CASE SCENARIO 7

Questions:

1. What are the normal vital signs of the newborn baby?

Temperature is 36.5C–37.5C (axilla), 36.6C–37.2C (rectal) having a Normal Temperature at birth at 37.2’C
The heart rate or pulse rate of a fetus in utero averages 120 to 160 beats/min. If the newborn is sleeping 110-140
bpm. If crying, up to 180 bpm.
The respiratory rate of the newborn in the first few minutes of life may be as high as 90 beats/min. As
respiratory activity is established and maintained over the next hour, this rate will settle to an average of 30 to
60 breaths/min Blood Pressure Is not usually measured but it is 80–60/45–40 mm Hg at birth.
2. What is a reflex? What does it indicate? Why are these important in a newborn development?

A reflex is a muscle reaction that happens automatically in response to stimulation. Certain sensations or
movements produce specific muscle responses. Many of your baby's movements in their first weeks are done by
reflex. This means it is involuntary or happens without your baby trying. The presence and strength of a reflex
is an important sign of nervous system development and function.

3. What are the normal newborn reflexes?

Reflexes are involuntary movements or actions. Some movements are spontaneous and occur as part of the
baby's normal activity. Others are responses to certain actions. Healthcare providers check reflexes to determine
if the brain and nervous system are working well. Some reflexes occur only in specific periods of development.
The following are some of the normal reflexes seen in newborn babies:

Rooting reflex This reflex starts when the corner of the baby's mouth is stroked or touched. The baby will turn
his or her head and open his or her mouth to follow and root in the direction of the stroking. This helps the baby
find the breast or bottle to start feeding. This reflex lasts about 4 months.

Suck reflex Rooting helps the baby get ready to suck. When the roof of the baby's mouth is touched, the baby
will start to suck. This reflex doesn't start until about the 32nd week of pregnancy and is not fully developed
until about 36 weeks. Premature babies may have a weak or immature sucking ability because of this. Because
babies also have a hand-to-mouth reflex that goes with rooting and sucking, they may suck on their fingers or
hands.

Moro reflex The Moro reflex is often called a startle reflex. That’s because it usually occurs when a baby is
startled by a loud sound or movement. In response to the sound, the baby throws back his or her head, extends
out his or her arms and legs, cries, then pulls the arms and legs back in. A baby's own cry can startle him or her
and trigger this reflex. This reflex lasts until the baby is about 2 months old.

Tonic neck reflex When a baby's head is turned to one side, the arm on that side stretches out and the opposite
arm bends up at the elbow. This is often called the fencing position. This reflex lasts until the baby is about 5 to
7 months old.

Grasp reflex Stroking the palm of a baby's hand causes the baby to close his or her fingers in a grasp. The grasp
reflex lasts until the baby is about 5 to 6 months old. A similar reflex in the toes lasts until 9 to 12 months.

Stepping reflex This reflex is also called the walking or dance reflex because a baby appears to take steps or
dance when held upright with his or her feet touching a solid surface. This reflex lasts about 2 months.

4. What reflex is displayed by baby Belle when reaching for the mother’s breasts? How would you elicit
a rooting reflex?

The rooting reflex prompts the baby to turn her head toward your hand if you stroke her cheek or mouth. This
helps her find the nipple at feeding time. At first, she'll root from side to side, turning her head toward the
nipple and then away in decreasing arcs. Simply moving her head and mouth into position to suck.

5. What newborn reflexes are present at birth and remain unchanged through adulthood?

Newborn reflex is a muscle reaction that happens automatically in response to stimulation. Presence and
strength, it was an important sign of nervous system development and function. Many infant reflexes disappear
as the child grows older, although some remain through adulthood. This is the list of newborn reflexes that
remains throughout life:

*Blinking reflex: blinking the eyes when they are touched or when a sudden bright light appears

*Cough reflex: coughing when the airway is stimulated

*Gag reflex: gagging when the throat or back of the mouth is stimulated

*Sneeze reflex: sneezing when the nasal passages are irritated

*Yawn reflex: yawning when the body needs more oxygen.

6. How would you know that the baby is getting enough milk? Give signs of good attachment during
breastfeeding.

You would know if your baby is getting enough milk when:

• Your baby is feeding at least eight to 12 times in 24 hours. He comes off your breast when he's ready, and
seems settled and content in between feeds, which may be frequent

• Breastfeeding feels comfortable and pain-free. Letdown may be painful, but this only lasts half a minute.

