STAGES OF GROWTH AND DEVELOPMENT

CHILD HEALTH NURSING

1.Prenatal period

GROWTH AND DEVELOPMENT THEORIES 0-14 days after conception Ovum

1.Psychosocial development – Erikson 14 days to 8 weeks Embryo

2.Psychosexual development- Sigmund Freud 8 weeks to birth Fetus

2.Post natal period

3.Cognitive development – Jean Piaget 0-28 days Neonate

- It defines cognitive acts as ways to adapt to the 1 month- 1 year infant

environment (mental mapping)
1-3 year Toddler
- Schemata- as per this theory ,schemata are categories in
which mind organise and understand the world 3-5 year Pre schooler

6-12 year schooler

NEURON ACADEMY Page 1

13-18 years Adolescent 2 YEARS 4X

3 YEARS 5X

THE PROCESS OF DEVELOPMENT IS IN CEPHALOCAUDAL 5 YEARS 6X

AND PROXIMO-DISTAL DIRECTION
7 YEARS 7X

10YEARS 10X
WEIGHT

AGE WEIGHT
 Neonate lose 5-10 % weight in the first 10 days to 2
NORMAL WEIGHT AT BIRTH 2.5 KG – 3.5 KG weeks

AT BIRTH X INFANT LENGTH

6 MONTHS 2X AT BIRTH= 50 CM

1 YEAR 3X 1 YEAR =75 CM

2 YEAR=90 CM

NEURON ACADEMY Page 2

 At 1 year chest circumference equals to head
circumference
AFTER THAT
MID UPPER ARM CIRCUMFERENCE
HEIGHT= (AGEX 6)+77CM
At birth= 11-12 cm

At 1 year= 12-16 cm
HEAD CIRCUMFERENCE

 AT BIRTH =33-35 CM
MILESTONES
 AT 3 MONTH=40 CM
AGE MILESTONE
 AT 1 YEAR -45 CM
2 MONTHS SOCIAL SMILE

3 MONTH HOLDING NECK

CHEST CIRCUMFERENCE
8 MONTHS SITTING WITHOUT
AT BIRTH =31 CM
SUPPORT

NEURON ACADEMY Page 3

  SUCKING –ENDS AT 3 -4 MONTHS
9 MONTHS STAND WITH SUPPORT
 PALMAR GRASP-START AT BIRTH ,ENDS AT 3
12 MONTHS STAND WITHOUT
MONTHS
SUPPORT
 PLANTAR GRASP –ENDS AT 8 MONTH
8-9 MONTHS CRAWLS
 BABINSKI REFLEX –ENDS BETWEEN 9 -12 MOTHS.
8 – 12 MONTHS PINCER GRASP
 WHEN SOLE OF THE FOOT IS STROKED TOES FANS
9 MONTHS SAYS MAMA
OUT
,DADA,WAVES BYE BYE

15 MONTHS WALK ALONE

REFLEXES
 ROOTING – TOUCH THE CORNER OF THE MOUTH OF
THE BABY ,THEN BABY TURNS HEAD TOWARDS
STIMULATION.ENDS AT 3-4 MONTHS
 STARTILE REFLEX-SUDDEN REACTION TO SHARP
NOISE ETC.DISAPPEAR WITHIN 4 MONTHS
 MORO REFLEX-SUDDEN MOVEMENT OF THE NECK
OF THE BABY CAUSE RAPID ABDUCTION AND
EXTENSION OF HANDS.DIASPPEARS AT 4-5 MONTHS

NEURON ACADEMY Page 4

  TONIC NECK OR FENCING-WHILE TH NEWBORN FALL
2-3 YEAR ONLOOKER
ASLEEP,TURN TO LEFT SIDE ,THE LEFT LEG AND ARM
EXTENDED WHILE RIGHT LEG AND ARM FLEX AND TODDLER (2.5 -4YEARS) PARALLEL
VICEVERSA .DIASAPPEARS AT 3 TO 4 MONTH
PRESCHOOLER(3- 4 YERS) COPERATIVE
VITAL SIGNS – NEW BORN AND INFANT
SCHOOLER (ABOVE 4 COMPETITIVE
 TEMPERATURE -97.5 -98 DEGREE F YEARS)

