Module 5 - NCM 107 - Midterms

N OR TH W E ST ER N UN IV ERS I T Y, IN C
Laoag City, Ilocos Norte
NCM 107: CARE OF THE MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS)
Page 1 of 90
ACTIVITY 7. Word Search: Shade the words or group of words listed below. Words
appear straight across, backword straight across, up and down, down and up, and diagonally.
Check your work with the answers below.
N P T S U R T S I M S V T S U R T
O O K Z M T O S K A K R X W O G E
I G S W A O D R F R R C P T U Q G
T R C H S D M J Q O H A E N L P A
A O W Q L D C N O G U G R E A R T
Z W I L O L T E T R K R S C N O S
I T X M W E N O C E W E O S A X L
L H J Y K R D I G B I B N E G I A
A A R L Z M L X Q L K L A L C M R
U S D T L L C I U H S H L O Q O O
T K L R A U T O N O M Y I D N D G
C I M H B F R Z C K U K T A Y I L
A N P O G E R E P U S V Y B N S I
F F S T A G N A T I O N F O B T B
L A T N N E W P D W D I L I F A I
E N D E V E L O P M E N T A Q L D
S T N S U O I C S N O C N C W A O
ADOLESCENTEGO ANAL TRUST VS MISTRUST

ORAL STAGE INFANT TODDLER SUPEREGO
STAGNATION SELF ACTUALIZATION
LIBIDO AUTONOMY PROXIMODISTAL PHALLIC
PERSONALITY MASLOW KOHLBERG
GROWTH DEVELOPMENT CONSCIOUS
Page 2 of 90
A. IMMEDIATE NEEDS OF THE NEWBORN

a. to breath normally
b. to be warm
c. to be protected
d. to be fed
CORE STEPS
Page 3 of 90
1. Immediate Thorough Drying

 IMMEDIATELY for a full 30 seconds while doing a quick check on breathing
following an organized sequence unless the infants is both floppy/limp and apneic.
 stimulates breathing
 prevents hypothermia (associated with infection, coagulation defects, acidosis,
delayed fetal to NB circulatory adjustment, hyaline membrane disease, & brain
damage)
 DONT’S :
a. do not wipe off the vernix
b. do not let wet cloth on baby
c. do not slap, shake or rub the baby
d. do not ventilate unless the baby is floppy/limp and not breathing
e. do not suction unless the mouth/ nose are blocked by secretions.
2. Place baby on Skin-to-Skin Contact (SSC)
 for mother-baby bonding
 cover the NB; position prone on the mother’s abdomen or chest; temperature
check
 other benefits:
 B- breastfeeding success
 L – lymphoid tissue system stimulation
 E – exposure to maternal skin flora
 S – sugar (protection from hypoglycemia)
 T - thermoregulation
3. Properly-Timed Cord Clamping
 removed the first set of gloves; palpate the umbilical cord
 wait 1-3 minutes or until cord pulsations have stopped
 clamp cord using a sterile plastic clamp or tie at 2 cm from the umbilical base
then clamp again at 5 cm from the base using Kelly forceps
Page 4 of 90
 DRY cord care is recommended. Do not apply any substance onto the cord
 do not use a binder or “bigkis”
 observe for oozing of blood. If blood oozes, place a second tie between the skin
and the clamp.
4. Non-separation of NB and Mother – for initiation of BF
 never leave the mother and baby unattended
 monitor mother and baby every 15 mins in the first 1-2 hours. Assess breathing
and warmth.
 early and appropriate BF initiation
a. Leave the NB between the mother’s breasts in continuous skin-to-skin
contact
b. The baby may want to rest for 20-30 mins and even up to 120 minutes
before showing signs of readiness to feed.
c. Health workers should not touch the NB unless there is a medical
indication
d. Do not give sugar water, formula or prelacteals
e. Do not give bottles or pacifiers
f. Do not throw away colostrums
g. Let the baby feed for as long wants on both breasts
h. Help the mother and baby into a comfortable position
i. Observe the NB
j. Once the NB shows feeding cues, ask mother to encourage her NB to
move toward the breast
k. Counsel on positioning
 NB’s neck is not flexed or twisted
 NB is facing the breast
 NB is close to mother’s body
 NB’s whole body is supported
l. Counsel on attachment and suckling
 Mouth wide open
 Lower lip turned outwards
 Baby’s chin touching breast
 Suckling is slow, deep with some pauses
 More areola visible above the baby’s mouth
m. Proper BF Hold
1. cradle hold
2. cross cradle hold
3. underarm hold / football hold
4. side-lying position
Page 5 of 90
n. Promotion of BF
 Look for a quiet place
 Find most relaxed position for mother
 Provide adequate support
 Support feet
 Do not hunch shoulders
 Do not “scissor” the breast instead use C position of hand
STEPS IN IMMEDIATE ESSENTIAL NB CARE

1. Call out time of birth
2. Deliver the baby PRONE on the mother’s abdomen
3. dry the NB thoroughly for a full 30 seconds. Removed wet cloth
4. check breathing while drying
5. position NB prone on the mother’s abdomen in skin-to-skin contact. Cover the
back with a dry blanket
6. exclude second baby
7. remove first set of gloves
8. wait for cord pulsation to stop (approximately 1-3 minutes)
9. clamp cord at 2 cm away from the NB umbilical base using sterile plastic cord
clamp and apply sterile forceps 5 cm away from the skin then cut the cord in
between but near the cord clamp.
10. maintain SSC; do not separate baby from mother until a full breastfeed; watch for
feeding cues
11. Place identification band on ankle
12. Give eye prophylaxis within the first hour. Delay vitamin K and immunization
until after 90 minutes of uninterrupted skin to skin contact.
Classification of NB
1. AOG Preterm: < 37 weeks
Term: > 37 - 42 weeks
Post-Term: > 42 weeks
2. weight LBW < 2,500 gms.
VLBW: < 1500 gms
NBW: 2,500-3500 gms
Ave. 3000 gms
EVLBW: 500-1000 gms
3. weight and SGA: < 10th percentile (less than 2500 gms)
AOG AGA: between 10th to 90th percentile (2500 gms -3500 grams)
LGA: > 90th percentile (over 4000 gms)
Page 6 of 90
Periods of Reactivity
Assessment First Period: Resting Period Second Period
 15-30 mins of life  30 mins.- 2  2 hours to 6

 Highly responsive hours hours
(alert)  NB is difficult  Alert again
 NB is exploring to arouse upon responsive after
stimulation sleeping
Color Acrocyanosis Color stabilizing Quick color changes
occur with
movement or crying
Temperature Begins to fall from Stabilizes at about Increase to 99.8°F
intrauterine temp. of 99°F (37.2°C) (37.6°C)
100.6 °F (38.1°C)
Heart rate Rapid as much as 180 Slowing to 120-140 Wide swings in rate
b/min while crying b/min with activity
Respirations Irregular: 30-90b/min Slowing to 30-60 Becoming irregular

while crying; somenasal b/min, barreling of again with activity.
flaring, occasional chest occurs
retraction may be With period of rapid
present respiration
Activity Alert, watching Sleeping Awakening

Ability to Vigorous reaction Difficult to arouse Becoming
respond to responsive again
stimulation
Mucus Visible in mouth Small amount Mouth full of mucus,
present while causing gagging
sleeping
Bowel sounds Can be heard after the Present Often passage of first
first 15 mins. meconium stool
B. Profile of the Newborn

1. Vital Statistics
a. Birth weight: 2500 gms – 3500gms average 3000 gms
 Female BW – 3.4 kg
 Male BW – 3.5 kg
b. Birth length: 46-54 cm; average 50 cm
c. HC (head circumference): 33-35 cm;
Page 7 of 90
 Measure drawn across the center of the forehead and then around the most
prominent portion of the posterior head
 > than 37 cm or < than 33 should be carefully assessed for neurologic
involvement
d. CC (chest circumference): < 2 cm than the HC
 Measured at the level of the nipples
e. AC (abdominal circumference): 29-33 cm, sometimes the same with CC
2. Vital signs
a. pulse (CR): apical pulse rate
 180 b/min – NB heart rate immediately after birth
 120-140 b/min – w/in hour after birth, & stabilizes; ave. HR
 Rise up to 180 b/min – during crying
 Decrease up to 90 – 110 b/min during sleep
b. respiration: 30-60 b/min
 NB are obligate nose breathers
 Periodic apnea – respiratory depth, rate, and rhythm are likely to be
irregular, and short periods of apnea (w/ cyanosis); normal on NB
c. blood pressure:
 At birth – 80/46 mmHg
 By 10th day to infant year – 100/50 mmHg
d. temperature: about 37.2°C at birth (36- 37.4 be maintained). Average temp 37°C
 During the first few hours, it fluctuates due to immature temperature
regulating mechanism
 temperature should stabilized within 8 hours after birth
 heat loss in NB occur in four ways:
1. convection
2. radiation
3. evaporation
4. conduction
Page 8 of 90
Page 9 of 90
Newborn produced heat by:

a. increasing muscular activity – kicking
b. brown fat – present only in NBs, begin to form at 17 weeks gestation, the less
mature the infant the less brown fat.
c. increasing metabolic rate, which consequently increases the need for oxygen
C. Physiologic Function
1. Cardiovascular system
 When the cord is clamped, neonate is forced to take OXYGEN through the lungs;
pressure decreases in the chest generally, and in the pulmonary artery.
 Closure of the ductus arteriosus, a fetal shunt
 Pressure increases in the left side of the heart from increased blood volume, the
foramen ovale between the two atria closes because of the pressure against the lip
of the structure.
 Umbilical vein, two umbilical arteries and ductus venosus, no longer receive
blood, blood within them clots, and blood vessels atrophy over the next few
weeks.
 Special Structures
a. Ductus Arteriosus – found between pulmonary artery and aorta; closes at the
fourth day after birth -converted to ligamentum arteriosum.
b. Foramen Ovale –found between right and left atrium; functional closure
immediately at birth, anatomical around 3 months of age until 1 year of age –
converted to Fossa Ovalis.
c. Umbilical Vein and umbilical Arteries – constrict after clamping of the cord.
 Within 2-3 months are converted to ligamentum teres hepatis and
umbilical ligaments respectively
d. Ductus Venosus- found between lungs;
 in three months it is obliterated and converted itself to ligamentum
venosum.
 Blood Values
a. blood volume: 80-110 ml/ kg of body weight or about 300 ml
b. high RBC count - 6 million cells per cubic millimeter
c. Hgb: 17 to 18 g/100 ml of blood
d. Hct: 45% and 50%
e. indirect bilirubin level at birth: 1-4mg/100 ml
f. high WBC count at birth: 15,000 – 30,000 cells/mm3
 Blood Coagulation
 Born with a lower than normal level of vit. K
 Prolonged coagulation and prothrombin time
Page 10 of 90
 Vitamin K is synthesized through action of intestinal flora, and is

necessary for the formation of prothrombin
 NB’s intestine is sterile at birth
 All NB can be predicted to have this diminished blood coagulation
ability, therefore vit. K (aquamephyton) is administered IM into the
lateral anterior thigh.
 Acrocyanosis at birth - due to sluggish peripheral circulation
2. Respiratory System - the most critical and immediate change required of the NB is the
onset of breathing.
- first breath is initiated by:
a. low oxygen
b. high carbon dioxide
c. low pH
d. thermal stimulus (sudden chills of infant)
3. Gastrointestinal System
 Accumulation of bacteria -is necessary for DIGESTION & for VIT. K synthesis
 LIVER: most immature of the GIT organs
 NB is prone to HYPOGLYCEMIA (2-4 hours after birth)- prevented by early BF.
 GIT is sterile at birth. Bacteria may enter via oral and fecal route within 24 hours.
 Regurgitation: due to immature cardiac sphincter between the stomach and the
esophagus.
 Suckling and swallowing is good.
 STOMACH CAPACITY: 60-90 ml (1-20z). Infant require small frequent feeding.
 How to compute? 2 ounces + age in months = stomach capacity
 Stool (NB may have bowel movement after each feeding)

 Breastfed infants ( 3-4 times a day)
 Formula –fed infants (2-3 times a day)
Page 11 of 90
a.Meconium – a sticky, tart like, blackish green, odorless material formed from
mucus, vernix, lanugo, hormones, and CHO that accumulated during
intrauterine life.
b. Transitional Stool – diarrhea stool like; greenish brown to yellowish brown,

thin and less sticky, may contain some milk curds.
c. Milk Stool – yellow to golden to light brown and sweet smell- pasty to BF
baby.
 Pale yellow to light brown and offensive odor-formed to Formula fed
baby.
4. Renal System
 Kidneys are immature
 First voiding happens at 24 hours
Page 12 of 90
 Pale yellow and odorless - kidneys can’t concentrate urine