• Your breasts feel softer and less full after feeds.

• Your nipple looks the same shape after you've fed your baby, not squashed, pinched, or white. However, if
you have flat or inverted nipples your nipple is more likely to be drawn out after a feed.

• Your baby looks a healthy colour.

• Your baby is alert when he is awake, and readily wakes for feeds.

• Your baby has one or two heavy, wet nappies in the first 48 hours. Once he's over five days old, he has five or
six heavy, wet nappies.

• By five days, your baby’s poos are a yellowy-mustard colour and he's doing two poos (around the size of a £2
coin) every 24 hours.

• You can see your baby swallow while he is feeding, and he seems to be latched on properly. You'll be able to
hear him swallowing more clearly too, once your milk has come in.

• Your baby changes rhythm while sucking, and pauses during feeds. He should start feeding again when he's
ready. The good signs of attachment during breastfeeding are the baby's chin is touching your breast, their lower
lip is rolled down (you can't always see this) and their nose isn't squashed against your breast. You don't feel
any pain in your breasts or nipples when your baby is feeding, although the first few sucks may feel strong and
more of the areola is visible above the baby's top lip than below the lower lip; the baby's mouth is wide open.

7. How would you educate the mother being worried she doesn’t have enough milk supply?

• Express your milk as often as possible. - Your breast milk is produced on a supply and demand basis. How
often and how much milk is removed from the breast are the main factors that determine how much milk will be
made. In other words, the more often the milk is removed from the breasts (by baby or breast pump), the more
milk the breasts will produce.

•Increase how often you nurse and/or pump. - You can increase the frequency that you empty your breasts to
start signaling your body to produce more milk. Make sure you’re nursing or pumping at least eight times a day.

• Focus on self-care. - Taking good care of yourself can also impact your breast milk supply and potentially
increase breast milk production. Try keeping healthy snacks and bottles of water stashed by your bedside table
or the chair or couch where you most frequently nurse. Find time to relax and focus on yourself – take a bath,
take a nap, read a book, whatever helps relax you.

• Lactation enhancements. -Some moms have turned to lactation enhancements (galactagogues) to increase
breast milk production. Galactagogues are products that suggest taking them may help increase your breast milk
supply or improve your milk flow.

8. State the difference between rooting, sucking and gagging reflex in infant feeding
The sucking reflex is different from the rooting reflex. The two serve different purposes, but both are important
for allowing your baby to eat. The rooting reflex happens first, allowing your baby to reflexively find your
breast or a bottle nipple. The sucking reflex kicks in when the roof of a newborn’s mouth is touched. When this
area is stimulated, your baby will begin to “suck” or drink. For example, when you place your nipple or a bottle
nipple in your baby’s mouth, they automatically start sucking because of the sucking reflex. Gagging is a reflex
action that helps to prevent choking. It can be triggered by fingers, food, a spoon or toys touching the back of
the mouth. The gag reflex diminishes at around 6 months of age coinciding with the age at which most babies
are learning to eat solid foods.

9. Based on the narrative, is Baby Belle’s developmental milestones normal, delayed or advanced for
her age?

-She is advanced for her age for the following reasons:

-She turns her head to her direction when she hears her voice and smiles upon seeing her parents’ or familiar
faces at 3 months old which supposedly happens at 4th months old.

-At 4-months Baby Belle held her head steadily and unsupported, grasped toys dangled above her chest and
fixed eyes on objects and adult face which happens at 5th months of age.

-She put into her mouth any object she grasped, so her mom cleared away small objects away from her reach
which happens at 7th month.

-Baby Belle rolled from front to back and back to front and used monosyllabic babbles when she turned 5
months old, this happens at 6 months of age.

- Now at 6 months, Baby Belle could sit alone, hold a spoon and feed herself. This happens at 7th or 8th.month
of age.

10. Differentiate Growth from Development. What factors affect Growth and Development? Please
explain briefly.

Growth is defined as the development of a person in weight, age, size, and habits. On the other hand,
development is defined as the process wherein a person's growth is visible in relation to the physical,
environmental, and social factors. Different characteristics of growth and development like intelligence,
aptitudes, body structure, height, weight, color of hair and eyes are highly influenced by heredity. Sex: Sex is a
very important factor which influences human growth and development.