 HR- 120-140 BEATS PER MINUTE

 RR- 30-60 PER MINUTE

 B.P-73/55mmHg

TYPES OF PLAY NEWBORN CARE –some important

points
INFANTS UNOCUPIED

-While suctioning a newborn, suction mouth first

0-2 YEARS SOLITARY
then nostrils with a bulb syringe to prevent
aspiration

NEURON ACADEMY Page 5

 -Birth trauma mass
1.caput succedaneum – edema of the soft tissue
over the bone,subsides within a few days.edema
crosses the suture line
2.cephalohematoma- swelling due to bleeding into
the area between bone and periosteum. Subsides
within 6 weeks.swelling does not cross over the
suture line.
-Low set ears is related to down syndrom
-Milia – small white sebaceous glands appear on the
forhead ,nose etc
-First voiding and passing of stool meconium shoul
occur within 24 hours after birth
NEURON ACADEMY
-If a baby is exposed to cold ,vasoconstriction may
occur which later result in METABOLIC ACIDOSIS
-PHYSIOLOGICAL JAUNDICE (NORMAL)- it appear
after 24 hours of birh in full term baby and after 48
hours of birth in premature baby.
-PATHOLOGICAL JAUNDICE (ABNORMAL)- jaundice
within 24 hours of birth.it indicate early hemolysis
of red blood cells
-Vitamin k is not synthesized in newborn body so
there is a risk for bleeding disorder.
Vitamin K is administered intramuscularaly,lateral
aspect of the middle third of the vastus lateralis
.dose 0.5 to 1 mg .
-During the first week after birth the birth weight
reduced 5 percent to 10 percent.
Page 6
 After 10-14 days the birth weight is regained. 2.Respirotory rate

-While taking input and output chart ,weigh the 3.Muscle tone
diaper and 1 gm of diaper equals 1 ml of urine.
4.Reflex response
-Ortolani’s sign and Barlow’s sign – assessment test
5.Skin color
for developmental dysplasia of the hip.
Total score :10
developmental dysplasia of the hip- head of the
femur is improperly attached to hip socket If the total score is between

c/f – shortening of the affected side limb (Galeazzi’s 8-10 means no depression,no intervention required
sign,Allis’ sign)
4-7 means mild depression,administer oxygen,rub
APGAR SCORE newborn’s back

Dr.Virginia Apgar developed APGAR SCORE . 0-3 means severe depression ,require resucitation.

APGAR score assess five items In apgar scoring if the skin color is pallor or cynosis ,0
is the score given.if the body skin color normal and
1.Heart rate
extremity is blue then 1 point is given.if both the

NEURON ACADEMY Page 7

 body and extremity is normal color then 2 point is
given.
APGAR SCORE IS ASSESSED AT 1 MINUTE AND AT 5
MINUTE AFTER BIRTH
LOW BIRTH WEIGHT
-LOW BIRTH WEIGHT – LESS TAN 2500 G
-VERY LOW BIRTH WEIGHT –LESS THAN 1500 G
-EXTREMELY LOW BIRTH WIGHT –LESS THAN 100O G
SMALL FOR GESTATIONAL AGE- newborn who is
below 10th percentile on the intrauterine growth
curve
NEURON ACADEMY
LARGE FOR GESTATIONAL AGE – newborn who is
above 90th percentile on the intrauterine growth
chart.
RESPIRATORY DISTRESS SYNDROM
 ETIOLOGY- HYALINE MEMBRANE DISEASE
(DEFECIENCY OF SURFACTANTS)
SEESAW RESPIRATION AND EXPIRATORY GRUNTING
PRESENT
RX- ADMINISTRATION OF SURFACTANTS
PREVENTION
ADMINISTRATION OF BETAMETHASON TO MOTHER
48 HOUR BEFORE DELIVERY OF FETUS
Page 8
 Toxoplasmosis

HYPERBILURUBINEMIA’ Other infections- HIV,hepatitis B,syphillis

SERUM BILURUBIN LEVEL MORE THAN 12 MG/DL Rubella

 COMPLICATIONS-KERNICTERUS (brain damage due Cytomegalovirus

to deposition of bilurubin in brain cells)
Herpex siplex virus
 RX- PHENOBARBITONE
LIVE VACCINE SHOULD NOT BE GIVEN FOR A HIV INFECTED
 PHOTOTHERAPY INFANT

COVER EYES/GENITALIA

45 CM DISTANCE BETWEEN BODY AND LIGHT NEONATAL HYPOGLYCEMIA

 LESS THAN 40 mg /dL

TORCH SYNDROME OR INFECTIONS  ADMIN 10 % IV GLUCOSE AT A RATE OF 2 ML/KG

It includes infections caused by

NEURON ACADEMY Page 9

 HYDROCEPHALUS  Increase in head circumference

-An imbalance in C.S.F production and  Macewen’s sign- percussion on head produce
absorption,result in increased ICP cracked pot like sound

-A high shrill cry in an infant can be a sign of Rx

increased ICP
 VP shunt –ventriculo peritoneal shunt
Types
 AV shunt- ventriculoatrial shunt
-Communicating- no disturbance in C.S.F flow.it
Common sign of shunt malfunctionin toddler-
occurs due to impaired absorption of CSF
headache
-Non communicating- due to obstruction in CSF flow
Common sign of shunt malfunction in older children-
change in level of consciousness

Signs and symtoms

 Anterior frontanel bulging CROUP SYNDROME

 Sunset eyes INCLUDES

NEURON ACADEMY Page 10

 1.ACUTE EPIGLOTTITIS  MECONIUM ILEUM IN INFANTS

CHERRY RED SWOLLEN EPIGLOTTITIS

2.LARYNGITIS Kawasaki disease

3.LARYNGOTRACHEOBRONCHITIS Inflamation of the blood vessels throughout the body

BARKING COUGH Signs and symptoms

HAOARSENESS  Strawberry tongue

INSPIRATORY STRIDOR  High spiking fever

CLEFT LIP AND PALATE

CYSTIC FIBROSIS  Cleft lip-failure of fusion of maxiallary and median

nasal process.it is also known as cheiloschisis.
 DUE TO GENE MUTATION
 Cleft palate is otherwise called as palatoschisis
 THICKENED MUCUS GLAND SECRETIONS CAUSE
OBSTRUCTIONS IN PANCREAS AND ALVEOLI Surgical repair of cleft lip-cheiloplasty