 Brick red/pinkish spots in diaper – due to presence of URIC ACIDs CRYSTALS
that were formed in the bladder in utero.
5. Integumentary System
 Smooth and elastic with fair amount of subcutaneous tissue
 Skin color is pinkish or ruddy because of increased concentration of RBC in
blood vessels
 Skin is thin, vernix caseosa are present, milia present, with skin pigmentation
such as Mongolian spot, stoke bite, and café oleit
 Preterm infants have lesser subcutaneous tissue so their skin appears almost
transparent.
 Posterm infants have pale, dry and feeling skin (dequamation)
 NB do not sweat because of immature sweat, sweat begins after a month
 Vernix caseosa – white cheese like substance in the NB’s skin.
 Desquamation – feeling of the skin during the first 2-4 weeks
 Milia – are clogged and distended sebaceous glans seen in NB’s face particularly
on nose. Disappear with/o treatment within 2-4 weeks after birth
Page 13 of 90
 Lanugo- a fine downy hair that usually covers the infant’s shoulder, back and
forehead, cheek and upper arm, disappears within 2 weeks.
 Mongolian spots – bluish discoloration of the lower back and buttocks,

disappear at school age
Page 14 of 90
 Erythema toxicum / pink macular rashes– a harmless rash found in many NBs
which appear anytime during the first four hours of life and persists up to 2 weeks.
 The lesions begin as papule that develop in hive like elevations with a
center containing fluid.
 It’s the reactions of the infants skin to clothes and sheets.
 It subsides without treatment.
 BIRTHMARKS
 Nevus flemmeus or Portwine stain – a dark red lesion found in the skin
at birth.
 composed of newly formed capillaries, are colored red to purple
and do not blench.
 usually found in face but may also appear in other parts of the body
such as thighs and arms.
Page 15 of 90
 Strawberry marks or nevus vascolosus – are elevated areas of the skin

that are dark red with rough surface.
- composed of dilated immature capillaries occupying the dermal and
subdermal layers of the skin.
- may continue to enlarge up to 1 y/o but disappear when the child is
at school age.
- Application of cortisone may speed up their disappearance.
 Stork bites or telangiectatic nevi – occurs more frequently in girls than

in boys; are pink and easily blanched; appear mostly in the face and
nape of the neck.
Page 16 of 90
 Cavernous hemangiomas- similar to strawberry marks in appearance

but do not disappear.
 Cyanosis – refers to bluish discoloration of the skin

 Acrocyanosis - bluish discoloration of the hands and feet of the NB due to
poor peripheral circulation and should be seen only during the first 24to
48 hours of life.
Page 17 of 90
 Mottling of the skin – when NB is exposed to cold temperature, this is due to

instability of the circulation but disappears as the baby gets older
 Mottling- irregular discoloration of the skin resulting from
vasoconstriction, lack of fat and hypoxia.
 PHYSIOLOGIC JAUNDICE – normal jaundice that occurs almost 50% of NB

infants.
 Jaundice appears first in the head, progressing to the abdomen and the
extremities.
 Occurs between 2-7 days, peak in 3rd day or 72 hours after delivery.
 PATHOLOGIC JAUNDICE – jaundice that occurs before 24 hours after birth

is caused by incompatability, ABO incompatability (erythroblastosis fetalis /
HDN) or hepatitis.
 Kernicterus - occurs when bilirubin reaches the brain and damage brain
cells.
 if bilirubin levels is beyond 12 mg/100 ml or persists for more than a week
in term infants and more than 2 weeks in preterm infants
Page 18 of 90
6. MusculoskeletaL System
 At birth, skeletal system contains larger amounts of CARTILAGE than of
ossified bone.
 Muscular system is almost completely formed at birth
 Limpness or total absence of a muscular response to manipulation is never
normal and suggest NARCOSIS SHOCK or CEREBRAL INJURY.
7. Immune System
 Immature, NB lacks competency of localizing infection
 Immune is low, cannot produce antibodies, passive immunity from the mother
which last 2-3 months, the colostrums.
 Fever in the infant is most commonly due to DEHYDRRATION
8. Endocrine System
 Adequately developed but its function are immature
 Effect of maternal sex hormone in NB is evident, natural sex hormone is present
a.pseudomenstruation on baby – pink, mucoid discharged
b.breast engorgement both male and female- with milk known as “witch milk”
c.hypertrophied or enlarge labia due to maternal hormone
Page 19 of 90
9. Neurologic Function
 Incompletely integrated but sufficiently develop to sustain extrauterine life.
 Movement of the extremities
 Head – (MICROCEPHALIC, NORMOCEPHALIC, MACROCEPHALIC,
HYDROCEPHALUS).
Page 20 of 90
 Most are PRIMITIVE REFLEXES

a. eyes – blink, corneal pupillary reflex should present
b. nose – sneezing reflex
c. mouth – coughing, suckling, swallowing, gag and cough reflex
d. neck – tonic neck reflex
e. hands – palmar grasp
f. foot – plantar reflex, babinski , walking, stepping reflex
Page 21 of 90
10. Sensory Function

 Vision – fixate on object, can see at the distance of 1 foot, cannot see beyond
midline, color blind, fearless
 Hearing – positive startle reflex, recognize mother voice in 3 days
 Smell – react to strong odors
 Taste – recognize from sweet and sour taste, recognize by care giver through
facial expression
 Touch – found any part of the body, strong from the lips.
PHYSICAL ASSESSMENT OF THE NB

Assessment Area Usual Findings
1. Posture Flexion of head and extremities
2. skin Smooth, good skin turgor
3. head
 Anterior fontanel Diamond –shaped
 Posterior fontanel Triangular in shape
 Eyes Edematous lid
 Ears Top of pinna in horizontal line with outer
 Nose canthus
 Mouth and throat Patent
Intact
 Neck
Short no webbing
4. chest Barrel or circular
5. lungs Respiration, abdominal
6. heart Apex (4th to 5th ICS
7. abdomen Cylindrical, slightly protruberant
8. umbilical cord AVA, no oozing
9. genitalia
 female Labia and clitoris edematous
 male Testes palpable in each scrotal sac, urethral
opening at tip of glans penis
10. anus Patent
11. back Intact, no opening
12. extremities Ten fingers/toes, full range of motion
PHYSICAL ASSESSMENT OF THE NB

1. HEAD
 MOLDING – cranial bones slide and overlap each other during delivery to
decrease the diameter (size) of the head
Page 22 of 90
 FONTANELLES – are spaces located at the area where skull bones meet. The
usually soft and pulsate.
a. anterior fontanel (bregma) – located at the junction of the 2 parietal bones two
fused frontal bones. It is diamond shaped, about 3cm long and 2-3 cm wide.
Closes at 12 – 18 months of age.
b. posterior fontanel (lambdoid) – located at the junction of parietal and occipital
bone.Begins to close at 2 months of age, completely closed at 6-8 months,
about .5 -1 cm in length
 ABNORMAL FINDINGS
a. very large may indicate hypothyroidism
b. bulging fontanel – may indicate ICP
c. sunken fontanel – sign of dehydration
 CRADLE CAP- greasy dirt found on the scalp of NB.
Page 23 of 90
 CAPUT SUCCEDANEUM – pressure of the presenting part against the cervix that
delay venous return resulting in accumulation of fluid within the scalp. No treatment
needed, disappear 3 to 4 days after delivery.
 CEPHALHEMATOMA – too much pressure against the pelvis may lead to rupture
of several capillaries of the periosteum of the fetal skull resulting to accumulation of
blood between skull bone and periosteum.
 It is a swelling that never crosses suture lines and appears several hours
after birth. It resolves within 3-6 weeks after birth without treatment
Page 24 of 90
 CRANIOTABES – are soft areas in the cranial bones that corrects without treatment
within a few hours after birth. It caused by prolonged pressure of thefetal skull
against the mother’s pelvis after lightening that is why common in firstborn.
2. EARS
 Level of the top part of the ear should be in line with the inner and outer canthus of
the eye.
 Ears below the line is found in children with Down’s Syndrome
 There should be no pinpoint openings in front of the ear
 Lack of cartilages in the ears indicate prematurity.
Page 25 of 90
3. EYES
 NBs cry tearlessly due to immature lacrimal glands
 Dolls eye- normal until 10 days old
 Strabismus and nystagmus- normal until 4 months
 Yellowish/jaundice sclera – sign of hyperbilirubinemia
 Purulent discharge present – sign of infection

 Redness, swelling with discharge of conjunctiva – sign of conjunctivitis
 Absence of blink- indicates deafness
 Protrusion of eyeball – exopthalmus
 Deeply placed eyeball – enopthalmus
Page 26 of 90
4. MOUTH
 With scanty saliva due to immature salivary glands
 Some NB has teeth after birth precocious (natal teeth).
 Epstein pearls – small white cysts may see at the palate which are accumulation of
epithelial cells; disappear within 2 weeks
 Esophageal Atresia – presence of excessive saliva

 Macroglossia – indicate prematurity
Page 27 of 90
5. NECK
 Appears short and chubby with many skin folds
 Lengthens at 2 to 3 years of age
 Absence of head control – sign of prematurity and Down’s Syndrome
 Distended vein – sign of cardiopulmonary disorder
 Torticollis/Wrye neck –rigidity of the neck due to injury of sternocleidomastoid
muscle
6. CHEST
 The chest looks small in relation to head. The chest has a barrel shaped appearance
(almost circular), should symmetric and clavicles straight.
Page 28 of 90
 HR is heard to the left of midclavicular space at the third and fourth ICS; may have
functional Murmur
 Chest retraction – respiratory distress
 Bulging of the chest – pneumothorax
 Funnel shaped- malformation
 Fracture of clavicle – Manifested by a lump or bony prominence
7. BREAST
 Nipples are prominent, well-formed and symmetrically placed
 Engorgement of the breast (male and female) is a response to maternal hormone in
utero, subsides within 2 weeks.
Page 29 of 90
 Witch Milk – is watery fluid secreted by the NB’s nipple, disappear within the first
week of life.
 Lack of breast tissue less than 5 cm – indicates prematurity
8. UMBILICAL CORD
 Appears as gelatinous substance with blood vessel visible as red and blue breaks
(AVA) during the first hour after delivery. After the 1st hour it begins to dry and
shrink. It blackens in color by the 2nd and 3rd day.
 Within 7-10 days cord off, and healed by the time the infant is one month old.
 Omphalitis – infection of the cord manifested by foul odor, purulent discharge,
redness and swelling
9. SPINE
 Spine should appear flat, back should be straight and fexible
 Spinal curve seen in adult and children appears only when infant begins to sit and
walk
 Spina bifida – imperfect closure of the spinal vertebrae; presence of pinpoint
opening in the skin, dimples or tuft of hair along the spinal area.
 Limited flexion of the spine- indicates CNS infection
 Hyperextension of the back (opithothunus) – indicates intracranial infection
 Limitation of movement- indicates deformity of NB
Page 30 of 90
10. ANUS
 Located at midline and patent
 Passed meconium within 24-48 hours, if not suspect imperforate anus
11. GENITALIA
 Urinary meatus in male should at the end of the penis
 Phimosis – tight foreskin of the penis
Page 31 of 90
 Epispadias – opening of the penis is located at anterior/ dorsal / upper part of

glands penis
 Hypospadias -opening of the penis is located at posterior/ ventral / under the

surface of glands penis.
 Cryptochidism – undescended tetes
Page 32 of 90
 Scrotum is usually larger on the left side

 Ambiguous genitalia – enlarge clitoris, fused labia majora
12. EXTREMITIES
 NB’s assumes general flexion at rest
 Arms are usually longer than the legs during NB period
 Polydactily – having extra digits of fingers
 Syndactily – fusion / webbing of fingers
Page 33 of 90
 Ortholani’s maneuver – when NB is placed in supine position, the legs can be

flexed and rotated outward 160- 170 degrees until they almost touch the bed.
Page 34 of 90
 Hip subluxation – clicking sound heard during maneuver/abduction, means shallow

or poorly formed acetabulum
 Kernig’s sign (sign of meningitis) – inability to flex the thighs to the abdomen and
the knees
 Tremors- sign of CNS disorder
 Duchene Erb paralysis – brachial palsy due to trauma to the 5th and 6th cervical
nerve root.
 Absence of femoral pulses – a sign of heart disease
Page 35 of 90
 Club foot/ talipes equinovarum – foot twisted inward or outward

