Week 1 Chapter 25 Flashcards
Developmental changes include:
Growth - Increase in physical size
Development- Sequential process of skill attainment
Maturation- Increased functionality of body systems or developmental skills
How do we measure physical growth?
Weight
Length
Head Circumference
Each plot on standardized growth chart
Also plot weight for length
What are the other measurements?
Chest at nipple line
Abdomen at the umbilicus
Growth percentiles measurements usually in approximately the same growth percentiles over time
True
When there are significant deviations from previous percentiles it may indicate ?
Further assessments needed
Children with down syndrome need a
Specialized chart.
Special populations
Average weight of infant is
3.4 kg
Doubles at 4 to 6 months
Triples by 12 months
Length average is about
50 cm (20 in) at birth
Increases by 50% by 12 months
Head circumference at birth is
35 cm (13.5in)
Increases by 10 cm by 12 months
How do we assess developmental milestones?
Ask the parents
Observe skill during assessment
Screening tools include:
ASQ
ITC
IDI
PEDS-DM
Name the systems immature at birth and somewhat mature over the first year
Neuro
Respiratory
CV
GI
Renal
Hematopoietic
Immunological
Integumentary
Neurologic system is fully myelinated at birth
False
Primitive Reflexes at birth
Step
Root
Suck
Moro
Asymmetric Tonic
Plantar
Palmar Grasp
Babinski
Step Reflex disappears at
4-8 weeks
Root disappears at
3 months
Suck Reflex disappears at
2-5 months
Moro and Asymmetric disappears at
4 months
Plantar Grasp disappears at
9 months
Palmar grasp disappears at
4-6 months
Babinski disappears at
12 months
A positive Babinski sign can indicate what?
Damage to corticospinal tract
As primitive reflexes disappear what appears ?
Protective reflexes appear
Protective reflexes are
Involuntary motor responses maintaining equilibrium and persist throughout life
Name Protective Reflexes
Neck Righting
Parachute (sideways)
Parachute ( forward)
Neck righting occurs at
4-6 months
Parachute Sideways occurs at
6 months
Parachute Forward occurs at
6-7 months
What is neck righting?
Baby will try to roll over to the side that the head is turned
What is parachute?
Extend arms to brace the fall either forward to protect the head or to the side
Differences between infant and adult respiratory
Nasal passages narrower
Larynx is funnel shaped
Trachea and chest wall is more compliantv
Bronchi and bronchioles are shorter and narrower
Respiratory fast and will decrease as child matures
The heart doubles in size the first year
TRUE
Pulse rate newborn is
120-140
Decreases to 100 at 1st year
Average blood pressure of newborn is
60/40
at 1st year increases to 100/50
Peripheral Capillaries are closer to the skin surface
Newborn and young infants more susceptible to heat loss
Thermoregulation becomes more effective over first few months
GI System
Tongue is large relative to oral cavity size
- Allows nipple to latch so infant can feed
Stomach capacity increases as infant grows
True
When do first teeth emerge?
Incisors at 6-8 months
Predictable pattern
Stool as newborn is
Meconium
Change of stools are based of what in the first year?
Intake ( Breast, Bottle, solid foods)
GU System compared to Adults
Frequent Urination
Low specific gravity
All renal functions reduced
More prone to dehydration
Poorer urine concentration daily
Acrocyanosis is
Blueness of hands and feet
Mottling
Pink and white marbled appearance due to immature circulatory systems , decreases over first few months
Integumentary system of newborns
Lanugo and vernix may be present
Acrocyanosis is normal and decreases over the first few days of life
Infant’s skin compared to adults is
Thinner
Peripheral capillaries are more superficial
Increased absorption of topical medications
High what is present at birth?
Hemoglobin
Decreases over the first 2-3 months
Stabilizes by 6-9 months w/ adequate iron intake
What IG is trasnmitted and protects the infant in first 3-6 months of life ?
IgG
What Ig reaches adult level at 9 months?
IgM
What Ig reaches adult level at 12 months?
IgG
What is Erikson’s Psychosocial approach?
Ego makes positive contributions to development by mastering attitudes, ideas, and skills
This mastery helps children to grow into successful members of society
Psychological conflict that must be overcome for child to be healthy, well adjusted adult
Erkison 0-1
Infancy
Trust vs Mistrust
Erikson 1- 3 yrs
Toddler
Autonomy vs Shame
Erikson 3- 6yr
Preschooler
Initiative vs Guilt
Erikson 6-12 yr
School age
Industry vs Inferiority
Erikson 12 yr- 20 yr
Adolescence
Identity vs Role Confusion
Cognitive development refers to long term changes in thinking and memory processes
Piaget’s
In Piaget’s Learning precedes to ?
Assimilation and Accommodation
Cognition is developed through
Stages
Happen in same order
No stage skipped
Stage is transformation from previous
Each later stage incorporates the early stages
Name Piaget’s Theory Stages
Sensorimotor
Preoperational
Concrete
Formal
Infant explores the world through direct sensory and motor contact. Object permanence and separation anxiety develop in this stage
0-2 y
Sensorimotor
Child uses symbols to represent objects. No logical reasoning. Pretends a lot. Egocentric
2-6 yr
Preoperational
Child thinks logically and can add and subtract. Understands conservation.
