FETAL GROWTH AND  The process of growth and

DEVELOPMENT development also affected in

Growth children with chromosomal
- Is the process of physical abnormalities.
maturation resulting an  SEX
increase in size of the body and  the sex in children influences
various organs. their physical attributes at
- It occurs by multiplication of birth, male babies are heavier
cells and an increase in and longer than the females.
intracellular substance. Girls mature easily then boys.
- It is a quantitative changes of  RACE
the body.  Height and structure of
American’s and Indians are
Development usually differ because of the
- It is the process of functional difference in growth and
and physiological maturation pattern.
of the individual. Prenatal Factors
- It is progressive increase in  Intrauterine development is an
skill and capacity to function. important predominant factor
It includes psychological, of growth and development
emotional and social changes. Maternal malnutrition
- It is qualitative aspects. Maternal infection
Basic Division of Childhood Maternal substance
STAGE AGE PERIOD abuse
Neonate First 28 days of Maternal illness
life Hormone – hormones
Infant 1month – 1 year like Thyroxine and
Toddler 1-3 years insulin influence the
Preschooler 3-5 years fetal growth.
School-aged 6-12 years Miscellaneous
Adolescent 13-21 years  Uterine malformation
 Malposition of fetus
Assessing the Average Newborn  Oligohydramnios
Length – 46-54 cm  Polyhydramnios
HC – 34-35 cm  Maternal emotional
Temp. – 97.6 – 98.6 ℉ during pregnancy
CC – 32-33 cm Postnatal Factors
HR – 120-140 bpm Childhood illness
RR – 30-50 cpm Nutrition
Factors Affecting Growth and Growth potential
Development Physical environment
 Growth and development Psychological environment
depends upon multiple factors Socio economic status
and determinants. Climate and season
 The determinants can be Play and exercise
grouped as Heredity and Birth order of the child
Environment. Hormonal influence
Genetic/Heridity Factor Principles of Growth and
 Abnormal genes from ancestor Development
may produce different familial Directional Terms
disease which usually hinders  Cephalocaudal/Head to Tail
the growth and development, - it occurs long axis in which
(e.g. hemophilia, Thalassemia, control over head, mouth and
etc.) eye movements and precedes
 control over upper body torso  Accommodation is equal to
and legs. adult
 Proximo-Distal/ Centro-Distal  Crying becomes
- the process in proximodistal differentiated at 1 month
from center or midline to  Decreased during awake
periphery direction periods
- Development proceeds from  Ceases when parent is in view
near to far-outward from  Vocalization distinct from
central axis of the body toward crying at 1 month
the extremities.  - Sequels to show pleasure at 3
 Symmetrical/Each side of months
the body  - coos, babbles, laughs,
- Develop at the same direction vocalizes when smiling
at the same time and at the Solitary Play
same rate  Birth to 4 Months
 Sequential Trend  Provide variety of brightly
- Involves a predictable colored objects, different sizes
sequence of growth and and textures
development to which the child  Hang mobiles within 8-10
normally passes inches of infant’s care
Locomotion  Expose to various
o Creeps stands walk environmental sounds; use
run rattles, musical toys
Language and Social Skills 5 - 6 Months
o Cry Coo  Birth weight doubles at 6
 Secular Trend months
- Refers to the worldwide trend of  Eruption of teeth begins
maturing and growing larger as o Lower incisor first
compared to succeeding o Causes increased saliva
generation and drooling
Neonate – Birth to 1 month o Enzyme released during
 Cries to express displeasure teething causes
 Smiles indiscriminately diarrhea, facial skin
 Receives gratification through irritation
sucking o Slight fever
 Makes throaty sounds  Intentional rolling over
1 – 4 Months  Supports weight on arms
 Posterior fontanel closes  Creeping
 Moro reflex and tonic neck  Can grasp and let go
reflex begins to fade voluntarily
 Gains Head Control: Balances  Hearing: can localize sounds
head in sitting position above and below the ear
 Rolls from back to side  Vision: smiles at own mirror
 Begins voluntary hand-mouth image and responds to facial
activity expressions of others
 Begins to be able to coordinate  Taste: sucking needs have