 Hypermobility of the joints- sign of Down’s Syndrome
 Yellowed nailbeds – sign of meconium staining
REFLEXES
1. Blinking or Corneal – infant blinks at a sudden appearance of a bright light oran approach
of an object toward cornea, persist throughout life,; protect the eye from any object
coming near it by rapid eyelid closure.
2. Pupillary – pupil constricts when a bright light shines toward it; persist throughout life
3. Doll’s Eyes – as head is moved slowly to right or left, eyes lag behid and do not
immediately adjust to know position of head, disappears as fixation develops; if persists,
indicates neurologic damage.
4. Sneeze – spontaneous response of nasal passages to irritation or obstruction; persists
throughout life.
5. Glabellar- tapping briskly on glabella (bridge of nose) causes eye to close tightly
6. Suckling – when a NB’s are touched, the baby makes a sucking motion. Begins to
diminish at about 6 months of age. It disappears immediately if it is never stimulated
7. Gag – stimulation of posterior pharynx by food, suction or passage of a tube causes
infant to gag; persist throughout life.
Page 36 of 90
8. Rooting – if a NB’s cheek is brushed or stroked near the corner of the mouth, the child
will turn the head in that directions; serves to help the baby find food, disappears at
about six week of life.
9. Extrusion – a NB will extrude any substance that is placed on the anterior portion of the
tongue; disappears by age of 4 months; protective reflex that prevents the swallowing
of inedible substances.
10. Yawn – spontaneous response to decrease oxygen by increasing amount of inspired air;
persist throughout life.
11. Cough – irritation of mucous membrane of larynx or tracheobronchial tree causes
coughing; persists throughout life.
12. Palmar Grasp – NB will grasp an object places in their palm by closing their fingers
on it; lessens after 6 weeks to age 3 mos. To be replaced by voluntary movement.
Page 37 of 90
13. Plantar Graps – when an object touches the sole of a NB’s foot at the base of the toes,
the toes grasp in the same manner as the fingers do, lessens by 8-9 mos. of age.
14. Babinski – when the side of the sole of the foot is stroked in an inverted “J” curve from
the heel upward, the NB fans the toes. Occurs because the NS is immature, remains
positive until at least 3 months of age.
15. Moro – can be initiated by startling the NB with a loud noise or by jarring the bassinet.
The NB abduct and extend their arms and legs with their fingers assuming a typical “C”
position; strong for the first weeks of life and then fades by the end of the fourth or fifth
month.
Page 38 of 90
16. Asymmetrical Tonic Neck – new NB’s lie on their backs, their head is usually turned
to one side, the arm and leg on the side or the other; disappears by age 2-3 mos.; also
called BOXER or FENCING REFLEX.
17. Trunk Incurvation – Stroking infants back alongside spine causes hips to move toward
stimulated side; disappears by age 4 weeks.
18. Dance or Step – if infant is held so that the sole of foot touches a hard surface, there is
a reciprocal flexion and extension of the leg, stimulating walking; disappears after age
3-4 weeks, to be replaced by deliberate movement.
19. Crawl – when placed on abdomen, infant makes crawling movements with arms and
legs; disappears about age 6 weeks
20. Placing – when infant is held upright arms and dorsal side of foot is briskly placed
against hard object, such as table, leg lifts as if foot is stepping on table; age disappears
varies
Page 39 of 90
NEWBORN EVALUATION
1. APGAR SCORING
 a method of assessing the NB’s adjustment to extra uterine life. It is taken at one
minute and five minutes after birth. With depressed infant repeat scoring every 5
mins. as needed.
 the one minute score indicates necessity for resuscitation. The five minute score is
more reliable in predicting mortality and neurologic deficits.
 the most important is the heart rate, then the respiratory rate, the muscle tone, reflex
irritability and color follows in decreasing order.
 a HR below 100 signifies an asphyxiated baby and HR above 160 signifies
distress
Page 40 of 90
 it also used as anticipatory guide for the management of the neonate.
SCORE
Sign 0 1 2
Muscle Tone Flaccid/limp Some flexion of Well-flexed
extremities
Heart Rate (most) Absent below (<100) Above (> 100)
Reflex irritability No response Grimace Cough or sneeze
Color (least) Blue, pale Acrocyanosis Pinkish
Respiration Absent Slow , irregular, weak Good, strong cry
cry
SCORE:
 7-10 Good condition/adjustment, do the routine NB Care
 4-6 Guarded, moderately depressed, needs airway clearance
 0-3 Poor, severely depressed, needs resuscitation
Page 41 of 90
2. SILVERMAN and ANDERSON SCORING

- A test used to evaluate the respiratory status / breathing performance of premature
and NB’s with respiratory distress.
Assess 0 1 2
Chest Movement Synchronized Lag on respiration See-saw respiration

Intercostals None Just visible Marked
Retraction
Xyphoid Retraction None Just visible Marked
Nares Dilatation None Minimal Marked
Respiratory Grant None Audible by Audible by ear
stethoscope
SCORE:
 Score of 0-3 indicates no respiratory distress/problem
 Score of 4-6 means moderately depressed ; guard
 Score of 7-10 means severely depressed
3. BALLARD SCORING
 With two categories
Page 42 of 90
a. Physical characteristic
Clinical Criteria for Gestational Age Variations
Characteristics 0-36 weeks 37-38 weeks 39-42 weeks
Sole creases Anterior transverse Occasional creases, Sole covered with

crease only anterior two-thirds creases
Breast nodule diameter 2 mm 4mm 7mm
Scalp hair Fine and fuzzy Fine and fuzzy Coarse and silky
Earlobe Pliable, no cartilage Some cartilage Stiffed by thick
cartilage
Testes and scrotum Testes in lower Intermediate Testes pendulous;
scrotal, scrotum scrotum full;
small, few rugae extensive rugae
b. Neuromuscular maturity
 neurologic assessment of the NB requires more manipulation than physical
assessment; performed when the infant has stabilized
Page 43 of 90
The six components or indicators

1. resting posture - assessed as the baby lies undistributed on a flat surface
2. square window (wrist) - elicited by flexing the baby’s hand toward the
ventral forearm. The angle formed at the wrist is measured.
3. arm recoil - recoil is a test of flexion development. Arm recoil is tested by
flexion at the elbow and extension of the arms at the newborn’s side.
 full term NB elbow – form an angle of less than 90° and rapidly
recoil back to the flexed position
 preterm NB elbow – form an angle less than 90° and have a slower
time.
4. popliteal angle - degree of knee flexion
 preterm : no resistance, 180° angel in a very immature NB
 term: 80° angle
5. scarf sign - drawn arm across the chest toward the infants opposite
shoulder until resistance is met. Note the location of the elbow in relation
to the midline of the chest.
6. heel to ear maneuver - gently draw the foot toward the ear on the same
side until resistance is felt
 preterm: leg will remain straight and the foot will go to the ear or
beyond.
Page 44 of 90
Other indicators / characteristics of neurologic status

1. Major reflexes: sucking, rooting, grasping, moro reflex, tonic reflex
2. Head lag (neck flexors): pull the NB to a sitting position and note the degree of
head lag.
 Premature up to 34 weeks: total lag is common
 Postmature (42+ weeks): NB will hold the head in front of the body line.
3. Ventral suspension
- note the position of the head and back and degree of flexion in the arms and
legs
 Premature ( 36-38 weeks): some flexion of arms and legs
 Term: fully flexed extremities.
Checkpoint:
Study and review the topic. A
graded quiz will be given online
via canvas. Schedule will be
posted. Good luck!
Page 45 of 90
NEWBORN SCREENING (RA 9288)

A procedure to determine if the NB infant has a hereditable congenital disorder that may
lead to serious PHYSICAL HEALTH complications, mental retardation and even death if left
UNDETECTED and UNTREATED.
 A HEEL prick method / GUTHRIE TEST
 performed after 24 hours of life but not later than 3 days (unless high-risk NB in NICU
– 7 days) from time of delivery; ideally done on the 24th hour.
 result available 7-14 days after; negative result means NORMAL
 Disorders being Tested
a. Congenital Hypothyroidism (CH) - results from lack or absence of thyroid hormone
which is essential for the physical and mental development of a child.
 If the disorder is not detected and hormone replacement is not initiated
within 2 weeks, the baby with CH may suffer from severe growth and
Page 46 of 90
mental retardation.
b. Congenital Adrenal Hyperplasia (CAH)- is an endocrine disorder that causes severe

salt loss, dehydration and abnormally high levels and male sex hormones in both
boys and girls.
 if not detected and treated early, babies with CAH may die within 7-14
days- there’s a high loss of salt that lead the baby to death.
Page 47 of 90
c. Galactosemia (GAL) – contraindication to BF; a condition in which babies are

unable to process galactose, the sugar present in milk. Accumulation of excessive
galactose in the body can cause many problems, including liver damage, brain
damage / mental retardation., cataracts/ blindness or death.
Page 48 of 90
d. Phenylketonuria (PKU) – blond hair, blue eyes; a rare condition in which the baby
cannot properly use one of the building blocks of protein called phenylalanine.
Excessive accumulation of phenylalanine in the blood causes brain damage
(severe mental retardation).
 Diet should be phenylalanine free
Page 49 of 90
e. Glucose-6-Phosphate Deydrogenase Deficiency (G6PD) is a condition where the

body lacks the enzyme called G6PD; babies with this deficiency may have
hemolytic anemia resulting from exposure to oxidative substances found in drugs,
foods and chemicals.
 severe anemia and kernicterus due to blood (RBC) hemolize
Page 50 of 90
f. Maple Syrup Urine disease (MSUD) is a genetic metabolic disorder resulting from
the detective activity of the enzyme branched chain alpha-keto-acid
dehydrogenase complex; accumulation of the branched chain amino acids are
toxic to the brain.
Page 51 of 90
B. NEWBORN CARE
1. Establishing and maintaining effective respiration (patent airway)
- most important responsibilities of the nurse immediately after delivery of the NB is to
provide a clear airway to facilitate effective airway.
 Nursing interventions
a. wipe the mouth and nose after delivery of the head.
b. suction secretions from mouth to nose (penguin aspirator)
c. a crying infant is a breathing infant. Stimulate baby to cry if baby does not cry
spontaneously or if baby’s cry is weak.
 Loud and lusty - is a term infant cry
 High pitched cry – hypoglycemia, increase intracranial pressure
 Weak cry - prematurity
 Hoarse cry – laryngeal stridor
 Position NB in side lying position to promote drainage of mucus from
the mouth.
d. keep the nares patent because the NB are obligatory nose breathers until they
are 2 to 3 weeks
e. give O2 prn - administered when remains cyanotic after initial suctioning and
stimulation.
 RETROLENTAL FIBROPLASIA – results of excessive 02
administration
f. if HR is below 60bpm – do cardiac massage
2. Bath
 no oil bath, bath only the baby after 6° of life.
 partial bath if cord still intact
 full bath / tub bath if cord off
 bath is from the cleanest area to the most soiled part that is from eyes, face, ears,
scalp, neck, upper extremities , lower extremities, the buttocks and genital area.
 bathing should be done BEFORE a feeding to prevent spitting up, vomiting and
possible aspiration.
3. Changing diapers
 wash and dry the wet soiled area and changing diaper immediately after voiding or
stooling to prevent / treat diaper rash.
 to prevent further excoriation, use skin barrier ointment as ZINC OXIDE
4. Eye prophylaxis – CREDES PROPHYLAXIS
 it prevent bacterial infection( gonorrheal / Chlamydia)
 give as prophylactic eye treatment against gonorrheal conjunctivitis or opthalmia
neonatorum within 24 hours after delivery.
 Neisseria gonorrhea – causative agent
Page 52 of 90
 The 2 types of drugs

a. Opthamic drop (1% Silver nitrate / 2.5 % Povidone iodine )
- into the center of the lower conjunctival sac of each eye.
- be careful not to drop the solution directly on the cornea as this cause the
NB much pain
 CHEMICAL CONJUNCTIVITIS - a normal reaction, usually develops
and persist within 2 to 3 days, characterized by redness swelling and
(edema).
b. Opthalmic ointment (tetracycline or erythromycin)
 apply 1 cm of medication, from inner canthus to outer canthus of the
lower lid of the eye
 these ointments are more effective against Chlamydia conjunctivitis.
C. Cord care
 no solution to be applied to the cord stump
 observe bleeding for the 1st few hour after birth
D. Vitamin K administration
 clotting factors II ( prothrombin), VII (proconvertin), IX (plasma thromboplastin
component) and X ( thrombokinase) are proteins which need vitamin K to convert
them into active clotting factors, thus they called vitamin K-dependent.
 administer .5 mg (preterm) to 1 mg (full term) vitamin K or aquamephyton ,
injected in the vastus lateralis muscle, IM.
 it prevents rare but often fatal bleeding disorder called Hemorrhagic disease of
the NB
E. Temperature regulation
 NB loss about 2 to 3°C of heat at birth because of external environment
 NB easily loss heat because they have immature temperature regulating system
 NB is most sensitive to hypothermia during the stabilization period in the first 6-
12 hours after birth.
 average NB temp. is 37.2°C
 the best route is on axilla- safe, no risk of membrane perforation, and prevention
also of excessive stooling.
 normal temp. (full term) – 36.5°C – 37.5°C (97.7°F to 99.5°F)
 normal temp. (preterm) – 36.3°C – 36.9°C (97.3°F to 98.4°F)
F. Breast feeding
 Anatomy of the Breast
1. areola – circular hyperpigmented area surrounding the nipple
2. nipple – conic elevation located at the center of the areola, contains 15 to 25
lactiferous ducts.
Page 53 of 90
3. lactiferous ducts – main ducts of the mammary gland numbering from 15 to 30

