and Development
119
blood volume is highest at this stage; weight gain continues; breathing may be difficult at times; heartburn; Braxton-Hicks contractions are stronger
Gestational age in weeks
28
Maternal Changes
120
16" (40-42 cm.)
4 lbs. (1700-
1800 gm.)
greater subcutaneous fat; period of rapid growth; body covered with vernix; storage of iron, nitrogen, and other nutrients
Gestational age in weeks
32
Fetal Size and Development
121
pelvic joints begin to relax due to relaxin; stretch marks deepen; heartburn common
Gestational age in weeks
32
Maternal Changes
122
18" (45-47 cm.)
5 lbs. (2000- 2500 gm.)
skin thicker and less wrinkled; subcutaneous fat accumulates; storage of maternal immunities from her past diseases
Gestational age in weeks
36
Fetal Size and Development
123
shortness of breath; ankle swelling; frequent urination; varicose veins more pronounced; baby settles into final position in mom's pelvis, usually head down
Gestational age in weeks
36
Maternal Changes
124
18-22" (48-55 cm.)
7.5 lbs. (3400 gm.)
lanugo shed; body contours plump; cartilage in nose and ears well developed; male testes descended; less active since less room to move; finger and toe nails developed; eyes may have slate blue color--will have permanent color by age 3 mos. At birth: breathing rate is 35-50 b/min. and is rapid, shallow and abdominal; HR (heart rate) is 90-160 b/min, body temperature control is not well developed.
Gestational age in weeks
(term 38-42 weeks)
Fetal Size and Development
125
weight loss of 2-3 lbs, 3-4 days before labor, so shoes and rings are less tight; nesting instinct; lightening occurs; this happens about 2 weeks before labor in 1st pregnancies, but right before labor in subsequent pregnancies; with it comes less shortness of breath but more frequent urination and hips get wobbly, so is hard for mom to move around
Gestational age in weeks
(term 38-42 weeks)
Maternal Changes
126
Early Preliminary
Preliminary
Accelerated Phase
Transition Phase
Birth Stage 1
127
Contractions: mild, irregular wave
Duration: 30-60 sec.
Interval: 5-20 minutes
Cervix: early effacement, recorded in %
Normal symptoms may include "bloody show"; rupture of membranes
Birth Stage 1 Early Preliminary
128
Contractions: stronger, more regular
Duration: 45-60 sec.
Interval: 2-4 minutes
Cervix—complete effacement
Dilatation: 0-3 cm.
Normal symptoms may include abdominal cramps, backache, rupture of membranes
Birth Stage 1 Preliminary
129
Contractions: stronger, longer
Duration: 50-60 sec
Interval: 2-4 minutes
Cervix: dilatation 3-8 cm. (or 4-6 cm.)
Normal symptoms include rupture of membranes, increased backache.
Birth Stage 1 Accelerated Phase
130
is most intense, but shortest, phase; usually lasting 5-20 contractions, or 30 to 90 minutes
Contractions: increased intensity, erratic, some overlapping
Duration: 60-90 sec.
Interval: 1-2 minutes (or 2-3 minutes)
Cervix: dilatation 8-10 cm. (or 7-10 cm.)
Normal symptoms include amnesia (forgets proper breathing for pain control), cramps in legs, generalized discomfort, nausea and possible vomiting, shaking and trembling, hiccups, hot or cold flashes, severe backache, increased rectal pressure, pulling or stretching sensation of perineum, rupture
Birth Stage 1 Transition Phase
131
Delivery of the baby
Contractions: strong and regular
Duration: 50-60 sec. (or 60-90 sec.)
Interval: 2-3 minutes (or 3-5 minutes)
Cervix: complete dilatation to 10 cm.; contractions push baby down and out
Normal symptoms include burning or stretching of perineum; exhaustion after each push; events include crowning, episiotomy
Birth Stage 2
132
Delivery of the placenta
A few minutes after baby is expelled, uterine contractions begin again at regular intervals; after about 8 minutes the placenta is expelled; the woman may need to push slightly to expel the placenta, but not as much as with baby; placenta is checked for integrity (no holes or tears) to be sure all is removed. At this point the Episiotomy is repaired.
Birth Stage 3
133
Rolling: Rolls from supine to side lying and prone to side lying (initially by accident)
Sitting: Does not sit independently. When held in position, initially head bobs/is fully forward.
Progresses to sitting position with head control, however trunk remains kyphotic, shoulders in front of hips
Month 1: Minimal head control, total forward flexion
Months 2-3: Able to maintain midline head orientation
Gross Motor Milestones 0-3 months (Sitting and Rolling)
134
When held in standing, will take some weight through legs (positive support reflex)
No/minimal head/trunk control
Gross Motor Milestones 0-3 months (Standing)
135
Month 1: will be able to slightly elevate and rotate head to be able to clear the airway and breath
Months 2-3: forearm propping, prone pivoting emerges. Hip flexors need to lengthen to be able to do this. Full extension required (hip, thoracic, lumbar, and cervical extension).
Gross Motor Milestones 0-3 months (Prone)
136
Month 1: reciprocal and symmetrical kicking occurring
Months 2-3: symmetrical kicking of both legs dominates volitional kicking movements. This helps the baby build muscles of the trunk
Gross Motor Milestones 0-3 months (Supine)
137
Rotates head with progressively improving control, rolls to side by accident initially, beginning to roll from supine to prone.
Flexion pattern dominated
Overview of Gross Motor Skills
138
Months 0-2: visual regard for objects emerges and becomes more consistent
Months 1-4: swipes at objects, attention to hand and alternating attention from hand to object emerges.
All development is connected. You cannot reach for something you cant see
Fine Motor and Upper Extremity Milestones 0-3 months (Reaching)
139
Months 0-3: hands are predominantly closed, at 3 months midline grasping hands together emerges, quickly becomes frequent
- Why? Life happens in front of you, hands are interesting to babies
Months 2-7: ulnar grasp (object between ring and little finger and palm emerges)
Fine Motor and Upper Extremity Milestones 0-3 months (Grasping)
140
Month 0-1: No volitional release, dominated by reflex
Months 1-4: involuntary release, grasp reflex may begin to integrate
Fine Motor and Upper Extremity Milestones 0-3 months (Release)
141
Reflex driven (root, suck, and swallowing reflexes)
Fine Motor and Upper Extremity Milestones 0-3 months (Feeding)
142
Month 1: Visual preference for humans develop, reflex driven smile
Months 2-3: Listens to voices, smiles purposefully in response to caregiver face or voice, mutual gaze and visual tracking becomes more consistent
Social and Emotional Milestones 0-3 months
143
Vision: 0-3 months vision continues to develop, initially 20/800 acuity at birth, limited to about 12 inches from face
- Most important things are 12 inches from their face
- Infant can see high contrast, patterns, colors yellow and red.
Hearing: more sensitive than adult hearing, less able to filter extraneous sounds via cognitive function
Sensory Milestones 0-3 months (vision and hearing)
144
Piaget's stages of development begins with Sensorymotor stage
Pre-linguistic period, crying is the earliest form of communication
Cognitive and Language Milestones 0-3 months