stimuli from various sense decreased and cup weaning
organs can begin; chewing, biting and
 Hearing: locates sound by taste preference begin to
turning and visually searching develop
 Vision: beginning hand eye  Vocalization: begins to imitate
coordination sounds
 Prefers human face
 Follow objects at 180°
 Socialization: recognizes  Shows emotions such as
parents, stranger anxiety jealousy, affection, anger, fear
begins to develop  Recognizes objects by name
 Solitary Play  Looks and follows pictures in
o Provide brightly colored book
toys to hold and  Shows more goal-directed
squeeze actions
o allow infant to splash in 1 – 3 years
bath  Slow growth
o Provide crib mirror  Primary dentition (20 teeth)
 Begins to imitate completed by 2 ½ years
 Can find partially hidden  Develops sphincter control
objects necessary for bowel and
7 - 9 Months bladder control
 Teething continues  Walks alone by 18 months
o 7 months: upper central  Climbs stairs and furniture by
incisor 18 months
o 9 months: upper lateral  Runs fairly well by 2 years
incisor  Jumps from chair or step by 2
 Sits unsupported; goes from ½ years
prone to sitting position  Balances on one foot
 Crawls  Rides tricycle
 Pulls self to standing position 3 – 5 years
 Develops finger-thumb  Permanent teeth may appear
opposition (pincer grasp) late in preschool
 Begins to understand object o Molars behind last
permanence, searches for temporary teeth
dropped objects  Walks upstairs with alternating
 Reacts to adult anger; cries feet by 3 yrs.
when scolded  Walks down stairs using
 Understands the word “NO” alternate feet by 4 years
10 – 12 Months  Stands on 1 foot by 3 years
 Birth weight triples  Hops on 1 foot by 4 years.
 Length: 50% increase over  Skips and hops on alternate
birth length feet by 5 yrs
 head and chest circumference  Balances on 1 foot with eyes
equal closed by 5 yrs.
 Teething  Throws and catches ball by 5
o Lower lateral incisors yrs.
erupt  Jumps rope by 5 yrs.
o Average of 8 deciduous 6 – 12 years
teeth  Slow growth continues
 Creeps with abdomen off floor  dentition
 Able to follow rapidly moving  Loses first primary teeth
objects at about 6 yrs.
 Vocalization: imitates animal  By 12 yrs. Has all
sounds, can say 4-5 words but permanent teeth except
understands many more (ma, final molars
da)  Vision completely mature
 Socialization: begins to  Gross motor skills: children are
explore surroundings very energetic, develops greater
 Play games such as pat-a-cake, strength
peek-a-boo  Develops smoothness and
speed in fine motor control
 12 years old
Girls
Increase in size of breast & Neurologic Assessment
genitalia REFLEXES
Appearance of axillary & pubic Extrusion
hair – food placed on infant’s
Menarche tongue is thrust forward
Boys and out of the mouth
Deepening of voice
Development of muscle
Increase in size of penis & Tonic neck
testes – as head is turned to one
Production of viable sperm side, arm and leg on
12 – 18 years that side extends and
Adolescence opposite extremities in
 Play – continuation of flexion
competitive play – Response usually
 Fear – of obesity disappears within 3-4
- of replacement from months
friends Palmar Grasp
- of death – elicited by placing finger
- of acne in newborn’s palm
Significant Development – Palmar response
 They have distinctive odor lessens within 3-4
 Nocturnal emission/ wet months
dreams are present Moro
 Sperm is viable by the age of 17 - place the newborn on a
Significant Development flat surface and strike
 Testes & scrotum increases at the surface or make a
age 17 loud abrupt noise to
 Breast & female genitalia startle the newborn
increases until the age of 18 Sucking and Rooting
Characteristics - touch the newborn’s
 Idealistic lip, cheek, or corner of
 Rebellions the mouth with a nipple
 Performance Stepping or Walking
 Conscious of body image o hold the newborn in a
 Adventure some vertical position,
 Smoking allowing one foot to
 Alcoholism touch a table surface
 Drug addiction & premarital o The newborn stimulate
sex walking, alternately
APGAR Screening Test flexing and extending
the feet
o the reflex is usually
present for 3-4 months
 Babinski Sign: Plantar Reflex
Beginning at the heel of the
foot gently stroke upward along
the lateral aspect of the sole,
and then move the finger along
the ball of the foot
 o The newborn’s toes
hyperextend while the
big toe dorsiflexes.