which open unto the nipple and carry the milk to the nipple
4. lactiferous sinus – dilatation of the lactiferous ducts located beneath the areola
where milk can be stored
5. Montgomery tubercle – sebaceous glands in the areola of the breast which become
more marked in pregnancy.
Contraindications to BF
1. Hepa B, HIV, AIDS infection
2. Inborn error or metabolism, galactocemia, maple syrup, phenylketonuria
3. herpes simplex
Signs of good attachment
1. more areola visible above baby’s mouth
2. baby’s mouth wide open
3. lower lip turned outwards
4. Chin close to the breast
5. mother feels no pain
6. baby suckless effectively: a few quick initial – “up” sucks, then slow deep
sucks, sometimes pausing.
Results of Poor Attachment
1. pain and damage to nipples
2. breastmilk not removed effectively
3. apparent poor milk supply
4. breasts make less milk
Signs of Good Positioning
1. baby’s body straight – not bent or twisted
2. baby facing the breast - not flat against mother
3. baby close to mother’s body
4. the baby’s whole body supported
NB nutritional allowance
 Calories 110-120 calories/kg of body weight (50-55 kcal/lb)
 CHON – 2.2 g/kg of body wt. for the first 2 months
 Fat - fatty acid for growth and skin integrity
 CHO - lactose
Composition of BF
- fats, carbohydrates, protein, vitamins and minerals, anti-infective factors,
bio-active factors
Indicators of adequate breast milk intake (early postpartum weeks)
1. breast full before feeding and softer afterwards
2. let-down sensation on mother’s breasts
Page 54 of 90
3. wet nappies / diapers: 6 or more /24 hours

4. several movements: several times/day
5. contented baby between feeds
6. audible swallowing during feeding
7. average wt. gain:
 18-30 grams / day (3/4 -1 oz. per day)
 125 -210 grams / week (4-7 oz. per week)
 BURPIN G newborn in between feedings / after feeding.
 BF baby per demand/ every 2-3 hours and alternate BF every 10-15 mins.
each breast
G. Ways of Holding the Infant
 NB loves to be touched, held and cuddled. Their sense of touch is the most
developed sense at birth. The way infants are held can communicate love, care,
enjoyment, and respect for them as significant individuals and new arrivals in
the big family of humanity.
 Types of Infant hold
1. kangaroo hold
2. cradle hold – for feeding and cuddling; traditional and most used type of
hold.
3. shoulder hold – is best for burping or bubbling an infant
4. football hold – is best for shampooing
5. transfer hold – is for lifting and transferring the infant to another place
Page 55 of 90
C. CONCEPT ON GROWTH AND DEVELOPMENT

1. Definition of Terms:
 GROWTH – increase in size or quantitative change, measured in lbs., kilos, inches
and centimeters
 DEVELOPMENT – increase in skill or the ability to function, qualitative change,
can be measured by observing a child’s ability to perform specific tasks
 MATURATION- increase in competence and adaptability.
2. Principles of Growth and Development
a. Growth and Development are continuous process from conception until death
b. Growth and Development proceed in an orderly sequence
c. Different children pass through the predictable stages at different rates.
d. All body systems do not develop at the same rate
e. Development is cephalocaudal
f. Development proceeds from proximal to distal body parts.
g. Development proceeds from gross to refined skills
h. There are optimum times for initiation of experiences or learning
i. Neonatal reflexes must be lost before development can proceed
j. A great deal of skill and behavior is learned by practice.
Factors influence Growth & Development

a. Genetic Inheritance and environment influences
– are two primary factors that determine a child’s pattern of growth and
development
 Temperament (the typical way a child reacts to situations) is an example of
genetic influence.
 an individual’s characteristics manner of thinking, behaving or reacting
to stimuli in the environment. Is not developed by stages but is an inborn
characteristic set at birth
 Nutrition – is an example of environmental influence.
b. Gender – girls are born lighter (by an ounce or two) and shorter (by one inch or two) than
boys.
 Boys tend to keep this height and weight advantage until puberty, at which time
girls surge ahead because they begin their puberty growth spurt 6 months to 1
year earlier than boys.
 By the end of puberty (14 to 16 years), boys again tend to be taller and heavier
than girls.
c. Health – a Childs inherit a genetically transmitted disease may not grow as rapidly or
develop as fully as a healthy child, depending on the type of illness and the therapy or
care available for the disease.
d. Intelligence – children with high intelligence do not generally grow faster physically than
other children, but they tend to advance faster in skills.
Page 56 of 90
BASIC DIVISION OF CHILDHOOD

1. Fetal – conception to birth
2. Neonatal – birth to 1 month – 1st 28 days of life
3. Infancy – 1 month to12 months.
4. Toddler – 1 year to 3 years old
5. Pre-school – 3 y/o to 6 y/o
6. School age – 6 y/o to 12 years old
7. Adolescence -12 years to 20 y/o.
THEORIES:
A. PSYCHOSEXUAL STAGE (FREUD)
Page 57 of 90
Page 58 of 90
Freud’s Five Stages of Development

Stage Age Characteristics Implications
Oral Birth to Mouth is the pleasure. Feeling of dependence Feeling produces
1 year arises and can persist through life. pleasure and sense of
An individual who is fixated at this stage may comfort and safety.
have difficulty in trusting others and may Feeding should be
demonstrate nail biting, drug abuse, smoking, pleasurable and
overeating, alcoholism, argumentativeness, and provided when
overdependence. required
Anal 2 and 3 Anus and rectum are the centers of pleasure. Controlling and
years This stage occurs during toilet training. expelling feces
Fixation at the anal stage can result in obsessive provide pleasure and
compulsive personality traits, such as obstinacy, sense of control.
stinginess, cruelty, and temper tantrums Toilet training
should be a
pleasurable
experience, and
appropriate praise
can result in a
personality that is
creative and
productive.
Phallic 4 and 5 The child’s genitals are the center of pleasure. The child identifies
years Sexual and aggressive feelings associated with with the parent of the
genitals come into focus. Masturbation offers opposite sex and
pleasure and the child experiences the Oedipus or later takes on a love
Electra complex. relationship outside
the family.
Oedipus complex – refers to the male child’s Encourage identity.
attraction for his mother and hostile attitudes
toward his father.
Electra complex- refers to the female’s
attraction for her father and hostile attitudes
toward her mother.
Fixation at this stage can result in difficulties

with sexual identity and problems withauthority.
Latency 6 to 12 Energy is directed to physical and intellectual Encourage childwith

years activities. Sexual impulses to be repressed. physical and
Unresolved conflicts at this stage can result in intellectual pursuits.
obsessiveness and lack of self- motivation
Genital 13 and Energy is directed toward attaining a mature Encourage
after sexual relationship. This stage involves separation from
Page 59 of 90
reactivation of the pregenital impulses. These parents, achievement

are impulses are usually displaced, and the of independence,
individual passes to the genital stage of maturity. and decision
An inability to resolve conflicts can result in making.
sexual problems, such as frigidity, impotence,
and the inability to have a satisfactory sexual
relationship.
B. PSYCHOSOCIAL DEVELOPMENT (ERICKSON’S)
Page 60 of 90
Erickson’s Eight Stages of Development
Stage Age Central Indicators of Indicators of Negative

Task Positive Resolution Resolution
Infancy Birth to Trust versus Learning to trust Mistrust, withdrawal,

18 mistrust others estrangement
months
Early 18 Autonomy Self-control without Compulsive self-restraint or
childhood months versus loss of self-esteem compliance
to 3
shame and
years doubt Ability to cooperate Willfulness and defiance
and to express
oneself
Late 3 to 5 Initiative Learning the degree Lack of self-confidence
childhood years versus guilt to which
assertiveness and Pessimism, fear of wrong
purpose influence doing
the environment
Over control and over
Beginning ability to restriction of own activity
evaluate one’s own
behavior
School age 6 to 12 Industry Beginning to create, Loss of hope, sense of
Page 61 of 90
years versus develop, and being mediocre

inferiority manipulate
Withdrawal from school
Developing sense of and peers
competence and
perseverance
Adolescence 12 to 20 Identity Coherent sense of Confusion, indecisiveness,
years versus role self and inability to find
confusion occupational identity
Plans to actualize
one’s abilities
Young 18 to 25 Intimacy Intimate relationship Impersonal relationship
adulthood years versus with another person
isolation Avoidance of relationship,
Commitment to career, or life-style
work and commitments.
relationships
Adulthood 25 to 65 Generativity Creativity, Self-indulgence , self-
years versus productivity, concern, lack of interest
stagnation concern for others and commitments
Maturity 65 years Integrity Acceptance of worth Sense of loss, contempt for
to death versus and uniqueness of others
despair one’s own life
Acceptance of death
C. COGNITIVE DEVELOPMENT (PIAGETS)
Piaget’s Phases of Cognitive Development

Phases and Stages Age Significant Behavior
Sensory motor phase Birth to 2 years Most action is reflexive
 Stage 1 use of reflexes Birth to 1 month Prepare of events is centered on the body
Objectives are extension of self
 Stage 2 primarily
circular reaction Acknowledge the external environment
1 t 4 month
Actively makes changes in the environment
 Stage 3 secondary
circular reaction
4 to 8 months Can distinguish a goal from a means of
attaining it.
 Stage 4 coordination of
secondary schemata 8 to 12 months Tries and discovers new goals and ways to
Page 62 of 90
 Stage 5 tertiary circular attain goals

reaction Rituals are important
12 to 18 months
 Stage 6 inventions of Interprets the environment by mental
new means image
18 to 24 months
Uses-believe and pretend play
Pre-conceptual phase 2 to 4 years  Uses an egocentric approach to
accommodate the demands of an
environment.
 Everything is significant and relates to
“me”
 Explores the environment
 Language development is rapid
 Associates words with objects
Intuitive thought phase 4 to 7 years  Egocentric thinking diminishes
 Thinks of one idea at a time
 Includes other in the environment
 Words express thoughts
Concrete operations 7 to 11 years  Solves concrete problems
phase  Begins to understand relationships such
as size
 Understands right and left
 Cognizant to view points
Formal operative phase 11 to 15 years  Uses rational thinking
 Reasoning in deductive and futuristic
D. MORAL DEVELOPMENT (KOHLBERG’S)
Kohlberg’s Stages of Moral Development

Level and Stage Definition Example
Level 1 The activity is wrong if one is A nurse follows aphysician’s
Pre-conventional punished, and the activity is order so not to be fired
Stage 1: Punishment and right if one is not punished
obedience A client in hospital agrees to
Stage 2: Instrumental- Action is taken to satisfy one’s stay in bed if the nurse will
relativist orientation needs buy the client a newspaper
Level II Conventional Action is taken to please A nurse gives elderly clients

Stage 3: Interpersonal another and gain approval in hospital sedatives at
concordance (good boy, nice bedtime because the nurse
girl) wants all clients to sleep at
night
Page 63 of 90
Stage 4: Law and order Right behavior is obeying the A nurse does not permit a
orientation law and following the rules worried client to phone
home because hospital rules
stipulate no phone calls after
9:00 pm
Level III Standard of behavior is basedon A nurse arranges for an East
Post-conventional adhering to laws that protect the Indian client to have privacy
Stage 5: Social contract, welfare and rights of others. for prayer each evening
legalistic orientation Personal values and opinions
are recognized, and violating the
rights of others is avoided.
Stage 6: Universal-ethical Universal moral principles are A nurse becomes an

principles internalized. Person respects advocate for a hospitalized
other humans and believes that client by reporting to the
relationships are based on nursing supervisor a
natural trust conversation in which a
physician threatened to
withhold assistance unless
the client agreed to surgery
STAGES OF GROWTH AND EVELOPMENT

Stage Age Significant Characteristics Nursing Implications
Neonatal Birth to 28 Behavior is largely reflective Assist parents to identify

days and develop more purposeful and meet unmet needs
behavior
Infancy 1 month to Physical growth is rapid Control the infant’s
1 year environment so that
physical and psychological
needs are met
Toddlerhood 1 to 3 years Motor development permits Safety and risk-taking
increased physical autonomy. strategies must be balanced
Psychosocial skills increase to permit growth
Preschool 3 to 6 years The preschooler’s world is Provide opportunities to
expanding. New experiencesand play and social activity
the preschooler’s social role are
tried during play. Physical
growth is slower
School age 6 to 12 Stage includes the preadolescent Allow time and energy for
years period (10-12 years). Peer group the school-age child to
increasingly influences pursue hobbies and school
behavior. Physical, cognitive, activities. Recognize and
and social development support child’s
Page 64 of 90
increases, and the child has achievement.

increased competence in
communication
Adolescent 12 to 20 Self-concept changes with Assist adolescents to
years biologic development. Values develop coping behaviors.
are tested. Physical growth Help adolescents develop
accelerates. Stress increases, strategies for resolving
especially in face of conflicts conflicts
Young 20 to 40 A personal life-style develops. Accept adult’s chosen life-
adulthood years Person establishes a relationship style and assist with
with a significant other, a necessary adjustments
commitment to something and relating to health.
competence Recognize the person’s
commitment and the
function of competence in
life. Support change as
necessary for health.
Middle 40 to 65 Life-style changes due to other Assists clients to plan for
adulthood years changes for example, children anticipated changes in life,
leave home, occupational goals to recognize the risk factors
change. related to health and to
fucos on strengths
rather than weakness.
Older Adaptation to retirement and Assist clients to keep
adulthood changing physical abilities is physically active and
Young –old 65 to 74 often necessary. Chronic illness socially active and to
years may develop maintain peer group
interactions
Middle – old 75 to 84 Adaptation to decline in speedof assist clients to cope-up
years movement, reaction time, and with loss ( hearing,
sensory abilities and increasing eyesight (ears, eyesight,
dependence on others may be death of love) provide
necessary. necessary safety measures.
Old-old 85 and over Increasing physical problems Assist client with self-care
may develop as require and with
maintaining as much
PLAY
- interpersonal contact, educational stimulation, recreational toys appropriate for age:
 Types of Play
1. Unlooker Play– children watch what other children are doing but make no
attempt to enter into play activity.
2. Solitary Play– children play alone with toys different from those used by other
children in the same area.
Page 65 of 90
3. Parallel Play – children play independently but among other children.