7-12 yr
Concrete operational
Think abstractly and think in hypothetical terms
Formal Operational
12yrs- Adult
Newborn Erikson is
Psychosocial approach - social devlopment, role of play.
Newborn Piaget
Senses and motor actions
When does stranger anxiety develop ?
- months
Infant recognizes self from others
Separation Anxiety
Develops later infancy
Infant distressed when parent leaves
Temperament ranges between
Low to moderate active, regular, and predictable
High active; more intense, and less adaptable
When doing assessment have infant ….
Caregiver’s lap due to stranger and separation anxiety
Where do gross motor skills develop?
Cephalocaudal fashion
Fine motor skills develop
Proximodistal
Center- periphery
Lifts and turns head with lag
1 month
2 months Gross motor skill
Raises head and chest, improves head control
Raises head 45 degrees in prone , slight lag
3 months Gross motor
Lifts head and looks around, rolls from prone to supine
4 months Gross motor
Rolls supine to prone and back, can sit with support
5 months Gross Motor
Tripod sits
6 months gross motor
7 Months Gross Motor
Sits alone with some use of hands
Sits unsupported
8 months Gross Motor
Crawls and abdomen off the floor
9 months Gross Motor
Pulls to stand and “ cruises”
10 months Gross Motor
12 Months gross motor
Sits from standing position, and walks independently
1 month Fine motor skill
Fists mostly clenched, involuntary hand movements
3 months Fine Motor Skill
Holds hand in front of face, hands open
Bats at objects Fine motor skill at what month?
4 Month
Grasps rattle
5 months Fine Motor Skill
6 Months Fine Motor Skill
Releases object in hand and takes another
7 Month Fine motor skill
Transfers objects from one hand to another
Gross pincer grasp develops at
8 Months fine motor skill
9 month Fine motor skill
Bangs objects together
Fine pincer grasp, puts objects into container and takes them out
10 month fine motor skill
Feed self with cup, spoon, and makes simple mark on paper, pokes with index finger
12 months fine motor skill
Toys for 0 -2 months
Mobiles
2- 4 mo toys
Rattles, cradle gym
Toys 4-6 mo
Bright toys small to grasp and large enough for safety
6- 9 months toys
Large toys with bright colors, movable parts, and noisemakers
9-12 mo toys
Books with large pictures, large push- pull toys, teddy bears
Infants born at less than 36 weeks are known as
Premature
List problems for premature infants
Immature respiratory and nervous systems
Lack adequate iron stores
Lack of adequate immunoglobulins
Immature GI system
- May not be capable or oral feeding
May not tolerate enteral feeding
G and D of Premature Infant
Use infant’s adjusted age to determine expected outcomes
Plot growth parameters and assess developmental milestones om adjusted age
Early warning signs for hearing
Does not respond to loud noises
Does not make sound or babble at 4 months of age
Does not turn to locate sound at age 4 months
How to calculate adjusted age
Subtract number of weeks infant was premature from chronological age
Early warning signs of vision
Crosses eyes most of time at age 6 months
Does not track interesting item
Does not try to study an object in visual field
Warning signs : Problems with language and development
Does not make sound at 4 months age
No laugh or squeal by 6 months
No babble by 8 months of age
Does not use single words with meaning at 12 months of age ( mam, dada)
Breastfeeding is heavily decided by
Cultural preferences
Breastfeeding best type nutrition for both mother and infant
Name benefits of breastfeeding
Increased bonding with mother
Immunologic protection
Possible enhancement of cognitive development
Decreased incidence of obesity later in life
Decreased incidence of :
Diarrheal Diseases
Asthma
Otitis Media
Bacterial Meningitis
Botulism
UTIs
Benefits of breastfeeding for Mothers
Increased bonding with Infants
Lessens maternal blood loss postpartum
Decreases risk of ovarian and premenopausal breast cancers
Possible delay of ovulation
Economic advantage; convenience of use
What are some exceptions of breastfeeding?
Infants with galactosemia
Maternal use of illicit drugs and a few prescription medications
Maternal untreated active TB
Maternal HIV infection developed countries
Unable to break down simple sugar galactose
Galactosemia
Can cause damage to the liver, brain, kidneys, and eyes
When can one add solids into feeding?
Tongue extrusion reflex has disappeared
Soft or mashed food until teeth erupts
May require 20 exposures to accept food
Introduce cup early- 6 months
Family models acceptable eating behaviors
Parent provides the food, child decides how much to eat
What are common developmental concerns in infancy
Colic
Spitting up
Thumb Sucking
Teething
Place newborns and young infants on back to sleep to prevent
SIDS
How many hours do newborns sleep?
20 hours
By 3 months infants sleep about
7- 8 hours per night with 2-3 naps per day
Around ____ months establish a bedtime routine
4 months
Facilitates relaxation and predictable sleep time
By 12 months infants sleep
8-12 hours per night
Takes 2 naps per day
Ways to Promote Safety
Car Seat- type, positioning, securement
Safe Crib and Changing table
Avoid use of baby walkers
Safety in home
- Safety gates
- Outlet Covers
Identify and avoid choking hazards
Water safety