The reflex disappears after the
newborn is 1 year old absence of this
reflex indicates the need for a
neurological examination.
Physical Assessment
HEAD EARS
Anterior fontanel
- Soft, flat, diamond
shaped, 3-4 cm wide by
2-3 cm long
- Closes between 12-18
months
Posterior fontanel
- Triangular shaped, .5-
1cm wide
- Closes 2-3 months
Caput succedaneum
 Swelling of scalp by NOSE
prolonged labor crosses
over suture line
 Gradually disappears at
NECK
 Short chubby with
creased skin folds.
Rigidity of the neck may
indicate Congenital NECK
Torticollis/ Meningitis
 about third day of life
Cephalohematoma
o Collection of blood
caused by increases
pressure of birth
o Caused by rupture of
periosteal capillary
o Absorbed within 3-6
weeks CHEST
Craniotabes
 Localized swelling of the
cranial bones caused by
pressure of the fetal
skull against the
mother’s pelvic bone in
uterus ABDOMEN
 Condition corrects itself
without treatment
EYES
 Infant eyes assume their
permanent color between 3 and
12 months of age
 Lacrimal ducts do not fully
mature until about 3 months of
age
 Strabismus is normal until 6
mos.
 Subconjuctival hemorrhage –
a red spot on inner aspects of
eye
 He pinna normally align from
inner to outer canthus of the
eye
 The low set ears indicate
Chromosomal disease such as
o Trisomy 21 (Down
Syndrome)
o Kidney anomaly
 Test newborn hearing by
ringing a bell held 6 inches
from each ear
 Nasal flaring – is the
enlargement of the opening of
the nostrils during breathing
 Indicates respiratory distress
 Test for Choanal atresia –
(blockage at the rear of the
nose)
 Short chubby with creased skin
folds. Rigidity of the neck may
indicate Congenital
Torticollis/ Meningitis
 The trachea may be prominent
on the front or the neck, and
the thymus gland may be
enlarged because of the rapid
growth of the glandular tissue
 It is approximately 2 inches
smaller than head
circumference
 Retractions or drawing in of
the chest during inspiration
should not be observed
 The abdomen of the child
should look slightly
protuberant, a scaphoid or
sunken appearance could
indicate missing abdominal
contents
 Bowel sounds – should be
present 1 hour after birth
  umbilical cord dermal sinus or spina bifida
 Stump should appear occulta
as a white, gelatinous EXTREMITY
structure with blue an Unusually short arms may
red streaks of the signify achondroplastic
umbilical vein and dwarfism – Achondroplasia is a
arteries form of short limb dwarfism
 (2 arteries, 1 vein) Inspect the pal for a simian
 Single artery could crease which could signify
signify congenital heart down syndrome
or kidney anomaly Assess for webbing
 Umbilical cord should (syndactyly)
break free by day 6 to Extra toes or fingers
10 (polydactyly)
ANOGENITAL AREA
 Inspect the anus of a newborn Preterm Newborn
to be certain it is present, a neonate born before 37 weeks
patent, and not covered by a of gestation
membrane (imperforate anus) Immaturity of all body systems
 if a newborn does not do so in Low birth weight neonate is
the first 24 hours, suspect <2.5 kg regardless of
imperforate anus or gestational age
meconium ileus. Very low birth weight neonate
MALE GENITALIA is below 1.5 kg irrespective of
 Both testes should be present gestational age
in the scrotum. Pathophysiology and Etiology
 If one or both testicles are not A. Factors associated with prematurity
present (cryptochirdism) include:
caused by agenesis (absence of  Poor nutrition
an organ)  Diabetes
 Ectopic testes (the testes  Drug-abuse
cannot enter the scrotum  Chronic disease
because the opening to the  Being a multigravida mother
scrotal sac is closed), or younger than age