4. Associate Play - children play together and are engaged in a similar or even
identical activity, but there is no organization, division of labor.
5. Cooperative Play - children play in a group with other children attaining a goal.
I. THE INFANT AND FAMILY

Division Month Gross Motor Fine Motor Socialization Play
Development Development /Language
Infancy 0-1 Largely reflex Keeps hands Make small Enjoy watching face
fisted; able to cooing (dovelike) of primary care
follow object to sounds giver, listening to
midline soothing sounds
(music box, music
rattle), watching a
mobile over their
crib /playpen
2 Hold head up Has social smile Makes cooing Enjoys bright-
when prone sounds; colored mobiles,
differentiates cry hold a light, small
that means from rattle for a short
hungry from one period of time and
that means of wet then drop
or from one that
means lonely
3 Holds headand Follows object Squeal with Spends time looking
chest up when past midline pleasure at hands or uses them
prone as toy (hand
regard)
4 Grasp, Very “talkative”, Needs space to turn
stepping, tonic cooing, babbling,
neck reflex and gurgling
are fading when spoken;
Laughs out loud
5 Turns front to Say simple vowel Handles rattles well
back; no sounds: goo-goo such as plastic rings,
longer has & gah-gah blocks, squeeze toys,
head lag when clothes-pins, rattles,
pulled plastic keys
6 Turns both Uses palmar Learn the art of Enjoy bathtub toys;
Page 66 of 90
ways; moro grasp imitating; imitate rubber ring for

reflex fading a parents’ cough teething
or say “oh! As a
way of attracting
attention
7 Reaches out in Transfers object Shows beginning Likes objects that are
anticipation of hand to hand fear of strangers. good size for
being picked transferring, more
up; sits Can imitate vowel interested in brightly
unsteady sounds well (oh- colored balls /toys
oh-ah-ah & oo- that previously
oo) rolled out of
reached
8 Sits securely Has peak fear of Enjoys
without strangers manipulation, rattles
support and toys of different
textures
9 Creep or Says first word Needs space for
crawls (da-da or ba-ba) creeping, enjoys toys
that go inside one
another such as
nested blocks or
rings of assorted size
that fit on a center
post
10 Pulls self to Uses pincer grasp Master another Play games like
standing (thumb and word such as bye- patty-cake and peek
finger) to pick bye or no” a boo
small objects
11 Cruises Cruises
12 Stand alone Holds cup and Says two words Likes toys that fit
spoon well; helps plus ma-ma and inside each other;
to dress da-da, they use nursery rhymes; will
those two words like pull toys as soon
with meaning as walking, enjoys
putting things in and
taking things out of
containers
Page 67 of 90
Guess my AGE
 I can use my pincer grasp?
 I can creep and crawl?
 I walk with support
 I can hold spoon well
 I can stand alone?
Motor Development
- the average infant progresses through systemic motor growth during the 1st year that
strongly reflex the principle of cephalocaudal development and gross to fine. Control proceeds
from head to trunk to lower extremities in progressive, predictable sequence.
The 2 major areas to assess motor development.

a.Gross Motor Development
 ability to accomplish large body movements to evaluate this development observe
infant in four position (ventral, prone, sitting, standing).
b.Fine Motor Development
 measured by observing or testing prehensile ability (ability to coordinate hand
movements)
PHYSIOLOGIC CHANGES
1. Height - the infant increases in height during the first year by 50% or grows from the ave.
birth length of 20 inches to about 30 inches (50 cm to 76 cm).
 Infant growth is most apparent in the child’s trunk during the early months. During
the second half of the first year, it becomes more apparent as lengthening of the
legs. Legs may appear short & bowed.
 Head circumference – increases rapidly during the infant period, reflecting rapid brain
growth. By the end of the 1st year, the brain has already reached 2/3 of its adult size.
2. Body Proportion – changes during the year from that of NB to a more typical infant
appearance. The mandible becomes more prominent as bone grows.
 Chest circumference – is generally less than that of the head at birth about 2 cm. it
is even with the HC in some infants as early as 6 months and in most by 12months.
 At birth: CC is less than 2 cm to the HC
 Early 6 months: CC and HC is even
 The abdomen remains protuberant until the child has been walking well for some
time, generally into the toddler period
 Lengthening of the lower extremities during the last 6 months of infancy readies the
child for walking and often changes the appearance from “baby-like to toddler like”.
3. Body System
a. Cardiovascular System
 HR slows from 120 to 160 bpm to 100 to 120 by the end of the first year.
Page 68 of 90
 PR may begin to slow with inhalation (sinus arrhythmia) but this does not become
marked until preschool age. The heart becoming more efficient is shown by the
deceasing PR and a slightly elevated BP (from 80/40 to 100/60 mmHg).
b. Respiratory System
 RR of the infants slows from 30 to 60 b/min to 20 to 30 b/min by the end of the first
year.
c. GIT System
 at birth GIT is immature in its ability to digest food and mechanically move it along,
these functions mature gradually during the infant year.
 the liver of the infant remains immature, possibly causing inadequate conjugation
of drugs ( if a drug should be necessary for treatment of illness) and inefficient
formation of carbohydrate, protein and vitamins for storage.
 Until age 3 to 4 months, an extrusion reflex prevents some infants from eating
effectively.
 TEETH
 first tooth usually erupts at age 6 months, followed by new one monthly.
 some NB”s maybe born with teeth (called natal teeth) or have teeth erupt in the
first 4 weeks of life (called neonatal teeth). This early growth occurs in about of
2000 infants.
Teeth Lower teeth Upper teeth

Central incisor 6-10 months 8-12 months
Lateral incisor 10-16 months 9-13 months
Cuspid 17-23 months 16-22 months
1st molar 14-18 months 13-19 months
2nd molar 23-31 months 25-33 moths
d.Immune System
 becomes functional by at least 2 months of age: the infant is able to produce IgG
and IgM antibodies by 1 year of age. The levels of the other immunoglobulin
(IgA, IgE and IgD) are not plentiful until pre-school age, which is the reason the
infants must be protected from infection.
 The ability to adjust cold is mature by age 6 months. By this age, an infant can
shiver in response to cold (which increases muscle activity and provides warmth)
and has developd additional adipose tissue that serves as insulation.The amount
of brown fat, which protected the NB from cold, decreases during the first year.
e.Urinary System
 The kidneys remain immature and not as efficient at eliminating body wastes as
in the adult.
f. Endocrine System
 remains particularly immature in response to Pituitary stimulation such as
adrenocorticotropic hormone, or insulin production from the pancreas.
Page 69 of 90
4. Promotion of Nutritional Health during Infancy

 An infant’s sense of trust develops through warm interpersonal relationships. It’s
important for infants to establish the ability to love, or trust, early in life this way
because development is sequential. Parents should set-up /establish schedule of care
for a childlike breakfast, bath playtime nap, lunch walk outside, quiet playtime, dinner
story and bedtime. This gentle rhythm of care gives infants sense of being able to
predict what is going to happen and gives life some consistency.
A. Breast milk
 is the most complete diet during the first 6 months
 no vitamins and minerals needed except iron by 4-6 months when iron stores are
depleted
 employed mothers may continue BF by pumping breast milk and bottle- feeding
infant with expressed milk.
Storage Guidelines
Room temperature Freezer compartment a refrigerator = 2 weeks
20°C - 37°C = 4 hrs Freezer of a 2 door refrigerator (-20°C) = 3

months
15° - 25°C = 8 hrs
Deep freezer = 6 moths
Below 15°C = 24 hrs
Thawed in ref. = 24 hrs
Milk should not be stored If temperature of the refrigerator is not kept

above 37°C constant = 3-5 days
Refrigerated (2-4°C) = 8 days
B. Additional of solid foods before 4-6 months is NOT RECOMMENDED

 are not compatible with the GIT and nutritional needs of infants
 extrusion reflex is strong and causes food to be pushed out the mouth
C. During the 2nd half of the first year: BF or formula is primary source of nutrition
 fluoride (0.25 mg) supplementation should begin
 addition of solid foods
 GIT matured to handle complex nutrients, less sensitive to allergenic foods
 tooth eruption begins and facilitates biting and chewing
 extrusion reflex disappeared
 swallowing more coordinated
Page 70 of 90
 voluntary gasping an improve eye hand coordination allow infants to pick up finger
foods
 desire to hold and try to help during feeding
D. Iron fortified is generally introduced first because of its high protein content
 it is easy to digest and less allergenic
 infant cereal is mixed with formula
 for BF, infant cereal is mixed with expressed BM or water
 after 6 months fruit juices can be mixed with dry cereals
E. fruit juices can be offered from a cup
F. the addition of other foods is arbitrary
G. introduced strained fruits, followed by vegetables and finally meats
H. citrus fruits, eggs, meats are delayed because of their potential allergy
I. at 6 months cracker as finger and teething food
J. 8-9 months junior foods such as cooked vegetables, raw piece of fruit or cheese
K. by 1 year well-cooked table foods are served
Methods of Introduction
1. introduce solid food when the infant is hungry
2. put food to back of tongue because infant has tendency to thrust the tongue forward
3. use small spoon with straight handle. Begin with 1 or 2 tsp. increase 2-3 tbsp per
feeding
4. introduce one food at a time at intervals of 4-7 days to identify allergies
5. decreased milk as solid food increases to prevent over feeding
6. never introduce food by mixing them with the formula in the bottle.
Sequence of introduction
1. cereals – iron fortified cereals
2. fruits and vegetables – 6-8 months
3. meat – 9 months
4. fish - 9 months
5. eggyolk – 10 months and cheese that do not contain excessive sodium
6. dessert and sweets
COMPLEMENTARY FEEDING
1. BF for 2 years or longer helps a child to develop and grow and healthy
2. starting other foods in addition to breast milk at 6 completed months helps a child grow
well
3. foods that are thick enough to stay in the spoon give more energy to the child
4. animal-source foods are especially good for children, to help them grow strong and lively
5. peas, beans, nuts and seeds are also good for children
6. dark-green leaves and yellow-colored vegetables help the child to have healthy eyes and
fewer infections
7. a growing child needs 2-4 meals a day plus 1-2 snacks if hungry; give a variety of foods
8. a growing child needs increasing amounts of foods
Page 71 of 90
9. a young child needs to learn to eat; encourage and give help… ........ lots of patience
10. encourage children to drink and eat during illness and provide extra food after illness to
help them recover quickly.
PROMOTING Infant safety (Prevention Injury)