NEURON ACADEMY Page 11

 Surgical repair of cleft palate-palatoplasty Choking

Surgery usyally performed by age 3-6 months cynosis

ESOPHAGEAL ATRESIA AND TRACHEOESOPHAGEAL PYLORIC STENOSIS

FISTULA
Signs and symptoms
-In this condition esophagus terminates before
Pojectile vomiting.
reaches to stomach .Due to this there will be a blind
pouch and fistula forms betwen easophagus and Metabolic alkalosis
trachea
An olive shaped mass in the epigastium
-Excessive drooling of saliva and excessive frothy
Surgical management- pyloromyotomy
saliva in mouth and nose are the main signs

-The 3 C’S of ESOPHAGEAL ATRESIA AND

TRACHEOESOPHAGEAL FISTULA CELIAC DISEASE

Coughing

NEURON ACADEMY Page 12

  Also known as gluten sensitive enteropathy or celiac  MANAGEMENT-AVOID DAIRY PRODUCTS
sprue

 Gluten is a protein component found in wheat,oats

HIRSCHPRUNG DISEASE
 Patient cannot tolerate gluten in this condition
 Hirschprung disease (aganglionic megacolon) is due
 It cause steatorrhea,acute diarrhea,severe to absence of ganglionic cells.
malnutrition,anemia etc
 Also known as congenital aganglionosis or
 Rx-gluten free diet aganglionic megacolon.

LACTOSE INTOLERCANCE  It is also associated with down’s syndrome

 INABILITY TO DIGEST LACTOSE DUE TO THE ABSENCE  It results intestinal obstruction

OF ENZYME LACTASE.CHILD CANT TAKE MILK
 Signs
PRODUCTS.
-Ribbon or pellet like stool can be seen in this
 COMPLICATION-CALCIUM AND VITAMIN D
DEFICIENCY. -Absence of meconium pass in the first 48 hours

NEURON ACADEMY Page 13

 -Bile stained vomiting Hydrostatic redyuction- by using air or fluid pressure.

Rx

Low fiber,high calorie high protein diet OMPHALOCELE

Herniation of the abdominal content through umblical ring

INTUSSUSCEPTION GASTROSCHISIS

Telescoping of one portion of the bowel into another Herniation of abdominal content is lateral to the umblicus
portion causing intestinal obstruction

Signs and symptoms

CRYPTORCHIDISM
-Currant jelly like stools
One or both testes fail to descend into scrotum.
-child will takes fetal position
EPISPADIAS- urethral orifice is located on the dorsal
-Fecal vomiting surface (upper) of penis

Rx

NEURON ACADEMY Page 14

HYPOSPADIAS- urethral orifice is located on the ventral
surface( below) of penis
NEURAL TUBE DEFECT
MARFAN SYNDROME
 ETIOLOGY
Connective tissue disorder due to fibrillin-1 gene defect
-FOLIC ACID DEFICIENCY
Tall and thin body with visual and cardiac problems
-SODIUM VALPORATE INTAKE IN PREGNANCY

-INCREASED ALPHA FETO PROTIEN

WILMS TUMOR (NEPHROBLASTOMA)
PREVENTION
 WILMS TUMOR – common kidney tumor of chilhood
- FOLIC ACID 0.4 MG FOR ANTENATAL WOMEN
 MALIGNANT NEOPLASM
NEURAL TUBE DEFECT (TYPES)
 MASS IN THE ABDOMEN
 ANENCEPHALY-PARTIAL OR COMPLETE ABSCENCE OF
 AVOID PALPATION OF ABDOMEN .RUPTURE CAUSES BRAIN
SPREADING OF CANCER CELLS.

NEURON ACADEMY Page 15

  ENCEPHALOCELE- HERNIATION OF BRAIN THROUGH CONGENITAL HEART DISEASE -classification
SKULL
ACYANOTIC CYANOTIC
 SPINA BIFIDA -INCOMPLETE CLOING OF SPINE AND
MEMBRANES AROUND THE SPINAL CORD
ASD TETROLOGY OF FALLOT
SPINA BIFIDA –TYPES
VSD TGA(TRANSPOSITION OF GREAT-
1.spina bifida occulta- common ,there will be
covering of skin later PDA ARTERIES)

2.meningocele COARCTATION OF AORTA TRICUSPID ATRESIA

3.myelomeningocele AORTIC STENOSIS

PULMONIC STENOSIS

NEURON ACADEMY Page 16

 TETROLOGY OF FALLOT -includes

 Pulmonar artery disease

 Right ventricular hypertrophy

 Ventricular septal defect

 Overriding of aorta

NEURON ACADEMY Page 17