undescended testes 18/primigravida mother older
 Elicit a cremasteric reflex this than age 40
is a test for the integrity of B. Complications of pregnancy-
spinal nerves T6-T10 associated with prematurity include:
FEMALE GENITALIA  PIH
 The vulva in female newborns  Bleeding
may be swollen because of the  Placenta previa/ abruption
effect of maternal hormones placenta
 (pseudomenstruation) female  Incompetent cervix
newborns have a mucus  PROM
vaginal secretion, which is  Polyhydramnios/
sometimes blood-tinged which oligohydramnios
is normal 1. Chorioamnionitis
BACK Nursing Assessment and Interventions
 Inspect the base of a newborn’s Notice the physical characteristics
spine carefully to be sure there of the premature neonate:
is no pinpoint opening, Hair – lanugo, fluffy
dimpling, or sinus tract in the Poor ear cartilage
skin, which would suggest a
 Skin – thin, capillaries are
visible (maybe red and
wrinkled)
Lack of subcutaneous fat
Sole of the foot is smooth
Breast buds 5mm
Testes – undescended
Labia majora – undeveloped
Rugae of scrotum – fine
Fingernails – soft
Abdomen – relatively large
Thorax – relatively small
Head – appears
disproportionately large
Muscle tone poor, possibly
weak reflexes
Clinical Evaluation
 Posture – the preterm infant
lies in a “relaxed attitude”,
limbs more extended; the body
size is small and the head may
appear somewhat larger in
proportion to the body size.
 Ear – the preterm infant’s ear
cartilage are poorly developed,
and the ear my fold easily
 Sole – the sole of the foot of the
preterm infant appears more
turgid and may have only fine
wrinkles. The mature infant’s
sole (foot) is well and deeply
creased.
 Female genitalia – the preterm
female infant’s clitoris is
prominent, and the labia
majora are poorly developed
and gaping
 Male genitalia – the preterm
male infant’s scrotum is
undeveloped and not
pendulous; minimal rugae are
present, and the testes may be
in the inguinal canals or in the
abdominal cavity.
 Scarf sign – the preterm
infant’s elbow may be easily
brought across the chest with
little or no resistance
Neurologic Evaluation
 Grasp reflex – the preterm
infant’s grasp is weak; the term
infant’s grasp is strong,
allowing the infant to be lifted
up from the mattress.
 Heel-to-ear maneuver – the
preterm infant’s heel is easily
brought to the ear, meeting
with no resistance
Post-term Newborn
- A neonate born after 42 weeks
age of gestation
Post-term Infant Characteristics
 Hair and nails long
 Dry peeling skin
 Creases covers soles
 Absence of lanugo
 Little if any Vernix caseosa
 Abundant scalp hair
 The skin is often cracked,
parchment-like and
desquamating
Assessment
 Assess that Vernix and lanugo
 Assess the skin
 Check fingernails and toenails
 Assess size
 Observe for hypoglycemia
 Observe for signs of birth injury
Contributing factors
 Low socioeconomic level
 Poor nutritional status
 Lack of prenatal care
multiparous mother’s
 Ciggarrette smoking
 The age of the mother (the
highest incidence is in mother’s
young than age 20
 Mother’s with diabetes mellitus
 Congenital abnormalities such
as omphalocele
 Body is covered with lanugo
 Old man facies
Cardinal Signs
 Intrauterine weight loss,
dehydrations and chronic
hypoxia, “old man faces”
 Long and thin with cracked
skin which is loose, wrinkled
and strained greenish yellow,
with no Vernix nor lanugo
 Long nails with firm skull
 Wide eyed alertness of one
month old baby
Abnormal Laboratory Values
 Increase total no. of RBC’s
 Increased hematocrit level
 Decreased serum glucose
Complications
 Meconium aspiration syndrome
 Respiratory distress syndrome