Accidents are leading cause of death in children from 1 month through 24 years of age.
a. aspiration prevention
 aspiration is potential threat to infants through the first year. 1 inch cylindrical such
as carrots or hot dog, is particularly dangerous because it can totally obstructs the
infants airway.
 educate parents who fed their infant formula not to prop bottles.
b. fall prevention
 falls is second major cause of infants accidents. Parents should not left their child
unattended on a raised surface.
c. car safety
 teaching car safety for infants 9as well for the whole family) is a preventive
measure. Infants up to 20 lb should be placed in rearing-facing seats in the back
seat because of an inflating front-seat airbag could suffocate an infant.
d. safety with siblings
 remind parents that children under 5 years of age, as group, are not responsible
enough or knowledgeable enough about infants to be left unattended with them.
They might introduce an unsafe toy
 Or engage in play that is too rough for an infant. Some preschoolers may be jealous
of a new baby they will physically harm an infant if left alone.
e. bathing and swimming safety
 caution parents never to leave an infant unattended in a tub, even when propped up
out of the water or sitting in a bath ring or bath seat.
f. child proofing
 remind parents to check for possible sources of lead paint, such as painted cribs,
playpen rails, or windowsills.
 if an infant allowed to play in the floor, parents should move furniture in front of
electrical fixtures or buy protective caps for the outlets. Infants especially
fascinated by the holes and will probe them with fingers.
 remind parents to stall safety gates at the top and bottom stairways.
 move all potentially poisonous substances from bottom cupboards and store them
well out of their infants reach.
II. The TOODLER and the FAMILY

1. Definition of Terms
a. Toddler – from age 1-3 years
b. Toddler period
 children accomplish a wide array of developmental task and change from
largely immobile and preverbal infants who are dependent on caregivers for
the fulfillment of most needs to walking, talking young children with growing
sense of AUTONOMY (INDEPENDENCE)
Page 72 of 90
SUMMARY OF Growth & Development

Development Development Language
Toddler 15 Walks alone well; Puts small pellets into 4-6 words Can stack 2
can seat self in chair; small bottles; blocks; enjoy
can creep upstairs scribbles; voluntarily being read to;
with a pencil and drops toys for
crayon. Holds a spoon adult to
well but may still turn recover
it upside down on the
way to mouth
18 Can run and jump in No longer rotates a 7-20 words, uses Initiates
place. Can walk up spoon to jargoning; household
and down stair names 1 body chores, etc.;
holding onto a part begins parallel
person’s hand or play
railing. Typically
places both feet on
one step before
advancing
24 Walks upstairs along Can open doors by 50 words, 2 Parallel play
still using both feet turning doorknobs, words sentences evident
on same step at same unscrew lids (noun, pronoun
time and verb)
“mommy go”,
“me come”
30 Can jump down Make simple lines or Verbal language Spends time
from stairs strokes for crosses increasing playing house,
with a pencil steady. Knows imitating
full name; can parents’
name one color action; play is
and holds up “rough-
fingers to show housing” or
age active.
Page 73 of 90
2. Growth & Development
A. Physical Growth
- toddlers are making great strides developmentally, their physical growth begins to
slow
a. Weight, Height and Head circumference

 A child gains only about 5 to 6 lb (2.5 kg) and 5 inch (12 cm) a year during the
toddler period
 Baby fat/ subcutaneous tissue begins to disappear toward the end of the 2nd
year, the child changes from plumb baby into a leaner, more muscular little girl
or boy.
 HC increases only about 2 cm during the second year compared to about 12 cm
from the 1st year.
 HC equals CC at 6 months to 1 year of age
 By 2 years the CC has grown greater than the HC
b. Body Contour
 toddler tend to have a prominent abdomen – a pouchy because although they
are Walking well, their abdominal muscles are not yet strong enough to support
abdominal contents as they will later.
 Many toddlers waddle or walk with a wide stance (wide-gait base)
Also have a forward curve of the spine at the sacral area (lordosis) – as they
walk longer, this will correct itself naturally.
c. Body System Changes
 Respirations slow slightly but continue to be mainly abdominal
 HR slows from 110 to 90 bpm, BP increases to about 99/64 mmHg
 Brain develops to about 90% of its adult size
 Stomach secretions become more acidic; therefore GIT infections are also
become less common
 Respiratory system – the lumens of the vessels enlarge progressively therefore
threat of lower respiratory infection becomes less
 Stomach capacity increases; a child can eat 3 meals a day
 Control of the urinary and anal sphincter becomes possible with complete
myelination of the spinal cord
 IgG and IgM antibody production becomes at 2 years of age. The passive
immunity obtained during intrauterine life is no longer operative
d. Teeth – eight new teeth (the canines and the first molars) erupt during the 2nd year.
All 20 deciduas teeth are generally present by 2 to 3 years of age.
Developmental Milestone
 Toddler development is influenced to some extent by the amount of social contact and
the number of opportunities children have to explore and experience new degrees of
independence. Also strongly influenced by individual readiness for a new skills.
Page 74 of 90
1. Language development
2. Emotional development
a. Autonomy is the developmental task of the toddler; the development of a
sense of autonomy versus shame and doubt.
 To develop a sense of autonomy is to develop a sense of independence.
 Toddler begin to make the differentiation. As they recognize they are
separate individuals, they realize they do not always to do what others
want them to do. From this realization comes the reputation toddlers
have being negavistic, obstinate, and difficult to manage.
b. Socialization
 once toddlers are walking well, they become resistant to sitting in laps and
being cuddled. This is not lack of a desired socialization but a function of
being independent.
 15 month old – ar3e still enthusiastic about interacting with people,
providing those people are willing to follow them where they want to go.
 18 months old – toddler imitate the things they see a parent doing, such as
“study” or sweep” so they seek out parents to observe and initiate
interactions.
 By 2 or more years – children become aware of gender difference and
may point to other children and identity them as “ boy” or “girl”
c. Play behavior – parallel play
3. Cognitive Development- toddler enters the 5th and 6th stages of sensorimotor
 12 to 18 months – toddler described as a “little scientist” because they are
interested in trying to discover new ways to handle objects or new results that
different actions can achieve.
 Example a child experiments by that trial and error methods in which
toddler discover that cats do not like baths, and cookies on the center of a
table can be reached by crawling up onto the table or pulling on the table
cloth. Obviously this type of scientific investigation can lead to errors or
injury.
 15 months – are able to follow a different path (walk in back of chair) to obtain
the object other than to follow the same path the object took. This results from
increased awareness that the object is permanent and even if it follows a different
direction from the one the child must take, it will be there to retrieve.
 18-24 months – toddlers are able to try out various actions mentally rather than
having actually performed them – the beginning of the problem solving or
symbolic thought.
 children at this stage are able to remember an action and imitate it later
(deferred imitation). Example; pretend to drive a car or put a baby to
sleep because they have seen this just previously but at a past time object
permanence becomes complete.
 At the end of the toddler period, toddler enters a second major period of cognitive
development: preoperational thought. Children deal much constructively with
Page 75 of 90
symbols that they did while still in the sensorimotor period of cognition. They
begin to use a process termed ASSIMILATION. Because they are not able to
change their thoughts to fit a situation, they learn to change the situation (on how
they perceive it) to fit their thoughts. This ability is what cause toddlers to use
toys in the wrong way. Example if they are given a tor hammer, instead of
pounding with it, they might shake it to see if it rattles.
4. Promoting Toddler Safety- accidents are the major cause of death of all ages.
a. accidental ingestions (poisoning) – are the type of accident that occurs mostly in
toddlers. Urge parents to childproof their house by putting all poisonous products
and drugs and small objects out of reach of the child.
b. other accidents that occur frequently in toddlers include motor vehicle accidents,
burns, falls and playground injuries. These occur because a toddler’s motor
ability jumps ahead of his/her judgment. To prevent serious injury, teach parents
to be alert to know what their toddler is doing at all times.
5. Promoting Nutritional Health of a Toddler

 teach parents to place a small amount of food on a plate and allow the child to eat it
and ask for more rather than serve a large portion the child cannot finish.
 allowing self-feeding is a major way to strengthen independence in a toddler
 offering finger foods and allowing a choice between 2 types of food helps promote
independe3nce while exposing children to varied foods.
 toddlers usually do not like food that is “mixed up” except maybe spaghetti , they
often prefer that different foods do not touch one another on their plate.
 they often prefer brightly colored foods to bland colors.
 1-3 years old child should consume = 1,300 kcal daily.
 CHON and Carbohydrate needs are often easily during the toddler periods:
diets high in sugar should be avoided.
 Adequate calcium and phosphorus intake is important for bone mineralization
6. Promoting Toddler Development in Daily Activities
a. Dressing – most children can put on their own socks, under pants and undershirts.
When toddlers dress themselves, they invariably put shoes on the wrong feet and shirt
and pants on backwards.
 Encourage parents to give up perfection for the benefit of the child’s developing
sense of autonomy.
 If parents feel they must change the child’s clothes, they should begin with
positive statement such as “you did a good job” before making the switch.
b. Ritualistic Behavior
 toddler enjoy ritualistic patterns, they will use only “their “ spoon at mealtime,
only “their” washcloth at bath time. They will not go outside unless mother or
father locates their favorite cap.
Page 76 of 90
c. Negativism
 as part of establishing their identities as separate individuals, toddlers typically
go through a period of extreme negativism. They do not want to do anything a
parent wants them to do. Their re ply to every request is a very definite “No”.
 parents must be help to realize that this is not only a normal phenomenon of
toddlerhood but also a positive stage in development.
d. Discipline
- remind parents that ‘discipline” and punishment are not interchangeable terms.
 Discipline – means setting rules or road signs so children know that is expected
to them.
 Punishment – is consequence that results from a breakdown in discipline, from
the child’s disregard of the rules that were learned.
 “Time out”- is a technique of helping children learns that actions have
consequences.
 To use “time out” parents first need to be certain their children understands the
rule they are trying to force: for instance, if you hit your brother you’ll have
time-out. Parents should give one warning. If the child repeats the behavior,
parents select an area that is non-stimulating such as a corner of a room or a
hallway. The child sits there for specified period of time. Time out chair is 1
minute per year age.
e. Separation Anxiety
 for being separated from parents begins at 6 months of age and persists
throughout the preschool period. This universal fear of this age group known
separation anxiety. Toddlers have difficulty accepting being separated from their
primary care givers to spend the day at a day care center.
 it helps parents if parent say goodbye firmly, repeat the explanation they will be
there when the child wakes in the morning, and then leave.
f. Temper Tantrums
 almost all toddlers has a temper tantrum at one or another. The child may kick,
scream, stamp feet, shout, No, no, no, lie on the floor, flail arms and legs and bang
the head against the floor.
 children may even hold their breath until they become cyanotic and slump on the
floor.
g. Sleep
 the amount of sleep on children need gradually decreases as they grow older.
 toddler period napping twice a day and sleeping 12 hours each night, and end it
with one nap a day and only 8 hours sleep at night.
 toddlers naturally fall asleep when they tired.
 caution parents that when they say “well do this after naptime’, they wait until
then to do it. Otherwise, a child may be reluctant to nap the next day for fear of
missing another activity.
 toddlers love a bedtime routine: choosing a toy to sleep with, pajamas, a story etc.
Page 77 of 90
h. Bathing
 time for a toddler’s bath should depend on the parents and the child’s wishes and
schedule.
 bath time is usually so enjoyable for toddlers that parents can use it as a
recreational activity.
 remind parents that although toddlers can sit well in a bath tub, it is still not safe to
leave them alone unsupervised. They might slip and get their head under water or
reach and turn on the hot-water faucet and scald themselves.
i. Care of Teeth
 calcium is especially important to the development of strong teeth. If is available
children should continue to drink fluorinated water, so that all new teeth form with
cavity-resistant enamel.
 toddler begin to do the brushing themselves under supervision. Remind parents it
is better for a child to brush thoroughly once a day, probably at bedtime, than to
do it poorly many times a day.
j. Promoting Healthy family Functioning
 learning self-reliance is the primarily goal of a child during the toddler period.
Some parents who enjoyed caring for their children as an infant may find it
difficult to have their authority challenged by a toddler.
 help parents to understand their responses to these attempts as independence are
crucial to the healthy development of their child.
k. Parental Concerns associated with the Toddler Period
1. Toilet Training is one of the biggest tasks a toddler must achieve.
 before children can begin to be toilet trained, they must have reached 3
important developmental levels, one physiologic and the other 2 cognitive
a. they must have control of rectal and urethral sphincters, usually achieved
at the time they walk well.
b. they have a cognitive understanding of what means to hold urine and
stools until they can release them at a certain place and time.
c. they must have a desire to delay immediate gratification for a more
socially accepted actions.
III. The Pre-schooler and the Family
Pre-schooler – ages 3-5 years

 Physical growth slows considerably during this period; personality and
cognitive growth are substantial.
 Most children of this age want to do things for themselves – choose their own
clothing and dress by themselves completely, wash their own hair and so
forth
Page 78 of 90

