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6-12 years
0
Pale
Absent
No response
Flaccid
Absent
1
Blue
<100 bpm
Grimace
Some flexion
Weak
2
Pink
>100bpm
Cough/ sneeze
Well flexed
Good cry
TEMP REGULATION
-In utero, its increased than mothers temp
-Heat loss/unit body wt is 4x than that of adult due to its greater surface are in relation to the BW.
-Temp should be taken/rectum
PE
Color, respiration, cry is lusty, vigorous
Skin
Pink tinged and warm to
-Increased concentration of RBC in the blood vessels and SQ fats
touch
-White cheese like substance w/c serves as skin lubricant
Vernix caseosa
-Vasomotor disability
Acrocyanosis
-When lying skin appears red on the dependent side
Harlequin sign
-Plugged sebaceous glands
Milia
-Bluish black pigmentation
Mongolian spots
-Breakdown of RBC at birth, inc lvl of bilirubin leads to jaundice
Physiologic jaundice
HEAD
Inc ICP
Bulging fontanelles, fontanelle tenses
Diamond shape(2-3 cm
Anterior fontanelle
width, 2-4 cm length)
Triangular shaped
Posterior
Molding
Assymetrical
Caput succedaneum
Localized soft are of scalp
Cephalhematoma
Collection of blood resulting from ruptured blood vessels bet surfaces of cranial base
and periosteum
Signs of bone pathology:
*Microcephaly
*Craniotabes
POSTURE
Fit are dorsiflexed, flexed body and will offer resistance when extremities are
straightened
Chest
Bell shaped and <HC
Face and neck
Tongue is large-cretinism
High palatine arch- small head and mental retardation
Laxity and webbing of neck- Down/turner syndrome
Abdomen
Cardiac sphincter not well developed
Umbilical stump 6-10 days healed slough off
Omphalocele-esophageal atresia
Liver is palpable 2-3 cm below right costal arc
Genitalia
-Undesceded testes
-Slightly swollen owing to hormone activites w/ mother
Skeletal
Bones are soft- Compose of cartilage
Feet is flat- plantar fat pads
Blood coagulation
The majority of newborns are born w/ prolonged coagulation time because there
blood levels of vit K are lower than normal
Vit K is synthesized to the action of intestinal flora
A newborn intestine is sterile @ birth unless membranes were ruptured >24 hrs of
delivery
Flora must therefore accumulate before Vit K be synthesized
Autoimmune system
The newborn infant has difficulty antibodies against invading antigens until he
reaches 2mos of age
This is why immunization against childhood dx are not given to babie <2mos old
Neuromuscular system
Limpness or total absence of muscular responses to manipulation is never normal
and suggests narcosis, shock or cerebral injury
Blink reflex
Protects the eye from any objects coming near it by rapid eye closure
Rooting reflex
Newborn check is brushed/stroke near the corner of his mouth, the child turns his
head in that direction. Serves help baby find the food.
Sucking reflex
Infant lip is touched makes sucking motion
Extrusion reflex
Any substance is placed in the anterior portion of infants tongue, he will extrude it.
Its a protective reflex to prevent infant from swallowing inedible substances.
Disappears in 4mos of age
Palmar grasp reflex
When object is placed in newborns palm, child will grasp it by closing fingers on it;
disappears 6 wks-3 mos
Plantar grasp reflex
When an object touches the sole of newborns foot at the base of toes, his toes grasp
in some manner as his fingers; disappears 3 mos
Lies on his back, his head turns to other side; the arm and leg on the side to w/c his
head turns extend and the opposite arm and leg contrasts; disappear 2 nd-3rd mos of
life
Moro reflex
Startling the infant by loud noise or jumping his bassinet, the infant abducts and
extends his arm and leg; his fingers assume atypical C-position
Babinski reflex
When the side of sole of newborns foot is stroked in J curve from the heel upward,
Magnet reflex
Landau reflex
Step in place reflex
INFANT CARE CONCERS
1. Bathing
6. Sleep
3. Lactose intolerance
4. Colic
5. Spitting up
6. Miliaria
the newborn fans his toes in contrast w/ adult; occurs because of immaturity of
nervous system; fade 3 mos of age
If pressure is applied to soles of ft of infant in supine pos, he pushed back against
pressure
When newborn is hel in prone pos w/ hand underneath him supporting his trunk, he
should demonstrate some muscle tone
Newborn in vertical pos, his ft touches a hard surface, he will take few quick
alternating steps, disappear 3 mos
Helps infant learn different textures and sensations and provide opportunity to
exercise and kick
A good time for parent to spend time talking to child and communicating
Dont allow infant to wear a lengthy period of time
Frequently changed every 4hrs
Easily laundried
Not be binding dapat
Teach parents to begin brushing an infant as 1st tooth arise
Use soft brush and water once a day to prevent plaque from forming
2 wks- expose skin to sunlight, it provides natural source of vit D, no >3-5min if 1 st
day
Best time-11 am and after 3 pm
Suggestion to eliminate or at least cope w/ night walking
Delay bedtime 1 hr shorten an afternoon sleep period dont respond immediately to
the child at night to be certain that baby wont fall asleep again
Because stools tend to be loose
Stools infrequent in formula fed infants if diet is too high in protein, fat/ deficient in
fuid
If it persists beyond 5-6 mos- add food w/ bulk such as foods/veges such as
increased fluid intake
Prune juice maybe given but too much may cause diarrhea
Infants w/ hx of constipation for >1 wk should be examined for anal fissure/ tight
anal sphincter
SX OF HIRSCHPRUNGS DISEASE
High fever, convulsions, vomiting, diarrhea and earache are never normal
signs of teething.
Discourage use of OTC drugs because they may contain bentocaine and if applied
too far back in the throat may interfere with gag reflex
Acetaminophen is the best treatment
2. Thumb sucking
Parents should be taught that thumb sucking is normal and does not deform the jaw
line as long as it stops by school age
Be sure the infant has adequate sucking pleasure and then ignore thumb sucking
3. Pacifier
A baby who has colic craves sucking and enjoys pacifiers because his abdomen
hurts and interprets this as hunger sensation
EFFECTS OF SEPARATION FROM PARENTS
Kind of parenteral care
Factors
Kind of person
Maternal deprivation
Term used for an infants lack of warm relationship
EFFECTS OF DEPRIVATION (1ST 6 MONTHS)
1. Becomes emotionally isolated from adults
2. Retarded mental development
3. Cry great deal
4. Poor motor development
5. Will refuse contact with adults
EFFECTS OF DEPRIVATION (2nd 6 MONTHS)
Period of analyctic depression occurs
1. Depressed infants
2. Look sad cry a great deal
3. Withdrawn in their relationship with adults
4. May refuse to eat, loose weight
5. Respiratory disturbance
Walks alone
The 15 month old (toddlerhood)
Creeps upstairs
Build a tower of 2 blocks
Holds a cup with fingers
around it
Grasps spoon but spills
content
Pat pictures in book