Development Development Language
Preschool 36 (3 Runs; Undresses self; Vocabulary of Able to take
y/o) alternates feet stacks tower of 900 words turns; very
on stairs; rides blocks; draws a imaginative
tricycle; stands cross
on one foot
48 (4 Constantly in Can do simple Vocabulary of Pretending is
y/o) motion; jumps; buttons 1500 words a major
skips activity
60 (5 Throws Draws a 6-part Vocabulary of Likes games
y/o0 overhead man, can lace 2100 words with numbers
shoes or letters
Growth and Development of Pre-schooler

a. Physical Growth
 a definite change in the body contour occurs during preschool years. The wide-
legged gait, prominent lordosis and protuberant abdomen of the toddler change to
slimmer, taller, and much more childlike proportions.
 contour changes are definite that future body type – ectomorphic (slim body build)
or endomorphic (large body build).
 lymphatic tissue begins to increase in size, particularly tonsils, and levels of IgG
and IgA antibodies increase (upper respiratory infection remains localized to the
nose with little systemic fever).
 Physiologic splitting of heart sounds may be present for the first time on
auscultation: innocent murmurs may also hear for the first time – due to the
changing size of heart.
 PR decreases to about 85 b/min; BP holds at about 100/60 mmHg
 Bladder is easily palpable above the symphysis pubis; voiding is frequent (9 to 10
times a day).
 Muscles are noticeably stronger and make activities such as gymnastic possible.
Many children at the beginning of the period exhibit genu valgus (knock-knees);
disappears with increased skeletal growth at the end of preschool period.
Weight, Height and Head circumference

 Weight gain is slight during preschool years; child gains only about 4.5 lb
(2kg) a year.
 Height is also minimal during this period: only 2 to 3.5 inch (6 to 8 cm) a year
on average.
 HC is not a routinely measured at physical assessment on children over 2
years of age.
Page 79 of 90
Teeth – have all 20 of their deciduous teeth by 3 years of age.
Developmental Milestone of Pre-schooler

– play activities change focus as the pre-schooler learns new skills and understands
more about the world.
1. Language Development
2. Emotional Development
a. Developmental task
 Initiative is the developmental task for the preschool age child to achieve sense of
initiative.
 If children are criticized or punished for attempts of initiative they develop a sense
of guilt for wanting to try new activities or have new experiences.
 To gain a sense of initiative, preschoolers need exposure to a wide variety of
experiences and play materials so they can learn as much as about the world as
possible.
 Urge parents to provide play such as finger paints, soapy water to splash or blow
into bubbles, mud to make into pies, sand to build castles and modeling clay or
homemade dough to mold figures or make pretend cookies.
b. Imitation – preschoolers need free rein to imitate the roles of the people around them,
again role playing should be fun and does not have to be accurate
c. Fantasy – toddlers cannot differentiate between fantasy and reality: they believe
cartoon characters or children in books are real. Preschoolers begin to make this
differentiation they may become so engrossed in a fantasy role, however they
become “stuck” in their fantasies, such intense involvement in play is part of
“magical thinking” or believing thoughts and wishes can come true.
d. Oedipus and Electra Complexes
Oedipus complex – refers to the strong emotional attachment of a preschooler
boy to his mother
Electra complex – is the attachment of a preschooler girl her father.
Each child competes with the same sex parent for the love and attention of the
other parent. Parents who are not prepared for this behavior may feel hurt or
rejected.
e. Gender Roles
- preschoolers need exposure to an adult of the opposite gender so they can become
familiar with opposite gender roles. Example a father may tell his son it iss
important for both boys and girls to do housework, but if the father will not
do dishes, he is teaching his son that managing a household is not a man’s job.
f. Socialization
 3 year old – are capable of sharing, they play with other children their age much
more agreeably than do toddlers, which is why the preschooler period is a
sensitive and critical time for socialization. Children who raised in an
Page 80 of 90
environment where they never see other children of same age had harder time
to relate to people.
 4 year old – continue enjoy play groups, they become involved in arguments more
did at age 3, especially as they become more certain of their role in the group.
 5 year old – begin to develop “best” friendships, perhaps on the basis of who they
walk to school with or live closest to them. An odd number of children don’t
play well together pertains to children at this age: 2 or 4 will play, but 3 or 5
will quarrel.
Cognitive Development of Pre-schooler

 3 year old – intuitional thought (second phase). They lack the insight to view
themselves as others see them or put themselves in another’s place because
preschoolers cannot make this mental substitution, they feel they are always right
(believing they are 100% correct).
 they cannot see your side of the situation; they cannot hurry because you
must have something done by 10 o’clock.
 Also preschooler are not yet aware of the property of conservation- this means that if
they have 2 balls of clay of equal size but one is squashed flatter and wider than the
other, preschooler will insist that the flatter one is bigger because it is wider. They
cannot see that only the form, not the amount has changed.
Moral and Spiritual Development

 Preschooler determined right from wrong based on their parent rule. They have little
understanding of rationale for these rules or even whether the rules are consistent.
Example if asked the Q? “Why is it’s wrong to hit other children? They answers
because my mom says it’s wrong; it just it, that’s all.
 Preschoolers begin to have an elemental concept of god if they have been provided
some form of religious training – they enjoy the security of religious holidays and
religious rituals such as prayer and grace before meals.
Promoting Preschooler Safety

 Preschooler broaden their horizons, safety issue increase. Preschooler interest in
learning adult roles may lead them into exploring the bladed of a lawn mower or
electric saw. Also they imitate adult roles so well, they imitate taking medicines if they
see family members doing so – a good rule for parent is never to take medicine in front
of their children.
a.Keeping Children safe, strong and free
 Warning a child never to talk or accept a ride from a stranger.
 Teaching a child how to call for help in an emergency (yelling or running to a
designated neighbor’s house if outside or dialing 911 if near a phone)
 Describing what a police officer’s look like and explaining that police can help
in an emergency situation.
Page 81 of 90
 Parents should explain to their children that they should tell to them the secret
even they have promised to keep the secret from someone.
 Explaining to them that bullying behavior from other children is not to be
tolerated but should be reported so they can receive help managing it.
b. Motor Vehicle and Bicycle Safety

 parents should stress the important role of seatbelts in preventing injury in
accidents and should make it a rule that the car doesn’t move until seatbelts
are fastened.
 preschool is also a right age to promote bicycle safety. Head injuries are
major cause of death and injury to preschoolers and bicycle accidents are
among the major causes of such injuries.
Promoting Nutritional Health of the Preschoolers

 offering small amount serving of food is still a good idea, so a child is not overwhelmed
by the amount on a plate and is allowed the successful feeling of cleaning a plate and
asking for more. Initiative, or learning how to do things, can be strengthened by
allowing a child to prepare simple foods, such as a making a sandwich or spreading
jelly on toast.
Promoting Development of the Preschooler in Daily Activities

a. Dressing
 3 year old can dress themselves except for difficult buttons, although they
maybe a conflict over what a child will wear
 Preschoolers prefer bright colors or prints and may select items that do not
match. Let the child experience choosing their own clothes.
 To solve the problem of misunderstanding is fold together matching shirts and
pants so a child sees as a set rather than individual pieces.
b. Sleep
 preschoolers when they tired, they often curl up on a couch or soft chair and fall
sleep. Age in this group may also refuse to go to sleep because of fear of the
dark.
c. Exercise
 rough housing is a good way of getting rid of tension and should be allowed as
long as it does not become destructive. In addition, preschoolers love time-
honored games such as ring around the rosy, London Bridge or other structured
games.
 promoting this type of active game can help children develop motor skills as
well as prevent childhood obesity.
d. Bathing
 preschoolers can wash and dry their hands perfectly, adequately if the faucet is
regulated for them (in order not to scald themselves with hot H2O). Although
preschoolers certainly sit well in bath tubs, they should still not be left
unsupervised at bath time.
Page 82 of 90
e. Care Teeth
 independent tooth brushing should be started during the preschoolers years. One
good tooth brushing period a day is often more effective than more frequent
half-hearted brushings.
- encouraging children to eat apples, carrots, celery, chicken or cheese for snacks
rather than candy or sweets is yet another way to attempt to prevent tooth decay.
Common Fears of the Preschooler

- preschoolers imagination is so active, this can lead to a number of fears.
a. fear of the dark
b. mutilation
c. separation or abandonment are all very real to a preschooler
Behavior Variation of Preschoolers

a. Telling Tall Tales
 child stretching stories to make them seem more interesting is phenomenon
frequently encountered in this group. Parents should not to encourage this kind of
story telling but instead help a child separate from fiction.
b. Imaginary Friends
 preschoolers have an imaginary friends who plays with them. They tell a parent
to wait for Eric, or set place at the table for Lucy.
c. Difficulty Sharing
 sharing is a concept that first comes to be understood around the age of 3 years
because before this, they are engage in parallel play.
 a 3 year old child begins to understand that some things are theirs, some belong to
others, and some can belong to both.
d. Regression
 some preschoolers, generally in relation to stress revert to behavior they
previously outgrew, such as thumb sucking, negativism, loss of bladder control
and inability to separate from their parents.
 usually due to such things as a new baby in the family, a new school experience,
seeing frightening and graphic television news, stress in the home or other
problems.
e. Sibling Rivalry
 jealousy of a brother or sister may first become evident this period. To help
preschooler feel secure and promote self-esteem, supplying them with a private
drawer or box for their things that pare3nts or other children do not touch can be
helpful.
IV. School-Age and the Family
School Age – commonly refers to children between the ages 6 and 12.
 these years represent a time of slow physical growth, cognitive growth and
development continue to proceed at rapid rates
Page 83 of 90
Growth and Development

a. Physical Growth
 school-age annual average weight gain is approximately 3 to 5 lb (1.3 to 2.2 kg);
increase in height is 1 to 2 inches (2.5 to 5 cm).
 posture become more erect
 10 year old of age – brain growth is complete; so fine motor coordination
becomes refined.
 The immunoglobulin IgG and IgA – reach adult levels and lymphatic tissue
continues to grow up until about age 9.
Sexual Maturation Summary: Chronic Development of Secondary Sex Characteristics

Age Boys Girls
9-11 Prepubertal weight gain occurs Breast: elevation of papilla with breast
bud formation; areola diameter enlarges
11-12  Sparse growth of straight, downy,  Straight hair along the labia. Vaginal
slightly pigmented hair at base of epithelium becomes cornified
pubis  ph vaginal secretions acid; slight
 Scrotum becoming textured; growth of mucous vaginal discharge present
penis and testes begins  sebaceous gland secretion increases
 Sebaceous gland secretion increases  perspiration increases
 Perspiration increases  dramatic growth spurt
12-13  pubic hair present across pubis  pubic hair grows darker; spreads over
 penis lengthens entire pubis
 dramatic linear growth spurt  breast enlarge, still no protrusion of
 breast enlargement occurs nipples
 axillary hair present
 menarche occurs
Sexual maturation in girls occurs between 12 and 18 year old; in boys between 14 and 20.
b. Sexual and Physical Concerns

 school age is a time for parents to discuss with children the physical changes that
will occur and the sexual responsibility these changes require.
 In both sexes, puberty brings changes in the sebaceous glands. Under the influence
of Androgen, glands become more active, setting the stage for acne.
c. Teeth
- deciduous teeth are lost and permanent teeth erupt during the school age period.
The average child gains 28 teeth between 6 and 12 years of age: central and
lateral incisors; first, second and 3rd cuspids; and first and second molars.
Page 84 of 90
Developmental Milestones
Summary of School Age Development

Age Physical Development Psychosocial and Cognitive Development
6 A year of constant motion;  First grade teacher becomes authority figure;
skipping is a new skill; first adjustment to all-day school maybe difficult
molars erupt and lead to nervous manifestations of
fingernail biting, etc.
 Defines words by their use: a key is to
unlock a door, not a metal object
7 Central incisors erupt; difference  A quiet year; striving for perfection leads to
between sexes becomes apparent this year being called eraser year.
in play (video games vs. dolls); Conservation (water poured from all
container to a wide; flat one is the same
spends time in quiet play
amount of H2O) is learned; can tell time; can
make simple change.
8 Coordination definitely improved; “Best friends” develop; whispering and
planning with gang becomes giggling begin; can write as well as print;
important; eyes become fully understand concept of past, present and
developed future.
9 All activities done with gang Gang age: a 9 year old club is formed to spite
someone has secret codes, is all boy or all girl;
gangs disband and reform quickly
10 Coordination Ready for camp away from home; collecting

age; like rules; ready for competitive games
11 Active, but awkward and ungainly Insecure with members of opposite sex,
repeats off-color jokes
12 Coordination improves A sense of humor is present; is social and

cooperative
Fine Motor Development

 6 year old - can easily tie their shoelaces. They can cut and paste well and draw a
person with good detail.
 7 year old – this has been called the “eraser year” because children are never quite
content with what they have done. They set too high a standard for themselves.
 8 year old – children makes reading as greater pleasure and school more enjoyable.
Learn to write script rather than print.
 9 year old – their writing begins to look mature and less awkward.
Page 85 of 90
 Older school age children begin to evaluate their teacher’s ability and may perform
at varying levels, depending on each teacher’s expectations.
Play
 Play continues to be rough at age 6 years; however, when children discover reading
as an enjoyable activity that opens doors to other worlds, they can begin to spend
quiet time with books. Many children spend hours playing increasingly challenging
videogames, an activity that can either foster a healthy sense of competition or
create isolation from others.
 6 years old – play continues to be rough, however when they discover reading as
an enjoyable activity that opens doors to other worlds, they can begin to spend
quiet time with books.
 7 years old – require more props for play than when they were younger. To be a
police officer, a 7 year old needs a badge and gun. Also interest in collecting
items such as baseball cards, dolls, rocks or marbles.
 8 years old – enjoy helping in the kitchen with jobs such as making cookies and
salads or frosting cakes. They start to be more involved in simple science projects
and experiments.
V. The Adolescent and the Family
Adolescence – the period during which the person becomes physically and
psychologically mature and acquires a personal identity. At the end of this critical
period in development, the person is ready to enter adulthood and assume
responsibilities.
The 3 stages of Adolescent Period

1. early adolescence – lasts from ages 12 and 13
2. middle adolescence – extends from 14 to 16 years
3. late adolescence – is more stable stage than the other two.
 adolescents are involved mostly with planning their future and
economic independence.
Puberty – the first stage of adolescence in which sexual organs begin to grow and mature.
 In girls – puberty normally starts between 10 and 14 years
 In boys – puberty normally starts between 12 and 16 years
Menarche – onset of menstruation begin in girls
Ejaculation – expulsion of semen occurs in boys
Physical Development of Adolescent - this period, marked by sudden and dramatic

physical changes, is referred to as the adolescent growth spurt.
 In boys – the growth spurt usually begins between ages 12 and 16
 In girls – it begins earlier, usually between ages 10 and 14 because the growth spurts
begin earlier in them, many girls surpass boys in height at this time.
Page 86 of 90
Physical Growth - growth is faster for boys at about 14 years and the maximum height is
often reached at about 18 or 19 years. Some men add another 1 or 2 cm to their height
during 20’s, as the vertebral column gradually continues to grow
 the faster rate of growth in girls occurs at about 15 or 16 years.
 growth is noted first in the musculoskeletal system. This growth follows a sequential
pattern: the head, hands, and feet are the first to grow to adult status. Next, the
extremities grow before the trunk, the adolescent looks leggy, awkward, and
uncoordinated. After the trunk grows in full size, the shoulders, chest, and hips grow.
Skull and facial bones also change proportions. The forehead becomes more
prominent, and the jawbones develop.
 poor posture - is a common problem during adolescence because weight gains may
precede a corresponding strengthening of postural muscles.
Glandular Changes on Adolescence - the eccrine and apocrine glands increase their
secretions and become fully functional during puberty
 Eccrine glands – found over most of the body, produce sweat
 Apocrine glands – develop in the axillae, anal and genital areas, external auditory
canals and around the umbilicus and the areola of the breast. It is released onto the
skin in response to emotional stimuli only.
 Sebaceous glands – become active also under the influence of androgens in both
males and females. It secretes sebum , becomes most active on the face, neck,
shoulder, upper back, chest, and genitals.
 Acne – results when the sebaceous glands become plugged and inflamed,
which a condition common in adolescence
 Pustule – is a visible collection of pus within the epidermis
 Papule – is a superficial, circumscribed elevation of the skin
Teeth – a adolescents gain their second molars at about 13 years of age and their third
molars (wisdom teeth) between 18 and 20 years of age. Third molars may erupt as
early as 14 to 15 years of age.
 The jaw reaches adult size only toward the end of adolescence, however
adolescents whose third molars erupt before the lengthening of the jaw is
complete may experience pain and may need these molars extracted because they
do not fit their jawline
Sexual Characteristics - during puberty, both primary and secondary sex characteristics
develop.
 Primary sexual characteristics – relate to the organs necessary for reproduction, such as
the testes, penis, vagina and uterus
 Secondary sexual characteristics – differentiate the male from the female but do not
relate directly to reproduction. Example: are the pubic hair growths, breast
development, and voice changes.
 Appearance of pubic hair – the first noticeable sign of puberty has begun in males
 The milestone of male puberty is considered to be the first ejaculation, which
commonly occurs at about 14 years of age, fertility follows several months later.
Page 87 of 90
 Breast bud (tenarche) – often the first noticeable sign of puberty in females, although
the appearance of hair along the labia may precede this.
 The milestone of female puberty is the menarche, which occurs about 2 years after the
breast bud appears. At first the menstrual periods are scanty and irregular and may
occur without ovulation. Ovulation established 1 to 2 years after menarche. Female
internal reproductive organs reached adult size about age 18 to 20.
Sexual Maturation in Adolescents

Age Males Females
13-15 Growth spurt continuing; pubic hair Pubic hair thick and curly, triangular in
abundant and curly; testes, and penis distribution, breast areola and papilla
enlarging further; axillary hair present; form secondary mound; menstruation is
facial hair fine and downy; voice changes ovulatory, making pregnancy possible
happening with annoying frequency
15-16 Genitalia adult; pubic hair abundant and Pubic hair curly and abundant (adult0;
curly; scrotum dark and heavily rugated; may extend onto medial aspect of thighs;
facial and body hair present; sperm breast tissue adult and nipples protrude;
production mature areolas no longer project as separate
ridges from breasts; may have some
degree of facial acne
16-17 Pubic hair curly and abundant (adult), End of skeletal growth
may extent along medial aspect of thighs;
testes, scrotum, and penis adult size; may
have some degree of facial acne;
gynecomastia (enlarge breast tissue)’ if
present, fades
17-18 End of skeletal growth
Psychosocial Development
 according to Erickson, the adolescent seeks answers to the questions “ Who am I” and
What am I to be”.
 The psychological task of the adolescent is the establishment of identity. The danger of
this stage is role confusion.
 The inability to settle on an occupational identity commonly disturbs the adolescent.
Less commonly, doubts about sexual identity arise.
 Adolescents are usually concerned about their bodies, their appearances and their
physical abilities. Hair styling, skin care, and clothes become very important.
 The adolescent needs to establish a self -concept that accepts both personal strengths
and weaknesses. Many adolescents experience temporary difficulty in developing a
positive self-image because they faced with dramatic changes in bodily structure and
function and greater expectations to assume responsibilities,.
Page 88 of 90
 Adolescents who are accepted, loved and valued by family and peers generally tend to
gain confidence and feel good about themselves
 Adolescents who have difficulty forming relationships or who are perceived by peers
as too different and not include in adolescent cliques’ may develop less favorable self-
images and have low self-esteem.
 about the age of 15 years, many adolescents gradually draw away from the family
and gain independence. This need for independence combined with the need for
family support sometimes creates conflict with the adolescent and between the
adolescent and the family.
 The young person may appear hostile or depressed at times during this painful
process. At this age, adolescents prefer to be with their peers rather their parents
and may seek advice from adults other than their parents. Parents sometimes are
wildered by this stage of development; instead of reducing controls, they increase
them, causing the adolescent to rebel.
 adolescents also have to resolve their ambivalent feeling toward the parent of the
opposite sex. As part of the resolution, adolescents may develop brief crushes on
adults outside the family – teachers or neighbors, for example.
 during adolescence, peer groups assume great importance. The peer group has a
number of functions. It provides a sense of belonging, pride, social learning, and
sexual roles. Most peer groups have well defined, sex-specific modes of acceptable
behavior.
COGNITIVE DEVELOPMENT
 Cognitive abilities mature during adolescence. Between the ages of 11 and 15, the
adolescent begins Piagets formal operations stage of cognitive development.
 The main feature of this stage is that people can think beyond the present and beyond
the world of reality. Adolescents are highly imaginative and idealistic. They consider
things that do not exist but that might be and consider ways things could be or ought to
be. This type of thinking requires logic, organization and consistency.
 The adolescent becomes more informed about the world and environment. Adolescents
use new information to solve every problem and can communicate with adults on most
subjects.
MORAL DEVELOPMENT
 According to Kohlberg, the young adolescent is usually at the conventional level of
moral development. Most still accept the Golden Role and want to abide by social
order and existing laws.
 Adolescents examine their values, standards, and morals. They may discard the values
they have adopted from parents in favor of values they consider more suitable.
 When adolescents move into the post conventional or principled level, they start to
question the rules and laws of society. Right thinking and right action become a matter
of personal values and opinions, which may conflict with societal laws. Adolescents
consider the possibility of rationally changing the law and emphasize individual rights.
Page 89 of 90
SPIRITUAL DEVELOPMENT
 According to Fowler, the adolescent or young adult reaches the synthetic-conventional.
As adolescents encounter different groups in society, they are exposed to a wide
variety of opinions, beliefs, and behavior regarding religious matters.
 often the adolescent believes that various beliefs and practices have more similarities
than differences. At this stage, the adolescent’s focus is on interpersonal rather
conceptual matters.
After this module, you will be given a post

evaluation exam in Canvas. Exams are
conducted to self-assess your learning and
determination, be confident and you will do
well. May you have good focus during the
exams! All the best!
Page 90 of 90

Module 5 - NCM 107 - Midterms

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Module 5 - NCM 107 - Midterms

Uploaded by

Copyright:

Available Formats

N OR TH W E ST ER N UN IV ERS I T Y, IN C

Laoag City, Ilocos Norte

ADOLESCENTEGO ANAL TRUST VS MISTRUST

A. IMMEDIATE NEEDS OF THE NEWBORN

1. Immediate Thorough Drying

STEPS IN IMMEDIATE ESSENTIAL NB CARE

 15-30 mins of life  30 mins.- 2  2 hours to 6

Respirations Irregular: 30-90b/min Slowing to 30-60 Becoming irregular

Activity Alert, watching Sleeping Awakening

B. Profile of the Newborn

Newborn produced heat by:

 Vitamin K is synthesized through action of intestinal flora, and is

 How to compute? 2 ounces + age in months = stomach capacity

 Stool (NB may have bowel movement after each feeding)

b. Transitional Stool – diarrhea stool like; greenish brown to yellowish brown,

 Pale yellow and odorless - kidneys can’t concentrate urine

 Mongolian spots – bluish discoloration of the lower back and buttocks,

 Strawberry marks or nevus vascolosus – are elevated areas of the skin

 Stork bites or telangiectatic nevi – occurs more frequently in girls than

 Cavernous hemangiomas- similar to strawberry marks in appearance

 Cyanosis – refers to bluish discoloration of the skin

 Mottling of the skin – when NB is exposed to cold temperature, this is due to

 PHYSIOLOGIC JAUNDICE – normal jaundice that occurs almost 50% of NB

 PATHOLOGIC JAUNDICE – jaundice that occurs before 24 hours after birth

 Most are PRIMITIVE REFLEXES

10. Sensory Function

PHYSICAL ASSESSMENT OF THE NB

PHYSICAL ASSESSMENT OF THE NB

 CRADLE CAP- greasy dirt found on the scalp of NB.

 Yellowish/jaundice sclera – sign of hyperbilirubinemia

 Purulent discharge present – sign of infection

 Esophageal Atresia – presence of excessive saliva

 Fracture of clavicle – Manifested by a lump or bony prominence

 Epispadias – opening of the penis is located at anterior/ dorsal / upper part of

 Hypospadias -opening of the penis is located at posterior/ ventral / under the

 Cryptochidism – undescended tetes

 Scrotum is usually larger on the left side

 Ortholani’s maneuver – when NB is placed in supine position, the legs can be

 Hip subluxation – clicking sound heard during maneuver/abduction, means shallow

 Absence of femoral pulses – a sign of heart disease

 Club foot/ talipes equinovarum – foot twisted inward or outward

 it also used as anticipatory guide for the management of the neonate.

2. SILVERMAN and ANDERSON SCORING

Chest Movement Synchronized Lag on respiration See-saw respiration

Characteristics 0-36 weeks 37-38 weeks 39-42 weeks

Sole creases Anterior transverse Occasional creases, Sole covered with

The six components or indicators

Other indicators / characteristics of neurologic status

NEWBORN SCREENING (RA 9288)

b. Congenital Adrenal Hyperplasia (CAH)- is an endocrine disorder that causes severe

c. Galactosemia (GAL) – contraindication to BF; a condition in which babies are

e. Glucose-6-Phosphate Deydrogenase Deficiency (G6PD) is a condition where the

 The 2 types of drugs

3. lactiferous ducts – main ducts of the mammary gland numbering from 15 to 30

3. wet nappies / diapers: 6 or more /24 hours

C. CONCEPT ON GROWTH AND DEVELOPMENT

Factors influence Growth & Development

BASIC DIVISION OF CHILDHOOD

A. PSYCHOSEXUAL STAGE (FREUD)

Freud’s Five Stages of Development

Fixation at this stage can result in difficulties

Latency 6 to 12 Energy is directed to physical and intellectual Encourage childwith

reactivation of the pregenital impulses. These parents, achievement